Hospital News March 2019

Special Focus: HSCN – Healthcare Supply Chain Network Conference Inside: From the CEO’s Desk | Evidence Matters | Ethics | Long-term Care | Careers

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March 2019 Edition

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Contents March 2019 Edition

IN THIS ISSUE:

Robotic pets delight patients with dementia

14 ▲ Cover story: Wound care

16

▲ Ending hallway healthcare

10

COLUMNS

▲ Wound Care Supplement

Editor’s Note ....................4 In brief ..............................7

22

Ethics .............................20 From the CEO’s desk .....40 Evidence matters ...........41 Long-term C are ...............42 Doctors without Borders . 52

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▲ Wound care revolution

HSCN

26

38

▲ Robotics enter the world of orthopedic surgery

50

Pledge to address your fear of dying and express your wishes for end-of-life care As physicians, we see death made worse and more painful every day by poor advance care planning

By Paul Hébert and George Heckman re you or a loved one aging, perhaps with a chronic heart or lung condition that limits daily activities? Do you have an older parent in a nursing home or who needs assistance with daily living activities? If so, read on and make the pledge.

As physicians, we see death every day. We see death made worse and more painful by poor advance care planning. Yet, despite the certainty of death in all our futures, it is astonishing how often families and loved ones have neither discussed nor planned for the inevitable.

Discussing death is hard. But not having these crucial conversations is far worse.

Over 50 per cent of Canadians who die each year do so in hospitals. We no longer die quickly at home from acute illnesses like infections, but from chronic illnesses whose protracted course often ends in hospitals. Death has been

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removed from daily life and is managed for us in sanitized institutional environments. Perhaps because death is less familiar, it is easier to fear. It is certainly much easier to ignore.

Consider older nursing home residents, most in their mid-80s, many of whom have some dementia, have daily pain, depressive symptoms and are affected by diabetes, heart and lung disease or stroke. “Frailty” is the term used to describe such persons, whose complex burden of age-associated conditions increases their risk of further decline. Their life expectancy is normally around 18 months – shorter still if they lose weight, need more assistance or become short of breath.

Because we do not have crucial discussions, as many as 30 per cent of frail nursing home residents are admitted to an intensive care unit and 50 per cent to hospitals in their last month of life.

Continued on page 7

Dr. Paul Hébert is a Senior Scientist at the Centre de recherche du Centre hospitalier de l’Université de Montreal (CRCHUM), and a Full Professor in the Department of Medicine of the Université de Montréal. He is also a Researcher with Canadian Frailty Network.

Dr. George Heckman is the Schlegel Research Chair in Geriatric Medicine and an Associate Professor at the University of Waterloo, and an Assistant Clinical Professor of Medicine at McMaster University. He is an interRAI Fellow, a Researcher with Canadian Frailty Network.

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IN BRIEF

Study examines how that children and youth not use cough the public feels about and cold products the use of their personal that contain opioids health data in research T Health Canada recommends

hat do members of the general public think about how their personal health data are being used for research? A new ICES study published last month in CMAJ Open set out to learn more about the public’s views on uses and users of personal health data.

ICES researchers conducted eight focus groups with a total of 65 people from Toronto, Sudbury and Thunder Bay in 2015 and 2017. In each focus group the participants were presented with background information about administrative data and ICES, and then asked to talk about specific examples of research studies based on ICES data.

The researchers identified three major themes: • The need for assurance about privacy and security • General support for research based on linked administrative health data with some conditions

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• Mixed and more negative reaction when there is private sector involvement The researchers also found that there was a low understanding of how administrative health data is used in research. Many participants were not aware that each time someone has an interaction with Ontario’s health care system, like a doctor’s visit or a lab test, a piece of information, or administrative data, is generated and collected in order to manage, administer and pay for services. Organizations like ICES have the authority to bring the data together, link it and remove or code identifying information, then use the data for research studies.

Since 1992, ICES – an independent not-for-profit research institute – has been the steward of a powerful repository of health care data with information from nearly 14 million people. These data can be linked

End-of-life care Because, we have not normalized difficult conversations around death, we will never know whether this is what they would have wished.

A key reason is fear.

Fear of death, fear of the unknown, fear of dying in pain and alone. Fear of talking to doctors and nurses about death. Fear of being abandoned if they forego aggressive care options. Fear of dying in pain and alone in a community ill-equipped to address their needs.

Doctors and nurses are also afraid.

They have limited training with difficult conversations. They fear the sense of defeat from the sense that they are giving up on patients. Fear is why these discussions don’t happen.

So, this year, pledge to overwww.hospitalnews.com

together with community and social data to understand how the Ontario health system is performing. ICES researchers use it to study the health system, and then health officials use the findings to deliver better health care. ICES carefully protects the privacy and security of these data, which is overseen by Ontario’s Information and Privacy Commissioner.

“The members of the public we heard from see data as an asset to be used, and generally support research based on linked administrative health data, but there is no blanket approval. Research and health data holding organizations should engage with members of the public to understand and address their concerns about privacy and security, and to ensure that research is aligned with social licence, particularly where there is private sector involvement,” H adds Paprica. ■

Continued from page 4

come your fear of death and have an end-of-life discussion with your frail loved ones and with your doctors and nurses.

Reflect on what matters to you most, your values, your life goals and expectations and anything else you feel is important. Ask yourself: how do your wishes align with the specific and best-practice care choices that you might have to make, today, or in the future? Know that you can seek help from your doctor or nurse, or use one of many available toolkits.

Once your wishes are clear, it is critical that they be honored. Write them down. Share them with your loved ones and powers of attorney, who need to know because they might

have to speak on your behalf one day if you lose that ability. Share them with your doctors and nurses. Know that you are allowed to change your wishes, especially as your health changes.

Our healthcare system must pledge to overcome its inertia and engage decision-makers and community stakeholders to ensure that all Canadians have equitable access to quality services that support their wishes as they approach the end-of-life.

Failure to do so is a pledge to continue with 3 a.m. “do everything” resuscitation attempts that prevent natural death, and that many frail patients would never have wished for, had that crucial discussion taken H place. ■

he Government of Canada is committed to better informing Canadians about the risks of health products that contain opioids. Following a safety review of cough and cold products containing opioids, Health Canada is advising that Canadian children and adolescents (under 18 years of age) should not use cough and cold products containing codeine, hydrocodone and normethadone, as a precautionary measure.

Health Canada’s safety review found that there is limited evidence to support the effectiveness of these products in children and adolescents (under 18 years of age). In addition, while the review did not find any strong evidence linking cough and cold products that contain opioids with opioid use disorders in children and adolescents, it did find that the early use of opioids may be a factor in problematic substance use later in life. Given the lack of strong data on effectiveness and the potential for longer-term risks, the Department is taking action to advise Canadians about the risks of these products.

Health Canada is also asking manufacturers to update their product safety information to reflect the Department’s recommendation that children and adolescents (under 18 years of age) not use these products.

Three prescription opioids are authorized to treat cough symptoms in Canada: codeine, hydrocodone, and normethadone. Codeine is also available without a prescription in low-dose formulations to treat cough and cold.

In Canada, the use of prescription cough and cold products containing opioids has been declining among children and adolescents over the past five years.

The current use of these products by children and adolescents (under 18 years of age) represents a small proportion (4%) of the total opioid cough and cold prescriptions dispensed in Canada.

Continued on page 8 MARCH 2019 HOSPITAL NEWS 7

IN BRIEF

molecules reverse memory Prolonged hip fracture New surgery is associated loss linked to depression, aging with increased N postoperative delirium he longer surgery for hip fracture repair lasts, the more likely patients are to have delirium after the operation, according to a new study by researchers at ICES and Sunnybrook Health Sciences Centre.

Postoperative delirium can be described as a state of confusion or agitation, and is common for older adults after surgery. It is unpleasant but almost always temporary. It has been linked, however, to longer stays in intensive care units, more total days in the hospital, and even a higher risk of death.

The study published Feb 22 in JAMA Network Open, showed that increasing surgery duration was associated with a higher likelihood of postoperative delirium, with the risk of delirium increasing per additional half hour of surgery. This risk was higher in patients that received a general anesthetic.

“Our findings show that nearly 11 per cent of older adults who underwent hip fracture surgery were diagnosed with postoperative delirium. We found that every half hour of addition-

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al surgery time increased the risk of postoperative delirium by six per cent,” says Dr. Bheeshma Ravi, lead author on the study, adjunct scientist at ICES and an orthopaedic surgeon with the Holland Bone and Joint Program at Sunnybrook Health Sciences Centre.

The researchers looked at the data for 68,131 patients aged 65 or older who had hip fracture surgery between April 1, 2009 and March 31, 2017 at 80 hospitals in Ontario. They found approximately 11 per cent of patients (7,150) experienced postoperative delirium.

“We found that general anaesthesia is also associated with increased risk of delirium after surgery when compared to patients who undergo regional anesthesia, such as spinal anaesthetic,” adds Dr. Ravi.

The researchers point out that the duration of surgery is affected by factors such as the complexity of the injury, the difficultity of the procedure and the technical expertise of the surgical team, and recommend that hip fractures should be managed in an expedited way by experienced surgeons and H anaesthetists. ■

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receptor target. The idea was that they would exert a therapeutic effect by “fixing” the impairment, resulting in an improvement in symptoms. The molecules are chemical tweaks of benzodiazepines, a class of anti-anxiety and sedative medications that also activate the GABA system, but are not highly targeted.

A single dose of these new molecules was administered in preclinical models of stress-induced memory loss.

Thirty minutes later, memory performance returned to normal levels, an experiment that was reproduced more than 15 times. In another experiment involving preclinical models of aging, memory declines were rapidly reversed and performance increased to 80 per cent after administration, essentially reaching levels seen in youth or earlier stages of adulthood. This improvement lasted over two months with daily treatment.

“The aged cells regrew to appear the same as young brain cells, showing that our novel molecules can modify the brain in addition to improving symptoms,” says Dr. Sibille. He expects to start testing the molecules in clinical research in two years. “We’ve shown that our molecules enter the brain, are safe, activate the target cells and reverse the cognitive deficit of memory loss.”

If successful, the potential applications are broad. Not only is there a lack of treatment for cognitive deficits in mental illness, but the brain improvements suggest the molecules could help to prevent the memory loss at the beginning of Alzheimer’s disH ease, potentially delaying its onset. ■

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ew therapeutic molecules developed at Toronto’s Centre for Addiction and Mental Health (CAMH) show promise in reversing the memory loss linked to depression and aging.

These molecules not only rapidly improve symptoms, but remarkably, also appear to renew the underlying brain impairments causing memory loss in preclinical models. These findings were presented recently at the American Association for the Advancement of Science (AAAS) Annual Meeting in Washington DC. “Currently there are no medications to treat cognitive symptoms such as memory loss that occur in depression, other mental illnesses and aging,” says Dr. Etienne Sibille, Deputy Director of the Campbell Family Mental Health Research Institute at CAMH and lead scientist on the study.

What’s unique and promising about these findings, in the face of many failures in drug development for mental illness, is that the compounds are highly targeted to activate the impaired brain receptors that are causing memory loss, he says.

It took a series of studies – the most recent appearing in January 2019 in Molecular Neuropsychiatry – to reach this stage. First, Dr. Sibille and his team identified the specific impairments to brain cell receptors in the GABA neurotransmitter system. Then they showed that these impairments likely caused mood and memory symptoms in depression and in aging.

The new small molecules were invented to bind to and activate this

Health Canada plans to consult with the Drug Safety and Effectiveness Network to study the links between opioid use disorder and related harms and the use of products that contain opioids in Canada. Health Canada will continue to monitor harms involving all products that contain opioids. The Department has also requested that manufacturers of prescription opioid products submit risk

management plans to track and monitor risks in the Canadian population.

Given the availability of other non-prescription products containing low-dose codeine and their potential to lead to problematic use, Health Canada has initiated a review of all non-prescription products for children and adolescents that contain codeine to determine whether similar H action is appropriate. ■ www.hospitalnews.com

Collaborating for Change in a New Era of Cancer Care The Rewrite Cancer Innovation Challenge Winners

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dvances in diagnosis and treatment are fundamentally changing the way Canadians live with cancer. But even with great progress, patients and families still face many challenges. The inaugural Rewrite Cancer Innovation Challenge brought together the brightest minds in oncology to collaborate and develop innovative solutions to a specific issue patients currently face.

Created and supported by Hoffmann-La Roche Limited (Roche Canada), the first Rewrite Cancer Innovation Challenge was established with the help of a steering committee of cancer experts from across Canada. The Challenge called on the oncology community to find ways to

facilitate better knowledge transfer between multi-disciplinary healthcare teams in an environment where new treatment approaches are transforming the patient experience.

Teams were invited to submit their ideas for an opportunity to partner with Roche Canada and bring their concepts to life. Of the 13 submissions developed by health and medical organizations across Canada, the steering committee identified the top two innovative solutions.

Roche Canada is supporting both teams to help them realize their ideas and enhance the cancer experience for many Canadians.

Electronic Side-Effect Kollector and Advice (ELSKA)

Facilitating Access to New Cancer Therapies in a New Era of Care

Royal Columbian Hospital

Canadian Oncology Drug Access Network (CODAN)

The team at Royal Columbian Hospital, led by an oncology nurse, saw an opportunity to help patients and care teams better track and manage side effects of cancer treatments.

With this in mind, the team created a digital tool where a patient can record side effects on their phone or computer and, in a few seconds, a doctor can gain access to that data. When patients record side effects, they are immediately offered an intervention via a video to help manage their symptoms. Care teams can then monitor their patients’ status and side effects, as well as learn how others are handling similar symptoms to improve overall side effect management, which could prove particularly helpful for newer types of treatment.

The tool On a mobile offers patients device or desktop, patients interventions via report symptoms video message into the ELSKA to help manage their symptoms. digital tool.

Healthcare teams access patient reports within minutes, track symptoms & learn from similar cases.

The Canadian Oncology Drug Access Network (CODAN) recognized a gap in how patients gained access to new cancer treatments. Access programs can be difficult to navigate, particularly in centres with limited resources, which can prevent patients from being placed on emerging therapies that could benefit them.

To address this issue, CODAN aims to develop an online platform to expand the role of drug access navigators (DANs) and provide a helpful resource where a DAN is not available. The platform, an online repository of current access programs, will provide healthcare teams a centralized resource with all the necessary information to match their patients with treatment options that may be right for them.

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Advertorial

NEWS

Ending hallway healthcare

By Marie Sanderson aureen Coleman always looked forward to her 6:00 a.m. swim every day. On one early morning, her swimming buddy noticed she looked shaky getting out of the pool. Maureen visited her family doctor and was admitted to Sunnybrook Health Sciences Centre for unsteady gait.

Maureen was in hospital about two weeks when she first heard the term ‘alternate level of care’, or ALC, patient. She no longer needed acute care hospital services but would not be able to live independently at her home.

In December 2018, Maureen was one of the first patients to move to Toronto’s newest Reactivation Care Centre near Jane Street and Highway 400. During her stay, she worked with the centre’s physiotherapy and occupational therapy staff to gain stability in her walking. “I got so much stronger and am more confident walking,” says Maureen. “And it was really good for me socially. I didn’t stop talking to the great staff and the other patients. I made some good friends.”

The Reactivation Care Centre was opened with funding from Ontario’s Ministry of Health and Long-Term Care to address high hospital occupancy and to help to alleviate hallway medicine. Patients like Maureen stay in one of the hospital’s two 30-bed units until they can move to another care facility in the community.

“The approach truly improves the safety and care of patients across the entire hospital,” says Dr. Andy Smith, President and CEO of Sunnybrook.

“The Reactivation Care Centre has helped to ease the occupancy pressures we’ve been experiencing for far too long.”

Before opening beds at the Reactivation Care Centre, Sunnybrook saw very high inpatient occupancy, typically hovering from 110 to 119 per cent.

To manage this level of occupancy, weekly meetings were held with clinical, operations and patient flow leads to discuss occupancy and help teams move patients in and out of the hos-

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Photo credit: Kevin Van Paassen

Maureen Coleman is pictured in a Sunnybrook unit of the Reactivation Care Centre.

THE REACTIVATION CARE CENTRE HAS HELPED TO EASE THE OCCUPANCY PRESSURES WE’VE BEEN EXPERIENCING FOR FAR TOO LONG. pital as efficiently as possible. When occupancy was surging, senior leaders maintained regular contact with the Ministry of Health and Long-Term Care about the pressures.

Sunnybrook’s units at the Reactivation Care Centre have accepted 83 patients and discharged 24 (as of early February 2019). Most importantly, the innovative approach to care has creat-

ed acute care capacity at Sunnybrook’s other campuses. The model has helped the hospital to provide the type of services needed by patients like Maureen, that otherwise couldn’t be offered with occupancy rates in excess of 110 per cent. Sunnybrook’s occupancy has averaged at 103 per cent since relocating patients awaiting an alternate level of care, while concurrently eliminating

all hallway beds. This is significantly lower than the weeks and months preceding the opening of the centre.

Maureen describes her time at the centre as “a lot of fun – I really enjoyed having my meals in the dining room, and the rehab services got me back on my feet.” Now living at a retirement residence, Maureen gets out with friends on most days. She credits the restorative care at the Reactivation Care Centre as being key to resuming normal routines and restoring her independence.

“I’m feeling great, I’m right where I should be,” adds Maureen, as she grabs her handbag, ready for a friend to pick H her up. ■

Marie Sanderson is a Senior Communications Advisor at Sunnybrook Health Sciences Centre.

10 HOSPITAL NEWS MARCH 2019

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SPONSORED CONTENT

Quitting smoking can improve your cancer treatment, period

By Craig Earle he start of the new year means many will be looking to fulfill resolutions, a major one being quitting smoking. While provincial and territorial governments continue to push for all people to give up cigarette smoking through the Endgame Tobacco initiative, one group who often get overlooked are those living with cancer.

One in 5 Canadians with cancer are smokers. A diagnosis of cancer is sometimes a “wake up call” that prompts a patient to throw away their cigarettes, but for many it’s a particularly difficult time to contemplate quitting because of the stress and anxiety of their new situation. This is something I can understand. Cancer and its treatment have significant physical, emotional and psychosocial effects and smoking can seem to help someone cope during such a difficult time.

Most of my patients who continue to smoke do not think it plays a major role in their treatment or outcomes.

I often hear, “I already have cancer, what does it matter now if I smoke?”

This is particularly apparent in people who develop a cancer perceived to be unrelated to smoking. Someone who develops lung cancer may be more likely to at least consider quitting than someone who develops, say, breast cancer, as they may not see the connection.

For many years, we cancer care providers felt the same way. We were not really aware of the impact smoking could have on cancer treatment. We thought smoking was a minor thing in the context of their larger health problem. But it turns out, it’s not.

Accumulating evidence now clearly shows that quitting smoking can make cancer treatment more effective. Plain and simple. This includes all types of cancer treatment, for all types of cancer.

Patients who smoke are more likely to have infections or problems with wound

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healing after cancer surgery. Smoking reduces oxygen levels in the blood, which makes radiotherapy less effective.

And for chemotherapy, chemicals in cigarette smoke can speed up the metabolism of cancer drugs, leading to lower effective doses.

No matter the treatment, strong evidence shows quitting smoking will help improve your outcomes on par with the effects of many new cancer treatments. Quitting smoking also lowers the chance of the cancer returning or another type of cancer developing, in addition to improving other more general aspects of your health.

With this recent evidence, the cancer system is starting to take notice.

Many cancer care providers are now routinely having conversations with patients about quitting smoking and directing them to tobacco cessation supports. And these resources will soon be more convenient for all cancer patients.

The Canadian Partnership Against Cancer is providing almost $2 million

to support the implementation of tobacco cessation programs in every jurisdiction in this country. The goal is to ensure every person with cancer who wishes to quit smoking has the support and resources to do so. Newfoundland and Labrador was the first jurisdiction to sign a contract with the Partnership on this initiative.

That province is providing free nicotine replacement therapy to all people newly diagnosed with cancer, as well as ongoing counselling to further assist them.

If you are a patient with cancer and looking to quit, you’re doing the right thing. I understand how challenging the addiction is. I will say that based on the available evidence, I would ad-

vise that in order to get the full benefit, you should quit smoking at least two weeks before starting cancer treatment. The sooner, the better.

For others who have been diagnosed with cancer and haven’t yet decided to quit, please know that no matter what type of cancer you have, quitting is one of the most important things you can do for your health. It will increase the effectiveness of your treatment, increase your chances of survival, and improve your quality of life.

If you are a cancer patient and still smoking, there are many resources out there for you and many organizations who can help you take the first H step. Q

For people with cancer and health-care providers looking for smoking cessation supports in your community, please visit csl.cancer.ca/smokershelpline.

Learn more about the Partnership at www.partnershipagainstcancer.ca.

Craig Earle is a GTA-based oncologist and Vice-President, Cancer Control, at the Canadian Partnership Against Cancer

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MARCH 2019 HOSPITAL NEWS 11

NEWS

Kasthuri (centre) visits with members of her care team: nurse, Eileen Knibb (left) and Hannah Ho, physiotherapist (right) holding a photo of colleague, occupational therapist, Holly Pearson.

To rebuild yourself from broken pieces

A patient’s story

By Natalie Chung-Sayers wenty-eight-year old Kasthuri Packiyanathan knows about the language of determination and the power of partnerships. Both helped in her recovery.

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An English studies graduate and aspiring elementary school teacher, Kasthuri loved working with children.

From being a camp counselor to tutoring students, there was nothing more rewarding.

In 2011, she had been diagnosed with Systemic Lupus Erythromatosus the most serious type of Lupus, an autoimmune condition that can cause swelling of the joints and inflammation of the tissues and organs. Last year, amid all

her activities, she had an unfortunate and severe flare up of her condition.

Weeks later when she arrived at St. John’s Rehab, she was barely able to move her legs and could communicate only through short phrases.

Natalie Chung-Sayers is a Communications Advisor at Sunnybrook Health Sciences Centre.

12 HOSPITAL NEWS MARCH 2019

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NEWS Cheetah illustration by Kasthuri Packiyanathan.

“I was just beginning my teaching career, starting to fulfill my dreams when my whole life went on pause,” recalls Kasthuri. “It took a while for me to realize what was happening. At first, even if I wanted to do things – I couldn’t. But I wanted to get there. I was determined.”

The care team including nursing, occupational therapy, physiotherapy and social work collaborated closely with Kasthuri to help her achieve her goals.

Occupational therapy supports by helping patients regain a level of independence and function. The focus is also on cognition to help with problem solving and doing activities of daily living (egs. dressing and toileting) and other activities that meet patient-specific goals.

Physiotherapy works with patients to help them regain their balance and to improve coordination of body mechanics, as well as meeting patients’ specific goals. The focus is also on the reconditioning of muscle, and overall mobility that includes strategies such as gait patterning.

Kasthuri soon realized that partnering with her care team, for example, during therapy, was vital to her recovery. “She started asking us questions about the team, and about her exercises,” says Holly Pearson, occupational therapist. “We saw a key change in her ability to participate.”

Mosaic (A poem to inspire) You won’t know how strong you are Until you have no other choice And being strong is the only way of survival It is true, that the heart is fragile It can break with just a single word Yet, it holds the power to overcome When it is pushed to its limits Find the faith within yourself That strength can be created To rebuild yourself from broken pieces And become a new mosaic Written by Kasthuri Packiyanathan a few weeks after leaving St. John’s Rehab. www.hospitalnews.com

“Working in partnership with patients helps them get that much closer to the ultimate goal of safely reintegrating to the community,” adds Hannah Ho, physiotherapist.

“As Holly and Hannah worked with me, I would ask them questions like what does this help me with? What does this do? to help me understand how to make the most of therapy.

They treated me like family and they got excited when you did something new, which in turn motivated me to try harder each time,” says Kasthuri.

Kasthuri also had a strong support network of family and friends. Says Holly, “We worked with her mom, who is so dedicated and was always at her side, and helped her know when to call for assistance.”

Kasthuri was able to return home safely and is slowly regaining her love of ‘busy’. She walks with the assistance of a walker, attends the gym weekly for muscle strengthening and is tutoring students again.

During her stay at St. John’s Rehab, she rediscovered her love of poetry and drawing. Creativity helped her stay focused and positive and someday she hopes to publish a collection of her poH etry and art. ■

Turn Turn Turn Turn Turn Turn Turn Turn

Mental health caregiver N av i gat i on T r a u m a resource health care Addiction Discharge PlaN

issues into answers issues into answers issues into answers issues into answers issues into answers issues into answers issues into answers issues into answers

From Everyday Issues TO COMPLEX NEeDS

Social workers

It’s what we do.

VISIT OASW.ORG #turnissuesintoanswers

Turn patient Flow issues into answers Turn r e c o v e r y issues into answers MARCH 2019 HOSPITAL NEWS 13

NEWS

The pets promote spontaneous interaction between staff and patients both one on one, and in groups.

Robotic pets delight patients with dementia

By Elise Copps hey don’t claw ya, you don’t have to feed ‘em, and they don’t need kitty litter.”

Wise words from Jackie Gale, a patient at Hamilton Health Sciences’ St. Peter’s Hospital (SPH). She’s referring to the hospital’s new litter of robotic cats. The digital kitties are furry, but not too feisty – the perfect temperament to put patients at ease.

“When we found out about these robotic cats, we thought they would be great for our patients,” says Jean Riley, a therapeutic recreationist on the Medically Complex unit at SPH. “They have so many benefits.”

Jean reached out to Hasbro, the toy company that makes the pets, to place an order, and it ended up donating a trio of cats to the unit. Since they arrived, they’ve become very popular with patients and staff. Each cat is paired up with a patient for the duration of their stay in the hospital.

“What’s great about these pets is that they are very portable, and can

“

T

be brought out when they’re needed most,” says Jean. “Staff and volunteers can use them, and it helps them have positive interactions with patients.”

Jean says the robotic cats help to spark conversation and memories.

When Jean gave a cat to Donna, a patient who’s been at SPH since March, they started to chat about pets they’ve had over the years. “My daughter’s cat Smokey used to wait at her bedroom door when she was away,” Donna recalled.

The robotic pets are also in use on SPH’s Behavioural Health unit. This unit caters to people with serious dementia, and the team has been using Hasbro’s robotic cats and dogs for about a year with great success. Their collection of ten cats and dogs was purchased through the Hamilton Health Sciences Foundation Family Grants Program.

“The pets promote spontaneous interaction between staff and patients both one on one, and in groups,” says Crissie Leng, a therapeutic recreationist on the Behavioural Health unit. “It’s

not easy for people with dementia to interact the way they used to. The robotic pets break down barriers and give them something to focus on. When patients interact with them, they also start to interact more with our staff and their peers.”

On both units, the pets are used for a number of reasons – different people benefit from them in different ways.

They motivate patients to move by giving them a reason to do so, like reaching to pet a dog, or brushing a cat. They make sounds and respond to touch, which gives patients sensory stimulation. They can be brought to a patient who is getting upset or anxious to help soothe them.

Gail, a patient on the Behavioural Health Unit, has become very fond of her orange robotic cat, named Fluffy.

When she gets agitated, petting the cat and listening to it purr helps to calm her.

“Gail, and some other patients actually ask for their pets by name,” says Crissie.

Roger, another patient on the Behavioural Health Unit, was never an animal person, but Daisy the robotic dog gives his family a chance to engage him in a different way. He doesn’t talk a lot, but when Daisy is present, he can socialize without having to converse.

The robo pets aren’t a replacement for live therapy pet visits, which are still a big hit at SPH. Instead, they’re a chance to get the benefits real pets offer, in a more spontaneous way.

“Because they are so portable, and easy to use, they are great for spontaneous interaction,” says Jean. “We do a lot of scheduled programming for patients, which is great, but this meets needs that can’t be met through scheduled programming.”

Both programs are hoping to get more robotic pets in the near future.

The pets must be paired with a specific patient to prevent the spread of germs, so each additional cat or dog means another patient can benefit H from this unique therapy. ■

Elise Copps is a Public Relations Specialist at Hamilton Health Sciences.

14 HOSPITAL NEWS MARCH 2019

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NATHALIE AND ÉMILE KNOW ABOUT “ACTIVE OFFER” OF FRENCH LANGUAGE SERVICES

DO YOU? It’s a parent’s worst nightmare: an emergency visit to the hospital in the middle of the night.

“My child’s in danger,” broadcasts the mind, sending alarm bells ringing. “Will he be okay?”

That’s what happened to Nathalie when she had to bring Émile to Emergency at a hospital in Toronto. Only, the thoughts going through Nathalie’s mind were in French because she and her child are French-speaking.

Though Nathalie was able to interact with staff in English, the situation was stressful for both her and Émile since their primary language is French.

By chance, one of the attending nurses spoke French.

“Quelle différence,” says Nathalie. It made a world of difference since she could speak to the nurse in their common language and more importantly, the young Émile could better grasp what was going on and be reassured in his mother tongue.

This time, by chance, Nathalie and Émile’s situation was fortunate. There was an improved outcome through linguistic and cultural responsiveness by the hospital.

Find out more here: refletsalveo.ca/active-offer-training

Reflet Salvéo is a French-Language Health Services Planning Entity funded by the government of Ontario through the Toronto Central, Central West, and Mississauga Halton LHINs

A free online course

“DON’T LEAVE IT TO CHANCE” Imagine a health system where upon arrival, Nathalie and Émile would have known the option existed to obtain French services (by visible signage), where they could have been identified as French speakers (through a simple question asked at intake) and where the hospital could have connected them to French speaking staff (by identifying staff ability and tracking it electronically) “Quelle différence!”

That’s Active Offer. It makes a difference. It improves patient experience, it reduces risks and sets up better health outcomes.

NEWS

The CHEO Access Team. Back row (L—R): Anne Lukey, Adele Ois, Claire Seymour, Erika Bertrand, Marie-Anne Savoie Front row (L—R): Amanda Young, Johanne Raymond

Creating “one door” access to development and rehabilitation

By Dave Scharf ttawa’s pediatric health and research centre, including a pediatric teaching hospital – has streamlined getting the right development and rehabilitation care for children, youth and families. Access to development and rehabilitation services is now accessed with a single phone call.

Navigating the health-care system can be complex, let alone when compounded by additional anxiety if one is worried about a child. Imagine a mom, concerned that her two-year-old daughter may be missing some developmental milestones. She wants the same thing that all moms want – the best life for her child. She wants a simple way to get the right diagnosis and treatment, right now.

In October 2016, the Children’s Hospital of Eastern Ontario (CHEO) amalgamated with the Ottawa Children’s Treatment Centre (OCTC).

Prior to this, families dealt with each organization separately. Does a child go to CHEO or OCTC for physiotherapy? For speech language pathology?

Parents and family doctors sometimes

O

had trouble knowing what was available and where to find it.

This amalgamation provided a unique opportunity to simplify access to development and rehabilitation – to create “one door” through which children and youth can be shepherded to the best services for their individual needs. Creating a streamlined intake system was made a transformational goal.

“We wanted to make accessing these services at CHEO, now including the Children’s Treatment Centre, easier for families and referral services like physicians and school boards,” says Susan Mendelsohn, CHEO Director of Development and Rehabilitation.

In March 2017, a multi-disciplinary team representing all the included services was brought together to design a new, simple access system – the “one door.” This included physiotherapy, occupational therapy, speech language therapy, the Autism Program, social workers, recreation therapy, respite services, behaviour services and the First Words Preschool Speech and Language Program.

“We have an incredible group of people. Throughout the process, everyone was dedicated and passionate about making sure that this was going to be the very best system we could build for children, youth and families,” Mendelsohn says.

Over the next year, this group consulted with families, community physicians, and more. They consulted with organizations like Holland Bloorview Kids Rehabilitation Hospital who had recently streamlined their intake system. The result of these consultations was a rigorous list of things that the new “one door” needed to include.

Three possible models were proposed. Again, families and referral sources were consulted. The three models were subjected to thoughtful analysis and by March 2018 the single best system was decided upon.

Then came the hard work of bringing the plan to life. What staff would be required to make the Access Team work? How could Epic, CHEO’s electronic health records system, be integrated? What information needed to be included on the new intake form?

How would this new system be communicated to families and the community? What training would staff require?

Finally, more than 18 months after work began, the CHEO Access Team launched on November 5, 2018.

Families no longer need to contact services separately. One call starts the ball rolling. After the initial call, if it’s not immediately clear which service a child needs, a CHEO Access Team outreach worker speaks directly with the family to understand their concerns and get a medical history.

The right services are identified and the family is placed with the correct booking lists. One child might only need one service, like speech language pathology, whereas another child may have more complex needs and require several services. The expert CHEO Access Team is trained to identify the services which will most benefit each child.

Now, when a child walks through CHEO’s “one door” to development and rehabilitation, the family only H needs to tell their story once. ■

Dave Scharf is a Communications Specialist at the Children’s Hospital of Eastern Ontario (CHEO).

16 HOSPITAL NEWS MARCH 2019

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A client’s MVP.

Troy Lehman loves football. When he isn’t working on personal injury cases involving municipal liability and other complex issues, this busy lawyer plays quarterback on the flag football field. Playing quarterback is all about strategizing, getting the ball to your teammates and working to get to the goal line.

As a litigator, Troy knows that careful planning, teamwork and focusing on his clients’ goals is the key to success. Troy is a litigation quarterback, planning the plays and involving the right experts to work in a tight formation. This approach keeps the case moving to the end zone.

There is one other thing you should know about Troy. Whether it is on the football field or in the courtroom, he can’t stand to lose. In football, winning is about who scores the most points. In personal injury law, winning is about exceeding your clients’ expectations. As a personal injury lawyer, Troy wins the game when he obtains compensation for his clients that will help them rebuild their lives in a meaningful way.

To learn more about Troy visit www.oatleyvigmond.com/troy Proud Member

1.888.662.2481 oatleyvigmond.com www.hospitalnews.com

MARCH 2019 HOSPITAL NEWS 17

NEWS

Oasis program offers seniors a community within a community

By Nikki Jhutti hen it comes to her morning coffee, Katherine Kroff likes a few laughs with her cream and sugar. The 94-year-old lives alone, but she doesn’t have to travel far to be social. That’s because Kroff is part of the Oasis Senior Supportive Living Inc. program with Providence Care.

The Oasis program helps Kingston seniors live independently in their homes longer, by providing them a space to be social, get active and enjoy a meal. The program was created by Christine McMillan, a senior herself, while doing research with the Kingston Council on Aging.

It began in Homestead Landholdings’ Bowling Green apartment complex, a decade ago. That’s where Kroff lives. “I’m having a fabulous time,”

W

Kroff beams. “I come down here every morning and have coffee, never miss it and there’s all these people to talk to, what could be better?”

Pearl Larsen agrees. The 80-yearold, affectionately known as the ‘young one’ by her peers, says the program not only gives seniors activities to do, but it’s also creating bonds. “We all care about each other,” Larsen explains.

“It’s not like living in one of the other apartments where you feel lost. Here you don’t, because someone is always smiling or asking ‘how are you doing today?’’

Both Kroff and Larsen have been with the program since the start, but Ada Gropp is the new ‘kid’ on the block. The 90-year-old signed up a year ago, and says her experience has been extremely positive. “I think it’s the

best thing since sliced bread,” Gropp exclaims. “I really think at this stage of life, loneliness is a real problem. Our families are all over, so we’ve created a new family here.”

When new tenants move into the building, they’re given an Oasis welcome handbook that outlines the program. Funded by the South East Local Health Integration Network, it’s free to join for people 65 years of age or older.

People under 65 who live with a disability can also sign up. It runs Mondays to Fridays. There are daily activities, exercise and fall prevention classes, and three times a week there are catered meals, at a subsidized cost. The seniors get full say on what activities are offered and if they wish to participate.

“It’s a very simplistic program, that really wants to keep seniors out of a

nursing home,” Tina Carson, Program Manager says. “Seniors have a right to stay in their own homes, and they have a right to good health. The program opens up a whole new world for them.

They feel like they’re a large family and do not feel scared or alone. Feelings of depression, illness, and loneliness are greatly reduced by being part of this community.”

Carson also does health checks and if necessary makes referrals.

The Oasis Board teamed up with Providence Care last fall to not only be a service provider, but also to help expand the program within the region and across Ontario.

“Since Oasis is a very small organization reliant on a volunteer board, it has been a great weight off the Board’s shoulders to know that we can rely Continued on page 19

Nikki Jhutti is a Communications Officer at Providence Care.

18 HOSPITAL NEWS MARCH 2019

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NEWS As part of the Oasis program there are daily activities, exercise and fall prevention classes, and three times a week there are catered meals, at a subsidized cost.

Oasis program Continued from page 18 on the professional expertise of Providence Care,” Helen Cooper, Oasis Board President explains.

“It really does feel like a community within a community,” Ben Gooch, Regional Director of Community Support Programs, adds. “We’re a leading provider of care in aging, mental health and rehabilitation in the region, and that really is the nexus of what Oasis does for people. It allows people to age in place, in the community of their choosing and it’s a really great fit with Providence Care.”

IT REALLY DOES FEEL LIKE A COMMUNITY WITHIN A COMMUNITY. Queen’s University is also involved with the expansion. It recently secured three provincial grants, totaling more than $1 million dollars, to study the Oasis model.

“From what anecdotal evidence we do have at this point, our Board is convinced that Oasis is making a difference in people’s lives by deferring or eliminating the need for institutional long- term care and emergency health services,” Cooper says.

So far, there are plans to start up three new Oasis programs in Kingston and one in Belleville.

With help from McMaster and Western Universities, two more Oasis locations will open in Hamilton and London.

Back at the Bowling Green, Kroff credits the program for changing her life. “When you come down here, you just feel it in the air, the happiness that’s here. I am so happy, I am so grateful and I am so thankful H every day.” ■ www.hospitalnews.com

Study finds heart-to-heart talk appears to boost use of cardiac rehab ace-to-face encouragement by a member of the healthcare team, preferably when patients are still in hospital, may boost subsequent enrolment in cardiac rehab by as much as 60 per cent, a new study finds.

The results, from researchers at Peter Munk Cardiac Centre (PMCC) and Toronto Rehabilitation Institute, are welcome findings given that, in spite of the benefits, enrolment is very low in cardiac rehab programs.

“Healthcare providers need to explicitly encourage patients to attend, and make sure they answer any patient questions about taking part,” explains Carolina Santiago, York University PhD student and physiotherapist, who co-authored the study, which was led

by Dr. Sherry Grace of PMCC and TRI. The researchers sought to determine how to encourage more patients to use cardiac rehab programs in a review published on Feb. 1, the start of Heart Month, in the Cochrane Library. This updated review incorporates new trials and provides evidence to suggest what makes a difference.

The review found strategies to increase enrolment may be effective, particularly those that target healthcare providers, training nurses, or allied healthcare providers to intervene face-to-face.

F

It found face-to-face encouragement by a member of the healthcare team, preferably when patients are still in hospital, may boost subsequent enrolment in cardiac rehab by as much as 60 per cent.

The review also found that interventions to increase adherence to programs and to increase completion are probably effective, particularly when cardiac rehabilitation was unsupervised.

‘The more people who are encouraged to attend and gain access, the better’ Heart disease is the leading cause of death and disability globally. Participation in cardiac rehab increases people’s chance at life, and lessens their chances of being hospitalized again.

Cardiac rehab is strongly recommended for patients with heart failure, or those who have undergone coronary stent placement, or bypass surgery (among others).

Patients are generally offered sessions a couple of times a week over about five months. Components of most programs include exercise, counselling, nutrition and patient education to control risk factors.

Physicians need to refer their patients, but even where they do, many patients do not enroll in the program.

They may not realize how important

it is to their recovery because providers may not be promoting it.

“We have established ways to overcome most patient barriers to attending cardiac rehab such as distance, language or cost, and we need to talk with patients about them faceto-face,” says co-author Rod Taylor, professor from University of Exeter, U.K., who has for years been tracking evidence on how best to boost use of these programs for years.

The researchers developed a position statement based on their findings, calling on policy-makers and healthcare providers to ensure their recommendations are put into place.

Many medical societies around the world are endorsing the statement, and helping spread the word about the benefits of cardiac rehab.

Researchers have also developed an online course that offers healthcare providers information about the impact of their promotion of cardiac rehab to patients, and about what patients need to hear to optimize their enrolment. It is available at UHN, and will later be made available globally.

“Cardiac rehab makes a fundamental difference in people’s lives – the more people who are encouraged to attend and gain access, the better,” says Dr. Grace, who is also a professor H at York University. ■

This article was submitted by UHN News.

MARCH 2019 HOSPITAL NEWS 19

Equitable transitions from rehabilitation care settings

By Kevin Rodrigues ehabilitation care is an integral part of the healthcare continuum that is oriented towards reintegrating patients into a community setting. Some core goals of rehabilitation care are independence, mobility, risk reduction, safe transitions home, and quality of life.

Additionally, studies have shown that appropriate, timely rehabilitation therapy can, for some patients, positively impact mortality outcomes. With advancements in technologies and therapies, rehabilitation is greatly improving the quality of life of patients, and is helping many of them get back to, and stay in their homes for as long as possible.

Rehabilitation is not immune to the issues of equitable access that apply across the healthcare system. Certain demographics of patients bear disproportionate illness burdens, and face greater barriers to healthcare access. The aforementioned benefits of rehabilitation care are not always equitably distributed. Access to services and the need to develop intra-rehab approaches that are oriented towards meeting the needs of vulnerable persons (such as culturally safe and trauma sensitive approaches) are important topics to consider when addressing the equitable distribution of benefits in rehabilitation. Closing the gap with regard to fair transitions and discharge practices have specific implications on the entire healthcare continuum, and deserve further exploration here.

From an ethics perspective, it is important to consider what a good transition from rehabilitation care would look like. If a good discharge, in general terms, entails the patient transitioning to a situation in which they are able to thrive, what would be required to achieve this? Not all rehabilitation outcomes are sustainable. Not every patient achieves their rehabilitation goals by the end of their length of stay. While there are often clinical reasons for a discharge falling short of the “thriving” standard,

R

POVERTY, SOCIAL ISOLATION, PRECARIOUS HOUSING, DISABILITY, HEALTH LITERACY AND THE DEEPER INFLUENCES OF STRUCTURAL RACISM, DISCRIMINATION, AND COLONIALISM ALL CONTRIBUTE TO POORER REHABILITATION OUTCOMES. it is even more concerning when social factors contribute to poor transition outcomes. For example, a transition home may be vastly different between a patient who is able to modify their home to make it more accessible, and a patient who is unable to afford the cost of such modifications. Poverty, social isolation, precarious housing, disability, health literacy and the deeper influences of structural racism, discrimination, and colonialism all contribute to poorer rehabilitation outcomes.

To a certain extent, all patients have vulnerabilities simply by being depen-

dent on healthcare services. However, disparities in social determinants of health increase the vulnerabilities of some patients. Rehabilitation that seeks to be equitable, must be vulnerability focused. Patients with greater needs, are in greater need of care. The restorative goals of rehabilitation face a dire threat when patients are discharged into situations where rehabilitation gains cannot progress or be sustained. In order to ensure equitable transition outcomes for the most vulnerable patients, rehabilitation institutions could make a valuable contribution by lending their expertise

ETHICS

to help improve conditions outside of their walls. For example, the unique skillset of rehabilitation professionals could benefit discussions about making community housing, shelters and cities in general more accessible. Developing technologies with vulnerable populations in mind, and conducting research that focuses on equitable transitions from rehabilitation settings could also provide pathways forward.

The way that patients receive care, can also influence the success of their transitions out of rehabilitation. Rehabilitation interventions involve a partnership between therapists and patients, in which trust is fundamental. This trust can be compromised by stigma and discrimination, or a history of previous negative healthcare interactions.

An example may be a patient with a substance use dependency whose commitment to rehabilitation is questioned, simply because of their substance use.

Patients with perceived “behavioural” or “non-compliance” issues often face less than optimal transition planning. In these cases, it is helpful to meet patients where they are, and to ensure that goal setting is patient driven. Only then can a transition be successful. Striving to be patient centred involves commitment at institutional and bedside levels. Institutionally, this would involve community engagement efforts that ensure that the voices of marginalized populations are considered when setting policy. At the bedside, this would involve a commitment to cultural safety, the elimination of stigma, and a sensitivity to diverse and often traumatic experiences.

Ultimately, rehabilitation professionals can help to create the conditions in which thriving may be possible for their patients, through care that is committed to equitable transition outcomes. This commitment involves rehabilitation professionals considering the role that they could play both at a system level, and in the community – both where health policy is shaped, and where it H is lived. ■

Kevin Rodrigues is a Bioethicist with Toronto’s University Health Network. Kevin provides bioethics support to Toronto Rehabilitation Institute.

20 HOSPITAL NEWS MARCH 2019

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WOUND CARE

Wound

care www.hospitalnews.com

MARCH 2019 HOSPITAL NEWS 21

COVER STORY

Wound care

By Rosemary Kohr hronic wounds have never had the same level of attention as cancer care, or treatments of heart disease, yet they quietly affect a significant share of our patients; and are responsible for longer hospital stays, sepsis and amputations. What are the numbers, you might ask – and the embarrassing answer is “we don’t really know”. Consistent, accurate data collection of chronic wounds (bedsores, diabetic foot ulcers, venous leg ulcers and stalled/infected surgical wounds) has been spotty at best – the last cross-Canada estimate was in 2004.

However, we can make some reasonable assumptions, based on US figures, where at any point in time, 15 per cent of the acute care population is estimated to have a pressure injury (Institute for Healthcare Improvement, 2012).

Now well into the 21st Century, patients admitted to hospital are older, sicker and often with multiple issues related to mental health, family stress, poverty, etc. What might have once been a fairly simple “throughput” experience, has become the unfortunate-

C

Stop Chronic Wounds Today!

WOUND CARE has changed, with new dressings and technologies, yet many wound care practices remain outdated. Do you have up-to-date knowledge to provide the best in safe, evidenceinformed wound prevention and care?

The Wound Care Certificate at York University will provide you with current, clinically relevant information about preventing and managing chronic wounds, such as pressure injuries, venous/ arterial, diabetic foot ulcers and infected wounds.

This practical 4-day course, offered through the Health Leadership and Learning Network at York University, is custom-designed for nurses and other health professionals. Experience education that you can apply directly to the workplace through interactive case discussions and hands-on opportunities to try various dressings.

The focus is on understanding the generic principles of each dressing type, and developing confidence to prevent, assess, treat and document wounds.

Currently in its fifth year at York University in Toronto, the course will be on the road for first time with sessions in Ottawa, Sudbury, Windsor (ON), and Halifax (NS) for 2019. Please contact us at hlln@yorku.ca or 416-736-2100 x 22170 for more information.

Inquire also about our special wound care course for chiropodists.

22 HOSPITAL NEWS MARCH 2019

ly common scenario for many patients.

Take for example, Mrs. Ida Jackson.

She’s an 86-year-old widow, living in her own home. On Saturday, she trips over a scatter rug and falls. She’s brought to the emergency department (ED) where X-rays confirm a hip fracture. Admitted for surgery, she still has to wait 24 hours in the ED for an apropriate bed to become available.

The ED is busy; Mrs. Jackson is in a continence brief (adult diaper). She’s NPO (“Nothing by mouth”), with an IV running.

Her surgery goes well on Tuesday, but discharge is put on hold, due to her slow recovery. Her mobility and activity have both been limited; due to pain, she has been reluctant to get out of bed or follow the deep coughing instructions from the respiratory tech.

She only picks at her food. Family visits have been sporadic, since her grown children are busy with work and other responsibilities.

The nurses have documented a Stage 2 Pressure Ulcer on her coccyx, and have notified the team. After a quick look, the doctor writes the orwww.hospitalnews.com

COVER STORY der, Daily dressing and reposition q 2 h.

The nurses use foam dressings, reinforced with a transparent film over top, but the whole dressing is often found in the continence brief. The nurses encourage Mrs. Jackson to change her position to decrease the pressure on her coccyx, but they note that she now appears to be developing a reddened spot on her “good” hip. By Friday, Mrs. Jackson is transferred to the General Medicine Unit.

There is a smell in the room, and one of the nurses suggests using an open box of kitty litter under the bed to deal with the odour. The doctor orders Betadine-soaked gauze b.i.d.

By the time her daughter asks to see Mrs. Jackson’s backside on Saturday, the bedsore has oozing yellowish- gray fibrous tissue as well as a strong odour.

The daughter hits the roof.

We know that elderly individuals are at higher risk of skin breakdown and slower healing, and that incontinence and poor nutritional intake are major culprits. But we also should know that appropriate prevention and treatment are available.

So why do situations like this one, which unfortunately happens to be a true story, occur with such alarming frequency?

One of the basic reasons is that medical and nursing students have virtually no education regarding upto-date, evidence informed knowledge relating to chronic wound prevention and management. Until they are in the work-force, nurses and doctors, along with other healthcare professionals, often don’t realize the magnitude and complexity of skin tears, pressure injuries, diabetic foot ulcers, venous leg ulcers and stalled surgical wounds.

And, poised over the patient’s wound, who has the time to stop and learn? It’s no surprise, then, to fall back on an out-of-date and usually inappropriate approach. If you don’t know that wounds change over time, and the order from last week is likely no longer what the wound needs, why would you question what you are doing? And if you do happen to ask, the response is likely to be, “Because that’s the way we’ve always done it”. In

over 15 years of teaching wound care to nurses and doctors, and consulting on more wounds than I can remember, this is the most common situation I have seen. The sad thing is, it is far costlier and time-consuming than to actually do the right thing.

It’s time to change this paradigm.

If we can’t change the academic programs to increase curriculum content on chronic wounds, at least in the clinical world, this shift can happen.

The first step is to ensure all staff, physicians and students have up-todate training in preventing and managing chronic wounds. This education (on-site, webinars, etc) must include a hands-on component to be able to confidently and quickly select appropriate treatments, particularly dressings. Everyone, from management to Personal Support Workers, needs to be on board with evidence-informed, practical and relevant education with a focus on how to work as a team to optimize patient outcomes. Zero tolerance for hospital-acquired pressure injuries can be a realistic goal, for example.

Continued on page 24

In Canada approximately

1 in 8 patients

in acute care hospitals,

1 in 11

nursing home residents, and

1 in 50

home care

clients experience

pressure ulcers.

a leader in health continuing professional education Learn everything you need to know about preventing and managing wounds such as: • pressure injuries • venous/arterial ulcers • diabetic foot ulcers Inquiry today about our practical Nfle[ :Xi\ :\ik`ÔZXk\ gif^iXd [\j`^e\[ ]fi nurses and other health professionals Upcoming Locations and Dates: • Toronto (May 1-4, 13-16, Oct 28-31, OR Nov 6-9 ) • Sudbury (June 5-8) • Windsor (June 11-14) • Halifax (June 17-20) 416-736-2100 ext 22170 | hlln@yorku.ca hlln.info.yorku.ca/open-programs www.hospitalnews.com

MARCH 2019 HOSPITAL NEWS 23

COVER STORY Continued from page 23

Hospital Acquired Wound care Pressure Injuries tend to stay Patients with

4 days longer in hospitals, are7% more likely to die,

and, on average, cost the health care system an additional $13,500. Although its financial burden to the health systems is not as well known as those of other diseases,

pressure ulcers are expensive, costing the health care system as much as diabetes

and about a third as much as cardiovascular disease.

PROMOGRAN PRISMA ™

WOUND BALANCING MATRIX

Did you know...

90% of wounds with elevated protease activity will not heal without proper interventions.

The second solution is the implementation of a consistent electronic documentation and data collection tool, that includes wound photo and measurement (apps to automatically do this are currently available), as well as tracking product utilization. I know this is a challenge.

But what is needed is the recognition that this MUST happen, and the will, at the senior levels of management, to make it so. Costs to implement the technology (already developed and commercialized) will be off-set through the savings directly related to patient outcomes.

The third aspect of this change is to recognize the need for a team approach. Wounds heal from the inside out, so the patient must be an integral part of the treatment plan as much as possible. Depending on the issue, different members of the team may be key players. The team also extends to staff where the patient will be going – home, long-term care, etc. Communication is critical. In our example of the unfortunate Mrs. Jackson, the dietitian, pharmacist (re: pain medica-

tion) and occupational therapist would have been involved from the start; the home care social worker would have been connecting with the family re: home supports.

So, in summary, the “big three” components of this change are knowledge, documentation and collaboration. From this month’s special focus on wound care, you can see that information abounds regarding treatment approaches to improve wound closure/ healing. As well, there are educational programs at a variety of levels, described and advertised – all designed for the needs of healthcare professionals across the continuum of care.

Consider the quiet frequency of stories like Mrs. Jackson’s. These can be avoided with a clear commitment to those values we all hold so dear: safe, effective and efficient care, with excellent outcomes for our patients, our organizations and our communities.

Leaders at all levels need to be fully engaged as champions to support this sustainable approach to skin breakdown and chronic wound prevention H and management. That’s you. ■

The five-year mortality rate for someone with

a healable, diabetes-related foot wound is similar to or higher than that of the most common types of cancer except for lung and pancreatic cancer.

Up to two-thirds of people with diabetes who have had an amputation die within the following year, 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)

24 HOSPITAL NEWS MARCH 2019

and up to

80% die within 5 years.

Rosemary Kohr RN, BScN, MScN, PhD, is a wound specialist with over 20 years providing clinical care and consultation in Acute Care (London Health Sciences Centre), long-term care and the community. She is currently Program Director, Health Leadership & Learning Network, York University and Instructor, Graduate Program, Faculty of Health Disciplines, Athabasca University. www.hospitalnews.com

1

Did you know... ...the 5 year mortality risk of Diabetic Foot Ulcers and Amputations is higher than breast cancer.

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V.A.C. VERAFLO CLEANSE CHOICE™ DRESSING

PROMOGRAN PRISMA™

SNAP™ THERAPY

WOUND BALANCING MATRIX

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Reference: Armstrong DG. Wrobel J. Robbins JM. Are diabetes-related wounds and amputations worse than cancer? Int Wound J. 2007:4(4):286-7. 5.

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.

Copyright 2018 KCI Licensing, Inc. Unless otherwise designated, all trademarks are proprietary to KCI Licensing, Inc., its affiliates and/or licensors.

PRA-PM-CA-00031 (06/18).

1

2/27/2019 8:41:58 AM

WOUND CARE

Wound care revolution:

Put away your rulers and reach for your phone

By Julie Robert onitoring a wound is critical, especially in diabetic patients, whose lack of sensation due to nerve damage can lead to infection of a lesion and, ultimately, amputation. Clinicians and healthcare professionals at the McGill University Health Centre (MUHC) and other hospitals believe that the use of a new app, Swift Skin and Wound™, which accurately measures and charts the progression of skin wounds, could potentially have a significant impact on clinical management and patient outcomes.

“Many of my patients are diabetic and are dealing with slow-healing foot ulcers; this app offers a way to clearly document and quantify the size of the ulcer to ensure it is actually healing, and if it is not healing, I can change strategies,” says Dr. Greg Berry, Chief of Orthopaedic Surgery at the Montreal General Hospital of the MUHC and Chief and Mueller Chair of the Division of Orthopaedic Surgery at McGill University. “I can concretely show them that what we are doing is working. They get on board and are more devoted to the treatment plan because they see it is successful,” he adds.

The app was the idea of Dr. Sheila Wang, a resident in dermatology in the Department of Medicine at McGill University and a scientist at the Research Institute of the McGill University Health Centre (RIMUHC). Early in her medical career, she saw that there was a problem with the way that wounds were measured and went on to co-found the company, Swift Medical, which developed the smartphone software.

“When I was in medical school in Toronto in 2013, I noticed doctors and nurses relied on rulers to measure patients’ wounds,” she says, “resulting in widely varied descriptions, depend-

M

NEW APP P PILOTED IN MONTRE EAL HOSPITALS S GIVES ACCU URATE, TOUCHLESS WOUND MEASUREMENTS

Photos courtesy MUCH newsroom.

Dr. Sheila Wang and Dr. Greg Berry ing on who was doing the measuring. It didn’t seem very exact, so I decided to do something about it.”

Dr. Wang was first author on a paper, published in the scientific journal PLoS ONE, which shows that the app

provides measurements of wounds that are more consistently accurate than those taken by using a ruler. They are as accurate as another measuring tool known as a digital planimeter, but using the app allows medical personnel to share and track wound information. She also recently published an article in the JMIR Dermatology that focused on understanding the type and location of skin and wound lesions found in longterm care facilities and mapping these on the body.

Swift Skin and Wound can be used remotely. Dr. Wang and her colleagues expect the app will play an important

role in telehealth monitoring in the future.

“The app allows different health care workers to collect images and data from each patient and to follow the wound over time, something which is very important in the Northern regions, where there is a high turnover of staff,” adds Dr. David Dannenbaum, Faculty Lecturer in the Department of Family Medicine at McGill University.

“This is one of the first wound measurement apps to be developed,” says Dr. Wang. “Swift Skin and Wound is now used to monitor over 100,000 patients in over 1,000 healthcare facilities across Canada and the USA. Its ability to transform wound care, even when used by those with little experience, will make it an invaluable tool H for health care workers.” ■

Julie Robert is the Communications Coordinator – Research at McGill University Health Centre.

26 HOSPITAL NEWS MARCH 2019

www.hospitalnews.com

WOUND CARE

Challenging the process for changing a dressing

By James Scarfone he problems and challenges confronting us in healthcare today are too big and too complex for top-down solutions. We need the collective wisdom of our large workforce to find solutions.

At Hamilton Health Sciences (HHS), we’re empowering and equipping our frontline staff to make improvements to their work environment and to patient care on a daily basis.

This is occurring with our Continuous Quality Improvement (CQI) model.

CQI has created a culture change within HHS that allows staff and physicians to see opportunities to improve the way a hospital unit works. People are more receptive to changes in process and embrace fixing even seemingly minor issues if it will make the job easier and more effective.

Staff in pediatric oncology unit at HHS’ McMaster Children’s Hospital identified that the adhesive remover they regularly used for IVs and dress-

T

PEOPLE ARE MORE RECEPTIVE TO CHANGES IN PROCESS AND EMBRACE FIXING EVEN SEEMINGLY MINOR ISSUES IF IT WILL MAKE THE JOB EASIER AND MORE EFFECTIVE.

ing changes was not overly effective.

It also was supposed to reduce pain for patients but that was not always the case due to it being ineffective.

Nurses had to sometimes re-apply the remover or spend extra time cleaning the area multiple times in order for the next dressing to be applied properly.

The product also emitted a strong scent that bothered several members of the team and violated HHS’ fragrance-free policy.

The team also found there was a different process in practice on the inpatient and outpatient pediatric oncology units. Therefore, they iden-

tified it as a process improvement to go through CQI. A small group was formed to tackle finding a solution.

As part of the CQI process, the group met with several other units that were high users of this brand of adhesive remover. They created a list of pros and cons of continuing with the product.

Then the group met with other areas in the hospital, namely housekeeping staff. Here they discovered the use of a similar product, as part of the cleaning routine, which was more effective.

This other product was actually safer for patients, didn’t smell as much,

and was already available within the hospital. Due to this, switching to the other adhesive remover turned out to be a relatively simple solution that could be implemented in a short period of time with few resources.

After implementing the solution, staff within the unit provided positive feedback on the new product. It’s now being used all throughout McMaster Children’s Hospital.

“We knew a better way existed, we just needed the tools to find it,” says Stephanie Furtado, a skin, wound and ostomy nurse clinician at HHS and the person who identified the problem and led finding the solution.

Switching products was not only safer for patients and easier for staff, but it also saved HHS money.

Though a small amount, the savings add up quickly with a large workforce working together to create positive change.

“Even something trivial can have a H big impact,” says Stephanie. ■

James Scarfone is a Public Relations Specialist at Hamilton Health Sciences. www.hospitalnews.com

MARCH 2019 HOSPITAL NEWS 27

WOUND CARE

The care team at Providence Healthcare (from L to R): Susan Chandler, clinical nurse specialist in wound care & prevention, Kimberly Mackenzie, relationships and partnerships manager, Chiara Campitelli-Thompson, patient care manager, and Kelly Tough, patient flow manager.

A new wound-care initiative is

tackling painful wait times

By Selma Al-Samarrai and Michael Oliveira revor Kampen marvels at the number of people he’s met during his journey from St. Michael’s Hospital to Providence Healthcare to treat his debilitating pressure wound, a condition caused by his spina bifida.

“There’s a lot of people involved in this,” the 30-year-old says with a chuckle as he tries to list off the names of all the doctors, nurses, occupational therapists, physiotherapists, his dietician and others who have had a part in his care.

“If I forget somebody, I’m sorry, but there’s a lot of names and faces to remember.”

Kampen is the first patient to take part in the new St. Michael’s-Providence clinical collaboration that could eventually help double the number of

T

28 HOSPITAL NEWS MARCH 2019

pressure wound surgeries performed at St. Michael’s each year. Pressure wounds are caused by prolonged or intense pressure to a localized area, and often develop in individuals with impairments in sensation or motor function.

Providence staff have enhanced knowledge to provide rehabilitation for patients who undergo the surgery.

“To be a part of this new initiative and be able to provide a service in such a meaningful and important surgery is very exciting,” says Providence patient care manager Chiara Campitelli-Thompson.

“It may sound a little cliché but this has been the true definition of collaboration.”

Previously, it was a struggle to find facilities that could take on a patient

for the typical six-to-eight weeks of post-operative recovery time, says Dr. James Mahoney, chief of Plastic Surgery, who performs the surgeries along with Dr. Karen Cross.

“I had actually stopped doing the surgery for more than a year because I did not have the rehab space to provide patients the support I thought they required,” Dr. Mahoney says.

“The surgery is only one little part,” he adds, stressing how important the collaborative nature of the initiative is.

“My surgery can be undone in one episode if something is not done correctly in the rehab process.”

Collaborating with Providence as the rehabilitation site means patients have access to the interdisciplinary care needed for a healthy recovery, explained Janeth Velandia, nurse prac-

titioner for the Wound Care Team at St. Michael’s Hospital, and one of three project leads for this clinical collaboration along with Cecilia (TingTing) Wan, occupational therapist for the Wound Care Team, and Kimberly Mackenzie, relationships and partnerships manager at Providence.

“Providence has the full range of health care providers who are needed for rehabilitation for surgery to be successful, such as doctors, pharmacists, occupational therapists, physiotherapists, registered nurses, and registered dietitians,” explained Velandia.

Kampen’s spina bifida – which limits the sensation in his lower body – led to his first pressure wound issue almost a decade ago.

Continued on page 30 www.hospitalnews.com

WOUND CARE

Virtual reality

helps ease the pain for wound care patients

By Blain Fairbairn n a Canadian first, patients undergoing wound care procedures at Calgary’s Rockyview General Hospital are now using a virtual-reality program to help ease pain and anxiety.

Using one of two Samsung Gear headsets funded by an anonymous donor, wound care patients are transported to an immersive, three-dimensional environment that includes a virtual lakeside campground, a pre-

I

historic landscape with dinosaurs and a tranquil ocean to swim with dolphins.

Graydon Cuthbertson used the therapy three times after having multiple surgeries involving his calves.

“It’s a godsend,” says the 47-year-old Calgary man. “Even with painkillers, the first time I had wound care after my surgery, the pain was excruciating.

But with virtual reality, I got through the next treatment with flying colours.

VIRTUAL REALITY’S VISUAL AND AUDITORY EXPERIENCE HAS BEEN CLINICALLY PROVEN TO BE EFFECTIVE IN REDUCING PAIN AND ANXIETY REPORTED BY PATIENTS. “I was focused on what I was seeing and hearing, and not thinking at all about how painful it might be.

All of the sudden, one-and-a-half

Continued from page 28

wound-care initiative “It involves an excessive load or direct pressure, typically over a bony prominence, and it overpowers our normal circulation leading to a wound,” says Dr. Mahoney in explaining how pressure wounds develop.

It can be shocking for patients and their family members to see how severe a pressure wound can worsen.

“These go all the way through your skin down to the underlying bone,” Dr. Mahoney says. “These are very significant and deep and often associated with complications.”

Kampen was referred to Dr. Mahoney after years of struggles and setbacks with managing his wound, including misdiagnoses.

He then had to go through an extensive assessment process to ensure he was a good candidate for surgery which was performed by Dr. Mahoney, Velandia and Wan, and included input from experts in infectious disease and imaging.

Kampen also had to commit to giving up smoking, eating properly, and following a regiment of care after surgery to prevent complications and to improve wound healing.

The care team at St. Michael’s Hospital (from L to R): Janeth Velandia, nurse practitioner, Wound Care Team, Dr. Karen Cross, plastic, reconstructive and aesthetic surgeon, Dr. James Mahoney, chief division of Plastic and Reconstructive Surgery, Elizabeth Butorac, program director, Trauma/Neurosurgery and Mobility programs, and Cecilia (TingTing) Wan, occupational therapist, Wound Care Team He was then booked for so-called skin flap surgery, which involves removing compromised tissue related to the wound and filling the cavity with flaps, or rearrangements of local tissue. In Kampen’s case, hip and lower leg muscle was used.

After a few days of recovery at St. Michael’s, Kampen was transferred to Providence for eight weeks of rehabilitation. Care teams at both sites

kept in close contact as his treatment progressed, often sharing images and updates electronically so Kampen wouldn’t have to be transferred back to St. Michael’s for follow up assessments by Dr. Mahoney.

“My health has been a lot better and my walking has improved greatly since the surgery. I’m now able to return back to work slowly and to enjoy H the outdoors more,” says Kampen. ■

Selma Al-Samarrai and Michael Oliveira work in communications at Unity Health Network.

30 HOSPITAL NEWS MARCH 2019

hours go by and it’s all over. It was awesome.”

Virtual reality’s visual and auditory experience has been clinically proven to be effective in reducing pain and anxiety reported by patients. The team leading the initiative at the hospital was inspired to investigate the therapeutic benefits of virtual reality after reviewing studies on its effectiveness from a pilot program conducted by Cedars-Sinai Medical Center in Los Angeles.

While virtual reality has been used in clinical settings around the world for a variety of therapeutic and relaxation purposes, Rockyview General Hospital is the first hospital in Canada to employ the technology for wound care patients.

During the research phase at the hospital, patients receiving wound care were asked to rate their level of discomfort and overall experience using surveys administered before and after virtual-reality therapy. Patient discomfort included ratings of pain, nausea and anxiety while measures of patient experience included feelings about future treatments and overall impression.

The results were impressive: All patients who used virtual reality found it helpful. Patients reported a 75 per cent reduction in patient discomfort with a 31 per cent improvement in overall patient experience.

Unlike conventional pain and anxiety-reduction therapies, such as painkillers or sedatives, no side effects were reported by patients who used virtual-reality therapy. While the program is not intended to replace pharmaceutical interventions, it’s anticipated virtual reality can be widely used as a complementary therapy that may reduce dependency upon drugs to enhance patient care.

“Rockyview’s virtual reality program www.hospitalnews.com

WOUND CARE

illustrates how AHS employs innovative technology to improve patient care,” says Christopher Burnie, allied health manager at the hospital.

“Technology has always played an important role in healthcare but this is particularly exciting in that we can make a really positive impact on a patient’s experience without having to invest in something costly or complex.

Interestingly, we’ve also seen how the therapy benefits staff. When surveyed, wound care staff described lower levels of distress while they delivered treatment because they know their patients are much more comfortable.”

In addition to wound care patients, the virtual-reality program is also being tested on patients in the hospital’s intensive care and cardiac care units.

Comprehensive criteria have been developed by the researchers and clinicians to ensure patients are suitable candidates for the therapy. Those who qualify can choose from 12 curated

Physiotherapists Jaclyn Frank, left, and Jane Crosley, right, help patient Graydon Cuthbertson take his mind off a painful wound care procedure thanks to virtual reality. Photo credit: Blain Fairbairn. spired to give because, as a cancer patient, she can relate to living in pain and she wants to help ease discomfort for other patients if possible.

Results from the virtual-reality study are being shared with other Alberta Health Services sites in the hopes the

virtual reality experiences currently offered by the hospital.

Rockyview recently announced a second donor has come forward with a gift to fund the purchase of two addition virtual-reality headsets and phones. This newest donor was in-

program may benefit patients across Alberta. Foothills Medical Centre’s burn unit is investigating the therapy for its patients and the program has received interest from the Royal Columbian Hospital in New Westminster, H B.C. ■

Blain Fairbairn is a Senior Communications Advisor at Alberta Health Services.

Diabetic foot infection he estimated lifetime risk of a person with diabetes mellitus developing a foot ulcer is 15–25 per cent. It is estimated that just over half of diabetic foot ulcers are infected at the time of presentation, and ulcers remain the most frequent complication of diabetes requiring hospitalization.

A foot ulcer precedes 85 per cent of all lower-extremity amputations in patients with diabetes.

Risk factors for developing diabetic foot ulcers include peripheral neuropathy, peripheral arterial disease, foot deformity and impaired immunity related to metabolic factors. Ulcers are often caused by trauma to the extremity – usually as the result of pressure – but can also develop as a result of chemical, thermal or mechanical factors.

Well-recognized risk factors for infection in a diabetic foot ulcer are:

T

www.hospitalnews.com

Classify Infection IWGDF, IDSA, CDA IV Antibiotic

Oral/IV Oral Mild

Uninfected

2 signs of classic inflammation, <2cm erythema, involves skin and subcutaneous tissue

Moderate Signs of local infection, erythema >2cm or involving deeper structures

Severe Local Infection +systemic toxicity

Classic signs of infection/inflammation – swelling, induration, erythema, tenderness, warmth, purulent discharge Reprinted with permission from Wounds Canada

• Ulceration present greater than 30 days • Previous or recurrent foot ulcers • Renal insufficiency • History of walking barefoot

• Positive probe-to-bone test Infection can advance quickly and requires careful clinical follow up.

Early identification and treatment of these wounds is key in preventing the

cascade of human and economic burden to the healthcare system.

PREVENTATIVE CARE Preventing ulceration and infection should always be the goal of patients and healthcare professionals. Measures that can help prevent diabetic foot infection include: • Patient education on proper foot care • Glycemic control • Blood pressure control • Smoking cessation • Use of prescription footwear • Professional foot care to examine the feet at regular intervals defined by patient risk factors For more information on prevention, visit woundscanada.ca for a downloadable brochure, available in sixteen languages.

Continued on page 32 MARCH 2019 HOSPITAL NEWS 31

WOUND CARE Continued from page 31

Surgical Management if:

Medical Management if:

• Substantial bone necrosis

• No need for surgery

HIDDEN DANGER

• Non-salvageable foot

• Small and contained foot infection

In individuals with diabetes, signs of inflammation may be concealed by several factors, meaning an infection may go unnoticed until it has progressed to a limb-threatening stage. The underlying immune disturbance and perfusion issues that are common in individuals with diabetes make it more difficult to detect inflammatory signs of infection. Diabetic sensory neuropathy might mean a patient doesn’t feel pain (and therefore will not complain about pain), while a reduced inflammatory response may decrease redness. Other signs of infection, such as presence of necrotic tissue, friable granulation tissue, increased pain, exudate and odour, can be helpful when inflammatory signs are diminished.

• No available active antibiotic

• Patient too unstable for surgery

• Non-correctable foot ischemia

• Patient preference

Diabetic foot infections

DIAGNOSING AND ASSESSING INFECTION Clinicians should exercise a high degree of suspicion to identify infec-

• Patient preference Table 1. Surgical vs. Medical Management tion in its early stages, thus enabling efficient treatment and a minimized risk of limb loss. Clinicians should assess the patient, the wound and the environment to determine risk of infection; consider using Inlow’s 60-Second Diabetic Foot Screen as a tool to aid in assessment. Obtaining a culture is recommended if infection is suspected. The ulcer should be cleansed prior to the culture. Ideally, culture should be obtained by biopsy of tissue or bone, however this is not always practical.

A diabetic foot infection, once diagnosed, can be classified as mild, mod-

erate or severe (see Figure 1). This requires careful evaluation of the patient (systemic symptoms), the affected limb (vascular status) and the ulcer. The severity of infection depends on the extent of the erythema, the depth of the wound and the presence of systemic symptoms (see Figure 1).

™

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)

32 HOSPITAL NEWS MARCH 2019

Treatment of a diabetic foot infection is based on the extent and severity of the infection and co-morbid conditions (see Table 1)(figure 1). Mild infections are treated with oral antibiotics, local wound care and pressure offloading. Patients with moderate or

CLINICIANS SHOULD EXERCISE A HIGH DEGREE OF SUSPICION TO IDENTIFY INFECTION IN ITS EARLY STAGES, THUS ENABLING EFFICIENT TREATMENT AND A MINIMIZED RISK OF LIMB LOSS. OSTEOMYELITIS

PROMOGRAN PRISMA

TREATING INFECTION

An infection can advance from the soft tissue by contiguous spread to the underlying bone. Osteomyelitis complicates about 20 per cent of infections. The probe-to-bone test involves using a sterile blunt probe to assess the depth of the ulcer. If gritty, hard bone is felt at the base of the ulcer in highrisk patients, there is a high likelihood of osteomyelitis.

Healthcare professionals should also consider laboratory testing and imaging to aid in assessment and diagnosis.

The types of laboratory tests ordered depend on the presenting factors of the patient, co-morbid conditions and medications. X-ray imaging is a readily available test and can give information on the status of the bone or the possibility of a radio-opaque foreign body.

X-ray changes related to osteomyelitis may take 2–3 weeks to develop, so serial x-ray may be required. Advanced imaging such as magnetic resonance imaging is considered the best test for diagnosing osteomyelitis.

severe infections can be considered for intravenous antibiotics and evaluated for possible surgical intervention. Antibiotics should only be used to treat the infection and not until closure of the ulcer. A guideline for antibiotic choices for the treatment of diabetic foot infection can be found in the Canadian Diabetes Association Clinical Practice Guidelines.

Debridement of devitalized tissue is also an important part of managing these infections. This, however, is contraindicated if significant peripheral arterial disease is present.

Ideally, the management of these complex infections is best coordinated at a multidisciplinary clinic, however it is essential that front-line clinicians are able to recognize the significance of the infection and to utilize early management principles. When a multidisciplinary foot clinic is not available, appropriate referrals may include infectious disease specialists, vascular surgeons, orthopedic surgeons, endocriH nologists, chiropodists or podiatrists. ■

Robyn Evans BSc MD CCFP is Medical Director at Women’s College Wound Healing Clinic and Medical Lead at Wounds Canada. Mariam Botros DCh DE IIWCC is CEO of Wounds Canada and a Chiropodist at Women’s College Wound Healing Clinic. www.hospitalnews.com

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)

NEWS

New transitional care option available to eligible patients awaiting long-term care in hospital, thanks to temporary local partnership

By Jennifer Gillard and Rebecca Scott Rawn cute care hospitals like Northumberland Hills Hospital (NHH) are designed for people with urgent or acute health care needs.

In recent years, however, acute care hospitals have become a fallback and less-than-ideal ‘home’ for those awaiting an alternate level of care – in most cases, a long-term care bed – as the need for these spaces has exceeded the current system’s capacity.

Additional long-term care beds have recently been announced for our community of Northumberland County. This is welcome news, but new construction takes time and the reality is that these new beds will not be built and operational for several years.

A

34 HOSPITAL NEWS MARCH 2019

WHILE LONGER-TERM SOLUTIONS TO PROVINCIAL ALC PRESSURES ARE DEVELOPED, THIS IS A RELEASE VALVE WITH IMMEDIATE, TANGIBLE BENEFITS FOR THE PATIENTS. Currently at NHH 25 to 30 per cent of available acute care beds are actually occupied by alternate level of care (ALC) patients who do not, in fact, require acute care service. In other words, only 75 per cent of the intended acute care bed capacity at NHH is technically accessible to acute care patients.

This situation has resulted in lengthening wait times for those en-

tering hospital through the Emergency Department (ED), an increase in patients who must be admitted to a bed in a crowded and noisy ED, and mounting frustration for patients, their loved ones and the health professionals who care for them.

A new transitional care option was recently introduced in Northumberland County, Ontario, thanks to a

temporary partnership between NHH and the local retirement home arm of Extendicare Cobourg, The Landmark Seniors’ Residence. While longer-term solutions to provincial ALC pressures are developed, this is a release valve with immediate, tangible benefits for the patients, their families and the local health system.

Through the partnership, up to four ALC patients at NHH now have the option of being transferred to a temporary home at The Landmark.

In so doing, four acute care beds at NHH will be freed up for patients who need urgent, acute care, while, at the same time, the quality of life for the eligible patients will be improved by offering a more home-like environment www.hospitalnews.com

NEWS

in which to wait for a more permanent long-term care placement, and other supports beneficial to their overall health and independence, including daily programming to support social and emotional well-being.

Patients eligible for the beds at The Landmark will have placement for long-term care papers completed and assessed as appropriate. A repatriation agreement is in place to support transfer back to the hospital should a patient’s needs change or the program funding is not sustained. At present, funding has been granted through the Central East Local Health Integration Network until March 31, 2019, with the potential that this will continue – and possibly expand to other area partners – until additional long-term care capacity is introduced.

The new option brings no additional cost to the participating patients.

Patients would be expected to pay a daily fee to The Landmark equal to the

THE NEW OPTION BRINGS NO ADDITIONAL COST TO THE PARTICIPATING PATIENTS.

current ‘co-payment’ they are required to pay in the hospital as an alternate level of care patient awaiting transfer to long-term care.

Eligibility for patients to be transferred to The Landmark is based on a range of clinical factors. A matching process is in place, to identify the most appropriate ALC patients for the program and to bring it to their attention for consideration. Ultimately, the decision of whether or not to temporarily transfer to The Landmark is up to the eligible patient and their loved ones.

“This is a new, temporary option for some families whose loved ones are receiving care in hospital simply because there is no available long-term care bed for them in the area at this

time,” said NHH President and CEO Linda Davis in a joint news release announcing the new collaboration. “It’s a stop-gap, in our view, and one that NHH and other hospitals in the province are exploring in order to meet our accountability to acute care patients.

Our aim is to free up bed space for those with acute care requirements – the care we exist to provide – while, at the same time, providing an alternate care space for ALC patients that is better suited to their current need.”

“We are very pleased to partner with the Northumberland Hills Hospital to help alleviate overcapacity challenges,” added Michael Harris, Extendicare’s Vice-President of Long-Term Care Operations. “It’s a win-win-win

in our view, to use excess capacity at The Landmark and create a temporary solution while new long-term care capacity is being built. We look forward to welcoming patients and their families to the Landmark community.”

“I would like to offer my congratulations to Northumberland Hills Hospital and The Landmark Seniors’ Residence for their partnership and innovative strategy in supporting NHH patients who are awaiting an alternate level of care,” stated David Piccini, Member of Provincial Parliament, Northumberland – Peterborough South. “Our government was elected to put the patient at the centre of a sustainable health care system. We have moved forward to address some of the immediate challenges faced by Ontario’s health care system through the creation of more beds to address hallway health care.

We appreciate the support of all of our health care partners in creating new H transitional care options.” ■

Jennifer Gillard, Senior Director, Public Affairs and Strategic Partnerships, Northumberland Hills Hospital Rebecca Scott Rawn, National Director, Communications and Strategic Partnerships Extendicare Inc.

There is hope for a better tomorrow.

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HSCN NATIONAL HEALTHCARE SUPPLY CHAIN CONFERENCE 2019

HSCN 12TH ANNUAL NATIONAL HEALTHCARE SUPPLY CHAIN CONFERENCE AND EXHIBITION SUCCESS THROUGH SYNERGY PROGRAM HSCN 2019 comprises a Professional Development Day (May 13) and two days (May 14-15) of lively and stimulating sessions. A roster of expert speakers from across Canada will be sharing best practices aimed at improving healthcare supply chain processes. Content will include new technologies that can help address accountable care challenges and align with strategic priorities. Sessions include: ■ Engaging clinical stakeholders in the innovation procurement process Learn how TransForm and Bluewater Health (BWH) worked together with hospital staff, bringing a fresh perspective to procurement while ensuring a fair, open and transparent experience process.

■ Protecting pharmaceutical supply chain from illegal online pharmacies The Alliance for Safe Online Pharmacies will discuss illegal online sellers and its risks to Canada’s medical supply chain. Detective Robert Whalen will address the connection between illegal online sellers and organized crime.

DELTA TORONTO AIRPORT HOTEL AND CONFERENCE CENTRE MAY 13-15, 2019 SCN’s Annual National Healthcare Supply Chain Conference will once again take place at Delta Hotels by Marriott Toronto Airport on May 13-15.

The two-day conference and exhibition is preceded by HSCN’s Professional Development Day. With its theme, Success through Synergy, the conference will highlight the benefits of healthcare supply chain professionals working together to optimize patient outcomes.

As well as an opportunity to interact with peers, the HSCN conference, now in its 12th year, provides healthcare supply chain professionals insights into the industry’s best practices which are designed to improve and refine supply chain processes in healthcare.

The conference will feature a line up of expert speakers from across Canada. It will focus on the future of supply chain in healthcare, HIS/digital health, leadership models, tying supply chain to the continuum of care, and synergies achieved by providers working together with suppliers.

Susan Smith, HSCN General Manager and Conference Lead, has planned a broad cross section

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of presentations. “Past audiences have expressed a desire for case studies that serve to provide encouragement, design options and learnings to peers.

This year we have a significant focus on experiential learning.”

She has seen the continued growth that has positioned the conference as the fore-most gathering place for healthcare supply chain professionals and leaders. “HSCN brings together industry influencers and frontline professionals into one central location to discover the latest developments in supply chain disruption and innovation, and to share best practices within the profession. Today, we host our national event in the largest conference centre and hotel in the Toronto airport vicinity and we expect more than 350 delegates from across the country.

“There is constant evolution within the industry and HSCN is recognized as the key voice in the promotion of industry changes. We bring together key stakeholders to share approaches that they have implemented to keep them abreast of change. This information sharing is critical to a sustainable future for everyone and it is the key ingredient contributing H to the success of the Conference,” adds Smith. ■

■ Hurricane Maria: risk management and recovery A clear picture will be given of the scope of problems that natural disaster can present in offshore manufacturing. It will include the lessons learned and mitigating steps to be taken to avoid similar issues.

■ Value-based Procurement: Pediatric Insulin Pump Program This session highlights Service New Brunswick’s competitive procurement initiative to obtain fair and affordable access to a range of insulin pump devices and supplies for New Brunswick children with Type 1 diabetes and their family.

36 HOSPITAL NEWS MARCH 2019

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HSCN NATIONAL HEALTHCARE SUPPLY CHAIN CONFERENCE 2019

RISKY BUSINESS: COLLABORATION AND INNOVATION The session will present real world case studies that identify new partnership risks, provide mitigation strategies, and introduce best practices for organizations to follow.

■ Implementation of a shared services model in Newfoundland and Labrador The presentation will cover the supply chain transformation in a province faced with extreme geographical and environmental divergences. Discussion will include Governance, strategic sourcing, technology acquisition and a proactive strategy.

■ Implementing value and innovation procurement at scale This presentation unpacks the essential innovation and value-based procurement challenges facing Canada. There will be a review of Plexxus’ innovation procurement decision making approach and how it enables value-based healthcare.

■ Outcomes-based procurement for deep infrastructure retrofits The presentation will examine why outcomebased procurement often surpasses expectations for operational savings, environmental and building condition improvements.

■ From Data to Value: Client engagement journey This presentation will explore an approach to making data accessible within an organization, the internal tools built to deliver insight to decision makers, and the interactive BI dashboards developed for both internal and external stakeholders.

■ Shining a light on a new supply chain in Ontario Key themes for industry improvement will be highlighted and operational readi-ness for necessary change management along with the innovative strategies HMMS and TransForm used to overcome barriers.

■ Fostering relationships/ increasing capacity in Innovation Procurement A panel discussion will provide insight from a healthcare procurement professional perspective on the importance of developing and maintaining meaningful collaborations to support undertaking Innovation Procurement.

■ IGNITE A high-octane session that brings together a diverse lineup of leaders to stimulate new ideas, present innovative solutions to common challenges, and inspire conversation – in 7 minutes or less.

KEYNOTE TO ADDRESS SUPPLY CHAIN DIGITIZATION IN HEALTHCARE r. Randy Bradley, keynote speaker at HSCN 2019, will share with conference delegates how supply chain digitization in healthcare can transform and improve patient outcomes. An Assistant Professor of Information Systems and Supply Chain Management at The University of Tennessee, his expertise includes IT strategy and supply chain performance in the healthcare sector.

“A digital supply chain is an integrated supply chain undergirded by emerging technologies. As such, it is always on, having the ability to quickly respond to prompts and triggers from stakeholders as they happen and not some time after they’ve happened,” explains Dr. Bradley.

During his session he will describe what he calls the ‘Amazon effect’ in healthcare, and the value and impact of digital supply chains and their implications for healthcare. “I will show how changing patient behaviours and expectations can be costly for healthcare organizations that are unable to undergo digital transformation, including digitalization of their supply chain.”

In his view, information technology is critical in the supply chain because of its potential to “facilitate the nexus of cost, quality, and outcomes in healthcare.” There is an increasing need to have seamless information flows in the supply chain. “In this digital era, the always-on digital supply chain is augmented by technologies, innovations, and advancements that will shape the digital supply chain in the future.”

Dr. Bradley will describe the rate of adoption of the various technologies in the supply chain and their potential to help reimagine healthcare and patient outcomes. He will also explain why the supply chain function should be the seat of innovation in healthcare organizations to help drive H digitalization. “It should be about value and not solely cost efficiency.” ■

■ Building a Unique Device Identification (UDI) implementation road map A panel of industry providers, suppliers, regulators and supply chain association leaders will explain the basics of UDI as well as Implementation steps: from data gathering, system integration, to point-of-care adoption and benefits.

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HSCN NATIONAL HEALTHCARE SUPPLY CHAIN CONFERENCE 2019

HSCN MEMBERSHIP: A MUST-HAVE FOR SUPPLY CHAIN PROFESSIONALS The Healthcare Supply Chain Network (HSCN) is the only supply chain association in Canada that is dedicated to healthcare with participation from both providers and suppliers.

HSCN members enjoy countless benefits including networking opportunities with hundreds of healthcare supply chain professionals from coast to coast, access to the latest education and training on subjects relevant to the healthcare supply chain industry, and alerts on industry and federal/provincial legislative developments, Members receive industry news and information through the HSCN website, HSCN monthly e-newsletter, and email bulletins, as well as valuable industry information through white papers, surveys and special reports posted online.

Members also enjoy significant savings when registering for the National Conference and professional development events. Contact HSCN for membership fees including provider, supplier, student and group rates.

AWARD DINNER CELEBRATES SUPPLY CHAIN ORGANIZATION OF THE YEAR he inaugural HSCN Award Dinner will be held on May 14 at Delta Hotels by Marriott Toronto Airport. The recipient of this year’s Supply Chain Organization of the Year Award is Northern Supply Chain (NSC).

Northern Supply Chain is an innovative shared services program driving collaborative procurement, operational guidance/oversight and cost efficiencies for healthcare in the north and provincially for child welfare service agencies. In announcing the award winner, Susan Smith, General Manager, HSCN, noted that Northern Supply Chain “demonstrated relevant traits of teamwork, innovation, customer service, patient care and strategic planning in their day to day operations.”

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Derek Gascoigne, General Manager, NSC, will be accepting the Supply Chain Organization of the Year Award on behalf of his team. “Northern Supply Chain is very pleased with this prestigious national award and the recognition it brings to the significant work, growth and results that staff have accomplished,” he said.

“As one of the younger shared service organizations in Canada, we will continue to expand our services and footprint to enable us to offer greater value to our members.”

Tickets for the Award Night are $50 and include a networking reception and dinner. For more informaH tion, visit hscn.org or email info@hscn.org ■

INNOVATION PROCUREMENT: OUTCOME-BASED APPROACH TO DELIVERING VALUE

CONNECT WITH YOUR PEERS Don’t miss your opportunity to register early for HSCN’s National Healthcare Supply Chain Conference, to be held at Delta Hotels by Marriott Toronto Airport on May 13–15.

Success through Synergy will highlight the benefits of healthcare supply chain professionals working together to optimize patient outcomes. Learn how to improve supply chain efficiencies through leading practices and network with providers and suppliers from across Canada.

Early Bird Registration ends March 10.

Register now and save.

DON’T MISS IT! For program details and registration, visit

HSCN.ORG 38 HOSPITAL NEWS MARCH 2019

fter a year in development, HSCN launched the Innovation Procurement Toolkit (IPT) last Fall. The toolkit is the result of extensive leading practice research, insightful feedback from advisors and collaborators, and numerous pilots to test the documents in the field and incorporate the learnings.

The IPT was developed to provide healthcare procurement specialists across the sector with practical tools to enable the adoption of outcome-based approaches in the procurement of unknown solutions. The toolkit supports the Ontario Ministry of Government and Consumer Services’ BPS Primer on Innovation Procurement, which provides overall guidance on innovation procurement and details processes for 7 early market engagement strategies and 6 innovation procurement models.

Available on the HSCN website, the toolkit includes a range of guides addressing key concepts such as Outcome-Based Specifications and Value-Based Evaluation Criteria, and templates that can be adopted or adapted to fit organizational procedures. HSCN continues to take an active role in maintaining the content of the toolkit, to ensure it remains current, and provides periodic training on the use of the toolkit.

The next IPT workshop will be held on May 13 as part of HSCN 2019.

The workshop will provide participants with the necessary skills to manage innovation procurement initiatives, using the HSCN Innovation Procurement Toolkit as a frame-work. The workshop combines lecture style delivery with hands-on skills labs, to enable participants to apply these concepts immediately and deliver organizational value through innovation H procurement initiatives. ■

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FROM THE CEO’S DESK

Communitybased care helps everyone get better

By Joanne Bezzubetz ver the past decade, our society has become more aware of the importance of mental health as part of overall health. People are increasingly coming forward for help – not just to mental health centres like The Royal, but also to emergency departments, family physicians, and other health services across the community.

The first thought is often getting the patient ‘into’ somewhere – like a specialized facility. But what if mental health care met patients where they are? What if specialized care was available right there in the family clinic, community health centre, school, or even in the patient’s home? This is already a reality in some cases. We want to make it a reality in most cases.

Each year, thousands of people in Ottawa and its surrounding regions receive mental health care from The Royal without ever walking through our hospital’s doors. Whether they’re seniors living in long-term care, people who are homeless, adults taking progressive steps towards recovery from serious mental illness, or people receiving therapy through the convenience of a video conference, they’re getting the care they need within their own communities.

In my five years at The Royal, I’ve seen the positive impact that community-focused services can make for individuals, as well as our ability to provide mental health care across our health system. Now, we are building on that foundation.

Our vision for The Royal is a hospital without walls – an organization of mental health experts working alongside other health care and so-

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cial service providers throughout the community.

Mental illness is never what defines a person. We all have or need other connections in our lives, whether they are family, friends, work, health services or social supports. Mental health care that is integrated with these things allows people to manage their illnesses within the context of their daily lives and to continue to be part of broader communities that support wellness.

The care that we offer in the community touches on many aspects of our clients lives. Staff in The Royal’s Community Mental Health Program, for example, help clients access housing, manage their finances, pursue education or work, and participate in activities that are meaningful to them.

These clients even have fun at social events and a camp organized by our team! The Community Mental Health Program also educates and provides insight to others working with these same clients.

providers. The Royal’s geriatric mental health outreach teams, for example, spend their days out in the community, meeting seniors where they live and providing consultations to care providers.

The ability to go out into people’s homes, whether that’s their long-term care home, private home, or retirement home, lets doctors, nurses and other clinicians do a much more ho-

MAKING MENTAL HEALTH CARE MORE ACCESSIBLE DOESN’T ALWAYS MEAN BUILDING BIGGER HOSPITALS. While inpatient care will always be an important and necessary part of the mental health system, a system of integrated community care helps reduce the strain on hospitals, in particular emergency rooms, by helping people get and stay healthy closer to home – closer to family, friends, and other supports.

Connecting with people outside of a hospital environment can also provide helpful insight for health care

listic assessment of their health and factors that contribute to it. This deeper understanding supports personalized patient and family-centred care, helping us determine next steps and establish a care plan that truly fits the patient.

Working directly with other community carers also provides the opportunity for education and collaborative problem solving. The day-to-day expertise exchanged between health

care partners increases the quality of and capacity for care across our mental health system.

The Royal’s telemedicine clinics exemplify this. Working in partnership with community health services in Ottawa and throughout the region, our clinicians provide virtual consultations to help establish the best care for people with mental health issues.

This may mean clarifying a diagnosis, making medication recommendations, or sharing information about other appropriate services. This benefits the individual patient, but it also helps build the referring physician’s ability to care for patients with similar concerns in the future.

Making mental health care more accessible doesn’t always mean building bigger hospitals. It also means looking beyond the hospital to help more people where they live, work and access other health services. It’s about our team working together with other community resources – sometimes leading, sometimes supporting, but always collaborating. This is how we all H get better. ■

Joanne Bezzubetz is President and CEO of The Royal.

40 HOSPITAL NEWS MARCH 2019

www.hospitalnews.com

EVIDENCE MATTERS

Sensory Rooms:

A treat for the senses and a treatment for dementia?

By Dr. Brit Cooper-Jones any of us have been affected by dementia, either directly or indirectly. When a loved one is diagnosed with dementia – a general term that refers to the progressive impairment of various mental functions – it can be devastating. While the condition currently affects 46.8 million people worldwide, this number is only expected to increase as people continue to live longer, and it is projected to affect 74.7 million people by 2030.

In addition to impaired memory, patients with dementia may experience a range of other symptoms, such as difficulties with reasoning and judgment, speaking or writing coherently, recognizing familiar surroundings, planning and carrying out complex or multi-step tasks, caring for themselves, and/or managing their mood and behaviour.

Alzheimer disease is the most common cause of dementia, accounting for about 60 to 80 per cent of cases.

However, other potential causes of dementia include a range of degenerative diseases and/or vascular (blood vessel) diseases. These can independently lead to dementia, or they may co-exist with Alzheimer disease as a person gets older and contribute to worsening symptoms.

Medications are available for treating dementia. However, while these have been shown to produce moderate benefits in the short term, they have also been associated with safety concerns. As a result, there has been interest in further exploring non-pharmacological treatment options (alternatives to medications) for patients with dementia.

One potential non-pharmacological treatment option is the use of a room equipped with a variety of sensory stimulation equipment, sometimes called Snoezelen therapy. In these rooms, patients’ senses of sound, sight, smell, and touch are stimulated using an array of equipment – for example,

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fibre optic lighting, aroma diffusers, projectors that generate changing colours and patterns, and water beds that gently vibrate and play music. Each form of sensory stimulation can be used independently, or in combination with other modalities, depending on what is most suited to each individual patient.

It has been suggested that Snoezelen therapy may be used to treat many conditions such as patients with learning disabilities, mental health challenges, autism, brain injuries, and more. Snoezelen therapy has also been explored as a potential therapeutic modality for elderly patients with dementia.

An interesting feature of Snoezelen therapy is that it can be used for different purposes depending upon a patient’s needs. For example, it can be used to calm a patient who is experiencing dementia-related agitation or behavioural disturbances (it has been suggested that sensory stimulation can improve mood and reduce behavioural problems). On the flip side, a sensory room may be used to provide a greater degree of stimulation and engagement with the world to a patient who is lacking such multi-sensory stimulation in their day-to-day life.

However, despite all of the proposed benefits of sensory rooms for patients with dementia, there remain key questions: Do they really work? Is there research out there to support their use?

Are they a cost-effective use of health care dollars? Is there any guidance regarding how best to use them, and for which patients they might be most useful?

To help guide decisions about sensory rooms such as the Snoezelen environment, decision-makers and the health care community turned to CADTH – an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures – to find out what the evidence says.

A recent CADTH review of sensory rooms for patients with dementia in long-term care identified two systematic reviews, three randomized controlled studies, four non-randomized studies, and two evidence-based guidelines on this topic. CADTH’s review found that although sensory room therapy seems to improve symptoms of dementia, at least in the short term, it is unclear if these improvements are significantly different than those that can be achieved with other sensory therapies – including garden visits, massage, aromatherapy, individualized music therapy, animal-assisted therapy, toy therapy, and exercise therapy. Additionally, these therapies may be less expensive to implement than sensory rooms, which can cost from $10,000 to $30,000 or more depending on the

complexity and quantity of equipment used.

CADTH also identified two evidence-based guidelines that recommend non-pharmacological treatments for dementia and include multi-sensory stimulation as a potential option. However, more research is still needed to further evaluate the benefits of sensory rooms in comparison to other similar treatment options in order to determine their most appropriate place in therapy.

To view CADTH’s full report, see: https://www.cadth.ca/sites/default/ files/pdf/RC0999%20Sensory%20 Rooms%20Final.pdf And if you would like to learn more about CADTH, visit cadth.ca, follow us on Twitter @CADTH_ACMTS, or speak to a Liaison Officer in your H region: cadth.ca/Liaison-Officers. ■

Dr. Brit Cooper-Jones MD is a Knowledge Mobilization Officer at CADTH. www.hospitalnews.com

MARCH 2019 HOSPITAL NEWS 41

Canada’s

new Food Guide and menu planning in long-term care

By Dale Mayerson and Karen Thompson he newly revised Canada’s Food Guide (the Guide) was released on January 22, 2019. Dietitians of Canada’s CEO, Nathalie Savoie commended Health Canada on the meticulous revision process and describes the 2019 Canada’s Food Guide as relevant, modern and evidence based.

This newest version of Canada’s Food Guide encourages healthy eating habits, and includes an education poster that summarizes the guide’s main principles. The poster shows a plateful of food, divided neatly into sections. One half of the plate is filled with vegetables and fruits, one quarter is whole grain food and one quarter shows assorted protein foods.

The new guide is easy to understand with messaging that states: • Eat a variety of healthy food each day • Have plenty of fruits and vegetables • Eat protein foods • Choose whole grain foods • Make water your drink of choice The focus of the Guide has changed over the years. In 1942 the first Canada’s Food Rules were focused more on

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42 HOSPITAL NEWS MARCH 2019

the prevention of malnutrition, and suggested foods that would be available to most Canadians. The focus and recommendations have changed, with more recent guides being quite specific and prescriptive, indicating the number and sizes of portions from each food group that should be eaten.

The latest guide is a dynamic tool that directs people to whole foods and does not recommend specific serving sizes. It emphasizes proportions instead of portions. It does shift the focus from meat to plant based protein sources and discourages eating processed or prepared foods and beverages on a regular basis to avoid consuming too much added sugar, sodium and saturated fat. As well, the guide includes advice on how to eat. This includes how we purchase and prepare foods.

There has been a shift over the past years towards eating more meals away from home, spending less time cooking, and eating too many processed, packaged foods. For the first time, the Guide is advising people to be mindful of eating habits, to cook more often, to enjoy food, eat meals with others and to use food labels.

The new Dietary guidelines acknowledge the additional guidance needed by individuals with specific dietary requirements, including those receiving care in a clinical setting, and steering these individuals to get specialized advice from a Registered Dietitian.

HOW THE NEW GUIDE CAN BE USED FOR MENU PLANNING Menu planning in long-term care (LTC) is an ongoing challenge. There is little doubt that what we eat influences our health and we need to consider this evidence in planning LTC menus both for residents with special needs and for the LTC population at large. Canada’s Food Guide continues to provide guidelines to develop healthy menus. In LTC, these guidelines need to be considered in conjunction with what residents are able and willing to eat. Conversations with residents, as well as audits, resident council meetings, meal time surveys and taste testing all provide information that allows planners to work towards providing foods that residents

can manage and enjoy. This balance is most important in the LTC setting because quality of life is considered a primary goal for residents and this may in some instances not consistently correspond with optimal eating. Guidelines to support changes to the menu planning process are beneficial at a home or institution level and there may be benefit in developing industry wide standards and /or updating provincial regulations.

HOW WILL THE GUIDE’S RECOMMENDATIONS AFFECT LTC MENUS? 1. Nutritious foods are the foundation for healthy eating Vegetables, fruits, whole grains and protein foods should be consumed regularly Currently LTC menus include serving sizes and number of servings based on the 2007 Canada’s Food Guide requirements for a male, 51 plus years of age. This includes seven servings of vegetables and fruits, seven servings of grain products, three servings of meat and alternates and three servings of milk and www.hospitalnews.com

LONG-TERM CARE NEWS

alternatives. Current mealtime patterns in LTC are similar to the new Guide’s recommended plate, but the variety of choices offered could be improved.

Protein foods include legumes, nuts, seeds, tofu, fortified soy beverage, fish, shellfish, eggs, poultry, lean red meat, lower fat milk or yogurt and cheeses lower in fat and sodium Current LTC menus offer these choices. The proportion of meat vs plant based protein choices offered will be a topic for discussion with residents going forward.

Foods that contain mostly unsaturated fat should replace foods that contain mostly saturated fat As part of the menu development process, the nutrition profile of all food

THE OBJECTIVES OF THE GUIDELINES ARE TO PROMOTE HEALTHY EATING AND OVERALL NUTRITIONAL WELL-BEING items and recipes should be assessed to determine appropriateness to include on a LTC menu. This would include at a minimum, a review of fats and oils used in food preparation and service.

The recommended limit is less than 10 per cent of total energy intake from saturated fat.

Water should be the beverage of choice Water is currently offered at meal times and between meals. Milk and juice are also offered in most LTC homes.

2. Processed or prepared foods and beverages that contribute to excess sodium, (free) sugars or saturated fat undermine healthy eating and should not be consumed regularly

As part of the menu development process, the nutrition profile of all food items and recipes should be assessed to determine appropriateness to include on a LTC menu. This would include a review of the menu and how it complies with recommended limits of: • Sodium – less than 2300 mg per day • Free sugars – less than 10% of total energy intake • Saturated Fat – less than 10% of total energy intake 3. Food Skills are needed to navigate the complex food environment and support healthy eating While food skills are not necessarily required by LTC residents, it is important to note that LTC residents for the

most part do eat with others at meals and it is important that staff work to make this as meaningful an experience as possible for each resident. In addition, cultural food practices should be celebrated in LTC homes as it can benefit many residents.

The objectives of the guidelines are to promote healthy eating and overall nutritional well-being and to support improvements to the Canadian food environment. Remember, it is the overall pattern of our diet that matters when it comes to health.

The new Canada’s Food Guide will be used as a resource for menu planning and food procurement that will result in positive changes for LTC residents.

Health Canada is planning to release more on Canada’s Food Guide later in the year. Stay tuned for more information as it becomes H available. ■

Dale Mayerson, B Sc, RD, CDE, and Karen Thompson, B A Sc, RD are Registered Dietitians with extensive experience in Long-term care. They are co-authors of “Menu Planning in Long Term Care and Retirement Homes: A Comprehensive Guide” and have participated for many years on the Ontario Long Term Care Action Group, an advocacy group of Dietitians in Canada.t

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LONG-TERM CARE NEWS

Antipsychotic medications in long-term care

By Daniela J. Acosta and Sara Owusu-Sarfo he Canadian Institute of Health Information (2016) reports that, in 2014, 39 per cent of longterm care residents were prescribed at least one antipsychotic order. This is alarming because antipsychotics may be only partially effective compared to the placebo in treating delirium and behavioral and psychological behaviors in dementia (BPSD). In addition, their adverse effects, which includes increased risk of mortality, may limit their effectiveness. Best practice recommends that residents on antipsychotic medications should be assessed closely for adverse reactions and effects on targeted symptoms of treatment; findings should be documented clearly.

Although our long-term care fa-

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cility, The Perley and Rideau Veterans’ Health Centre had made some gain in reducing inappropriate use of antipsychotics (17.5 per cent) of residents were receiving at least one antipsychotic in August 2017, we had no active policy or process outlining requirements or standardization of how antipsychotic medication must be administered and documented in geriatric residents.

One-on-one interviews with six regular staff nurses and two in-house physicians indicated that a new antipsychotic medication order would likely prompt documentation of resident behavior every shift for about one week, but there were notable variances in process. Twelve month retrospective chart audits on two units indicated,

based on three shift rotations charting for one week, only 56 per cent of expected documentation notes were actually written.

Monitoring and documentation is mandated when the resident is experiencing a new antipsychotic order, a change in a previous order, has ongoing treatment or is newly admitted with an antipsychotic order. Of these, only 48 per cent contained sufficient evidence that an assessment of targeted behaviors were conducted and only 19 per cent for adverse effects.

Both interviewed physicians reported that nursing documentation did influence their prescribing decisions. These practice knowledge deficiencies were alarming and troubling since lack of effective documentation increases the

occurrence of faulty decision making about the wellbeing of residents and the benefits of the antipsychotic medications on the residents.

This quality improvement project aimed to improve the monitoring and documentation of residents receiving antipsychotic medications in a longterm care environment. This project was led by a front-line Registered Nurse and supported by our Delirium, Dementia and Depression Quality Improvement Team, an inter-professional group that had been tasked to implement best practice recommendations outlined in the Registered Nurses Association of Ontario’s guideline “Delirium, Dementia and Depression in Older Adults: Assessment and Care” to the long term care sector of our

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LONG-TERM CARE NEWS

campus. Since structured nursing led medication assessments are thought to improve resident health outcomes, our team opted to develop and implement a documentation tool that would support and standardize comprehensive nursing assessments and documentation of the targeted and adverse effects of antipsychotic use on long term care residents. Implementation was focused on two specialized, veteran, dementia units with higher frequencies of antipsychotic med use compared to the rest of the facility (43.2 and 12.5 per cent of residents on each unit, respectively, was on at least one antipsychotic medication in August 2017).

The timeframe for the project was from September 2017 to February 2018. We used Plan-Do-Study-Act learning small cycles of change to create and implement a documentation tool which was built directly into our point-of-care electronic health re-

cords. Our implementation strategy included multiple components such as just-in-time 30 minute informal education sessions at the bedside, leadership support, pharmacy involvement, audit and feedback, reminders, as well as the availability of reference and resource materials. We designed the intervention to include multiple strategies since multifactorial interventions have been shown to be more effective for practice change than a single strategy. The team also focused on building interventions that were higher on the hierarchy of effectiveness rather than focusing on educational tactics alone.

Use of the tool demonstrated positive feedback from staff regarding usage, workflow management, and standardized nursing practice. Once fully implemented, repeat chart audits showed an increase in expected documentation from 56 to 86 per cent and an increase in the focus on adverse reactions and

Nurse Champions supporting colleague in completing the newly implemented electronic documentation tool and ongoing monitoring process related to antipsychotic medication use in elderly residents in long term care. effects on the resident’s targeted symptoms from 19 and 48 per cent respectively, to 100 per cent for both in a five month period. Implementation, audit

and feedback is ongoing. The team hopes that leveraging this tool will support decision making in appropriate use H of antipsychotic medications. ■

This article was submitted by Daniela J. Acosta, RN, GNC(C), BSc, BScN, Jennifer Plant, MSc, BHS, RRT; Mary Boutette BSc, MHA; and Sara Owusu-Sarfo RN, BScN, MScN of The Perley and Rideau Veterans’ Health Centre.

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LONG-TERM CARE NEWS

Better community partnerships

enhance the patient experience for seniors

By Lisa Cipriano carborough’s getting older and wiser. With an expected growth of 46 per cent by 2028 among Scarborough residents over age 65, care for our community, in our community, is more important now than ever before.

The Scarborough Emergency Department/Long-Term Care (LTC) Transitions Working Group hosted a recent conference at Scarborough Health Network (SHN), gathering the best minds in our community to share ideas and proven concepts for addressing the health needs of this population.

Formed to improve the health experience of LTC and retirement home residents, their families, and care providers in Scarborough, the working group is made up of community and health system partners.

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• Palliative support needs • Dementia care • Respite • Wound care

46 HOSPITAL NEWS MARCH 2019

www.vha.ca 1.888.314.6622

LHIN, and community service providers from across Scarborough, the conference challenged participants to explore: • Providing a seamless experience for patients transitioning between hospitals, LTC centres and retirement homes by strengthening relationships between institutions; • Helping people who are living in LTC and retirement homes to avoid ED visits; and • Giving people who are living in LTC and rettirement homes safe and timely medical care at home.

In addition, the Ontario Telemedicine Network (OTN), Revera Living, Toronto Paramedics, Yee Hong Centre for Geriatric Care, and Niagara Health Services shared worthwhile insights and key learnings from their organizations.

“We are all here to work together to improve the experience of residents, patients, families, and all the health care providers. We want everyone to feel confident in the health care system,” says Ivan Ip, Executive Director, McNicoll Centre, Yee Hong Centre for Geriatric Care.

Hands-on breakout sessions encouraged participants to identify improvement opportunities by using Lean methodology to map and examine patient journeys from LTC/retirement homes to the hospital and back again.

“Each of us came to the table with common goals: comprehensive com-

munication and better collaboration between patients, health professionals, and community partners,” says Shohreh Mahdavi, a manager within SHN’s Medicine program.

“We shared best practices and explored innovative ideas for improvement. We want the transition between LTC and retirement homes and the hospital to be seamless.”

NEW TOOL OFFERS CLARITY ON FOLLOW-UP CARE FOR RESIDENTS OF LONG-TERM CARE/ RETIREMENT HOMES At the conference, Shohreh discussed how SHN’s Medicine program is witnessing positive results from a pilot project with Fieldstone Commons Care Community and the Central East LHIN’s Nurse Practitioners Supporting Teams Averting Transfers (NPSTAT) program.

“The LHIN encourages relationships between partners, in building an integrated health system. NPSTAT encourages the development of interprofessional relationships between LTC homes and the hospital,” says Shannon Poyntz, Nurse Practitioner with NPSTAT. Working together with NPSTAT, the hospital and LTC home are working to develop better communication and collaboration between care providers. A shining example of this work www.hospitalnews.com

LONG-TERM CARE NEWS ED/LTC Transfer Information Initiative 100% % Of Requested Fields Completed

is the new standardized documentation tool used to assist with the transfer of information between the hospital and Fieldstone Commons.

This new tool is the result of a survey of 22 LTC homes in Scarborough and all three SHN hospitals. Of those who responded to the survey, 100 per cent of LTC home directors of care, physicians, and nurse practitioners, and 90 per cent of hospital physicians agreed standardized documentation would be useful.

The standardized documentation tool has resulted in increased patient health information being shared at the outset, enabling care providers to better understand a patient’s condition upon arrival to the hospital; treat patients more quickly and efficiently; and communicate to patients, family members, and the LTC home more clearly about a patient’s health condition and follow-up care plan.

They were right. The new tool has resulted in clarity for residents and

90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Baseline

Post Implementation

41% increas in requested information being received from the LTC home by the Emergency department families about what’s happening with their health and follow-up care, and has reduced hospital length-of-stay and unnecessary readmissions for patients.

“The project has made a significant impact in our hospital transfers.

The issue of gaps in information between the hospitals and LTC homes has required improvement for years,” says Rodolfo Ramon, Interim Director of Care, Fieldstone Commons.

“Designing the pilot project with SHN was a great learning experi-

ence; it helped us put ourselves in their shoes and vice-versa. The pilot project ensured that both parties had more than enough information to provide the best care possible for LTC residents. I would strongly encourage other LTC homes to do the same.”

According to Shannon, next steps include building initiatives to help LTC homes access hospital staff in order to facilitate transitions between sites. In addition, the standardized documentation tool will be rolled out broadly to support care transitions between all three SHN hospitals and Scarborough’s LTC and retirement homes.

Though the conference is over, the collaborative work to enhance outcomes for LTC and retirement residents continues, with the Scarborough ED/LTC Transitions Working Group looking to spread this type of cross-sector partnership to other local H issues. ■

Lisa Cipriano is a Communications Officer, Scarborough Health Network.

www.hospitalnews.com

MARCH 2019 HOSPITAL NEWS 47

LONG-TERM CARE NEWS

Aging out: Improving the culture of long-term care for LGBTQ seniors

By Rebecca Ihilchik icture this: you’re a personal support worker at a long-term care home. One of the residents, an elderly man with dementia, begins to show romantic affection for his male roommate, who is married to a woman. It dawns on you the resident has been closeted until now – but his actions are making both the roommate and his wife uncomfortable. What do you do?

That’s the type of scenario Rabbi Sara Paasche-Orlow might use in a training session. The director of spiritual care at Hebrew SeniorLife in Boston, Massachusetts, Paasche-Orlow spearheads an initiative called Aging Out, which focuses on disseminating best practices in LGBTQ aging, health, and dementia care.

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present in the world, they suddenly become much more vulnerable,” Paasche-Orlow says. “It’s across the board no matter who you are, but particularly for LGBTQ seniors because of social stigma.”

For example, LGBTQ seniors who have been closeted their entire lives might only come out or express the desire to transition once dementia sets in – and they’ll likely need vital emotional support when they do.

LGBTQ individuals are also more susceptible to discrimination in the care they receive because of cultural or religious beliefs held by frontline staff.

The bias can be unintentional, says Paasche-Orlow, but still prevalent.

“There’s a really strong argument to say this kind of support is an impera-

LGBTQ SENIORS WHO HAVE BEEN CLOSETED THEIR ENTIRE LIVES MIGHT ONLY COME OUT OR EXPRESS THE DESIRE TO TRANSITION ONCE DEMENTIA SETS IN Through specialized training for point-of-care, spiritual care, and other staff, the project aims to change the culture of care in long-term care settings to make sure LGBTQ seniors, especially those living with dementia, are supported appropriately.

With funding from the Baycrest-led Centre for Aging + Brain Health Innovation (CABHI), Paasche-Orlow is bringing that expertise to Baycrest and other long-term care facilities.

“As people with dementia are no longer able to control how they

tive right now in terms of equal access to healthcare for LGBTQ individuals,” she says.

SPREADING THE CONVERSATION, WITH A DEMENTIA LENS The Aging Out collaboration with Baycrest began in early 2018 with training sessions for spiritual care staff about safety, sensitivity, confidentiality, and other issues specific to LGBTQ individuals with dementia. Similar educational workshops will be held

Rabbi Sara Paasche-Orlow spearheads an initiative called Aging Out, which focuses on disseminating best practices in LGBTQ aging, health, and dementia care. for other staff, including point-of-care workers and management.

“I hope that seniors here at Baycrest will feel safe and able to freely express themselves in the completeness of their identity, which includes their gender identity,” says Rabbi Geoffrey Haber, director of spiritual care at Baycrest. He is also hopeful the initiative encourages LGBTQ staff to feel safe and welcomed.

The project team is also developing an e-learning module, which will help disseminate the Aging Out education model to even more Baycrest staff as well as other long-term care facilities.

Paasche-Orlow says the virtual education component will be practically implemented by reviewing current practices alongside Baycrest staff with fresh eyes, to ensure a safe and welcoming space for LGBTQ residents.

“My hope is that through this process, we open some new ideas and frontiers that spread the conversation more widely,” she says.

Aging Out is supported by CABHI’s Spark Program, which funds the development and testing of promising early-stage innovations in seniors’ care by point-of-care staff. In addition to financial backing, CABHI offers innovators acceleration services like business development and knowledge mobilization support.

“I really appreciate the dialogue and discourse with CABHI. When you have a strong thought partner, it moves your own thinking ahead,” Passche-Orlow says. “CABHI motivated us to look more critically and intentionally at dementia care in this area.”

She’s looking forward to seeing the positive impact the project will have at both an institutional and individual level.

“This project is about helping people lead lives that are affirming of difference,” says Paasche-Orlow. “We have to do it in ways that allow the LGBTQ person to feel heard, seen, and part of the community – in ways that allow H them to honestly be themselves.” ■

Rebecca Ihilchik is the Marketing & Communications Specialist at the Centre for Aging + Brain Health Innovation (CABHI).

48 HOSPITAL NEWS MARCH 2019

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St. Joe’s 1st Knee Surgery with Dr. Anthony Adili.

Canadian first: Robotics enter the world of orthopedic surgery

By Maria Hayes t was agile, confident strides that led Peter Sporta into the fracture clinic exam room at St. Joseph’s Healthcare Hamilton. The 66 year old Oakville resident showed no signs of having a partial knee replacement only 32 days earlier.

“It’s incredible! To think I was in such pain for two years,” says Sporta, “and within three days of the surgery I was walking without a cane or crutches.”

I

His satisfaction is an important marker for his surgical team.

The truth is one in five orthopedic patients are unhappy with their knee surgery.

“The complaint we hear is ‘it doesn’t feel like my knee,’” says Dr. Anthony Adili, Orthopedic Surgeon and Chief of Surgery at St. Joseph’s.

Adili and his team hope to change that statistic, by using the

MAKO Robotic System for orthopedic surgeries. St. Joe’s in Hamilton has already embraced the world of robotics, using the da Vinci system for thoracic and prostate surgeries for more than a decade. Now it is the first hospital in Canada to add robotics to its joint replacement practice. The two million dollar investment was made from philanthropic donations to St. Joseph’s Healthcare Foundation.

The device is a robotic arm that is guided by the surgeon. The significant advantage it provides happens in two stages: first in preparation, it allows the surgeon to plan the exact location and measurements of the knee implant on a computer in 3D. The second advantage is in execution, the MAKO prevents the surgeon from unintentionally cutting beyond the parametres created in the plan, significantly enhancing the precision of the surgery.

Continued on page 54

Maria Hayes works in communications at St. Joseph’s Healthcare Hamilton.

50 HOSPITAL NEWS MARCH 2019

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DOCTORS WITHOUT BORDERS

(above and opposite page) The hospital in Sununi, Iraq

Treating chronic diseases in post-conflict Iraq

By Dr. Stefanie Falz spent three months last fall working for Doctors Without Borders/ MÊdecins Sans Frontières (MSF) in Iraq, in the small town of Sinuni, near Mount Sinjar. The area is home to the Yazidis, an ethnic and religious minority group which had endured unimaginable atrocities when ISIS overran northern Iraq in 2014. Many of the women had been taken as slaves and many people had been killed. Mass graves were still being uncovered in the area. MSF had recently rehabilitated and reopened the hospital in Sinuni, and I was the expatriate emergency room doctor, supervising and training the national staff physicians. Similar to rural hospitals everywhere in the world, it was hard to attract doctors who were willing to work in this far flung outpost.

I

52 HOSPITAL NEWS MARCH 2019

THE BEST PART OF MY ASSIGNMENT WAS WORKING WITH THE NATIONAL STAFF. EVERYONE, FROM DOCTORS AND NURSES TO TRANSLATORS AND CLEANERS, WAS ENTHUSIASTIC AND HARDWORKING. The senior doctors wanted well paid jobs in the city, and many were concerned about security. As a result, our staff were quite junior. But what they lacked in experience they made up for with enthusiasm and a desire to learn.

One morning I was called about a pregnant 16 year old girl who was brought to the ER seizing. When I arrived, there were a lot of people in the resuscitation room and a lot of confusion. She was no longer seizing but her oxygen saturation remained low.

Listening to her lungs I was concerned that she had aspirated during the seizure. Then there was the pregnancy.

Could this be preeclampsia? Our gynaecologist quickly confirmed by ultrasound that she was only 14 weeks pregnant, which made preeclampsia unlikely. What then had caused her seizure? Unfortunately, we had run out of the cartridges for the machine which would have given us electrolytes and renal function. Blood sugar was normal. She had no fever. X-rays

could only be done at a private clinic down the street, and she was not stable enough to go there. With bedside ultrasound we were able to confirm lung infiltrates suspicious for aspiration pneumonia, but still had no cause for the seizure.

We decided to transfer the young woman to Mosul for a head CT and labs. Ambulance transfers were often complicated. Patients frequently refused to go to Mosul because they did not feel safe there, and our Kurdish speaking patients could not communicate with the Arab doctors. The roads, which had been badly damaged in the fight against ISIS two years before, were impassable in the rain. Bridges had been blown up and dry riverbeds became mud torrents during rain storms. Then there were the checkpoints. Even though we were only 130 www.hospitalnews.com

DOCTORS WITHOUT BORDERS km from Mosul, there were at least ten checkpoints, each run by a different army faction or militia. It could take three hours or more to get to Mosul.

The city had been badly damaged during the ISIS occupation and subsequent battle for liberation. Some of the hospitals had been destroyed and health care infrastructure was lacking.

Finally, the patient and her husband left in the ambulance. However, along the way it started raining and the road was blocked. Meanwhile, the battery of the portable oxygen concentrator in the ambulance was running low. We decided to bring her back to Sinuni and treat her as best as we could. I tried to get more information to figure out what had caused her seizure. Upon further questioning, it turned out that the young couple was living in a tent on Mount Sinjar, like many other internally displaced people in the area. It was the end of November and it was getting very cold on the mountain.

They had been running a generator inside their tent to stay warm. Her

husband had been feeling unwell too, and had complained of a headache and nausea, when the woman had the seizure. Aha: Carbon monoxide poisoning! We treated her with high flow oxygen, and antibiotics for the aspiration pneumonia. It continued to rain for the next two days and she stayed in the

ER observation room. She made rapid improvements and had no further seizures. She was discharged home a few days later. When I saw her for follow up a week later she and the baby were doing well.

This was just one of many memorable patients we treated in our small

ER. In MSF projects in Africa the main burden of disease is in young children. However, in middle income countries like Iraq it is mostly adults with chronic diseases like diabetes and hypertension who get sick. Because primary health care is lacking, these conditions are often poorly controlled. As a result, we saw many heart attacks, strokes, diabetic emergencies, and often fairly complex patients with multiple comorbid conditions. It was a challenge to care for these patients without advanced diagnostic tests.

Bedside ultrasound proved to be the most useful tool we had. It was also satisfying to care for patients who otherwise had no access to emergency care at all.

The best part of my assignment was working with the national staff. Everyone, from doctors and nurses to translators and cleaners, was enthusiastic and hardworking. The local people were incredibly warm and welcoming and I was sad to leave after three H months. ■

Dr. Stefanie Falz is an ER doctor in Invermere, BC

Aging + Brain Health Innovation: What’s Next Canada?

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• Learn how to build, scale-up, adopt and commercialize aging and brain health innovations in the senior’s sector.

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• This special Innovation Day is the third day of Baycrest’s 29th Annual Rotman Research Institute Conference.

A COLLABORATION WITH:

March 20, 2019 Metro Toronto Convention Centre cabhi.com/innovationday

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MARCH 2019 HOSPITAL NEWS 53

NEWS

Robotic orthopedic surgery Continued from page 50

Lynn Gauthier visits with a patient who recently suffered a stroke

Stroke survivor is here to listen

By James Scarfone ynn Gauthier suffered a stroke just a few years ago.

It was a trying experience she hopes she’ll never encounter again.

She saw an opportunity to enhance, though, to help others in need. Using her experience as a stroke survivor, Lynn volunteers in Hamilton Health Sciences’ (HHS) stroke rehabilitation unit to talk to new survivors about their experience in recovery.

Through a partnership with March of Dimes Canada, Lynn spends a couple hours every week visiting with patients who recently suffered a stroke. The program is called Peers Fostering Hope.

“I ask them about their families and where they live, really try to get to know them,” says Lynn. “We talk about the pictures on the wall or what’s on TV.” The introduction helps patients get more comfortable with Lynn and they look forward to those weekly conversations.

The Peers Fostering Hope program in Hamilton launched earlier this year.

It was modelled after the Linking Survivors with Survivors program, which began 10 years ago in the Waterloo-Wellington region.

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The goal is to enhance the patient experience while recovering from a major life event. It also helps patients feel less isolated by connecting with someone who’s been through a similar medical issue.

An increase in confidence and the knowledge of survivors re-engaging in the community are big factors in a patient’s recovery.

Volunteers can also make referrals to staff based on their observations.

Though Lynn speaks highly of her care team while she recovered from her own stroke, she wishes there was someone who could connect with her the way she’s able to connect with new stroke survivors.

“I think everyone wishes there was someone who can connect on their level after a medical event,” says Lynn.

“Someone to tell you it’s okay to have a bad day, and that you need to allow your brain time to recover. I try to help them come to those terms.”

Lynn believes her work is making a difference on the unit. Staff in the program agree.

“Engaging past persons with stroke to lend support to new persons with stroke builds our community capacity

James Scarfone is a Public Relations Specialist at Hamilton Health Sciences.

54 HOSPITAL NEWS MARCH 2019

and raises us to new standards of excellence,” says Jennifer Robinson, clinical manager for the stroke rehabilitation unit at HHS’ Regional Rehabilitation Centre at Hamilton General Hospital. “I thought this was something we should definitely make available to our patients.”

One patient, Jennifer says, envisioned his life outside the hospital for the first time.

“Having Lynn in the room helped him to see what life is like on the other side of recovery,” adds Jennifer. “I know she feels pride and satisfaction in what she’s doing for our patients. She’s a great addition to the team.”

“I am so happy I became a volunteer for stroke rehabilitation patients,” adds Lynn. “Meeting them all gives me such joy and has brought meaning to my life.

I look forward to Wednesdays.”

More than 30 volunteers like Lynn involved in Peers Fostering Hope contributed over 2,500 hours last year at 21 hospitals.

The partnership with March of Dimes Canada is also supported by the Dr. Ed & Bobby Yielding Fund, Ipsen Canada and the Central South RegionH al Stroke Network. ■

The exactness of the robotic arm is a game changer for patients like Peter.

Only part of Sporta’s knee was damaged but he was initially scheduled for a full knee replacement by traditional methods. Then his doctor offered another option. A partial knee replacement in Hamilton by Adili and a robot.

“At first I thought, oh no way,” Sporta says with a laugh. Then he did a little investigating online and was curious. He met with Adili and the Hamilton team and felt overwhelming reassurance. “They said recovery should be quicker. I’m happy with that.”

Partial knee replacements done by traditional surgery have a bad track record according to Adili.

“Partial knee replacements fail at a very early age, at a very high rate because the alignment is not good,” says Adili. “That’s why most people do total knee replacements rather than partial, because the outcomes are much more reliable.”

It’s hoped robotic surgery will change that. “This technology allows us to do a partial replacement with near exact alignment,” adds Adili, “We can leave the good the parts of the knee intact and just address the damaged part.”

Along with quicker recovery, it’s expected patient satisfaction will also improve. “By leaving as much of the patient’s normal anatomy untouched, we think they will have a more ‘normal’ feeling knee, better outcomes and better range of motion,” says Adili.

It’s certainly been the case for Peter Sporta. Although he feels what he describes as a ‘numbness’ where the implant lies beneath his skin, he is more than pleased with how strong his knee feels, and how well he can move.

“I really want to get back to playing tennis,” he adds.

“Go ahead,” says Adili, “just don’t go full out right off the bat.”

Matching Peter’s enthusiasm is the ultimate goal for Adili and the orthopedic team.

“We really want a knee, where the patient has a surgery but they don’t feel H like they’ve had a surgery.” ■ www.hospitalnews.com

NEWS

New lift boosts mobility for patients

By Amelia Schofield hysical therapy patients are enjoying the benefits of LiteGait, a new piece of equipment at Lacombe Hospital and Care Centre.

The LiteGait is a powerful patient lift device which allows physical therapists to get patients up and on their feet – in a safe and fully-supported manner – while they work together to improve their weight-bearing ability, posture and balance.

“It really provides a safe, effective environment to get people walking again – with walking and balance training,” says Patti Vaillant, a physical therapist at the hospital.

Vaillant and her team use the LiteGait with a wide variety of patients, including those who’ve experienced spinal cord injuries and stroke.

The lift raises patients from sitting in a wheelchair to a full standing position over a treadmill, which allows staff to keep patients safely and comfortably suspended on the treadmill, with control over the weight-bearing load on the joints.

Being able to increase or decrease the amount of weight through weakened or injured muscles and joints means walking and balance training can begin earlier in the rehabilitation process for patients, getting them up and mobile sooner adds Valliant.

For individuals like Jason Lunn, the equipment has had a remarkable impact on his life, and has enabled him to practice walking and perform weight-bearing exercises.

“When you’re in a chair every day, if you don’t get out of that position your bone density, your blood pressure and your circulation can be affected,” says Lunn, who suffered an injury in 2011 which left him a quadriplegic. Since then, he’s been undergoing physical therapy to work on his mobility.

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“The ability to feel an upright weight bearing sensation has been amazing. And to actually be able to do exercise – while you’re being supported to the point where you don’t have to have three people there to do it safely – feels incredible.”

According to Vaillant, the addition of the LiteGait not only benefits patients, but also healthcare providers.

“This is a really premium piece of equipment. The biggest thing is that it provides the patient the security, which protects the caregivers at the same time.”

The purchase of the LiteGait was made possible through the Lacombe Health Trust and its community of donors. Lunn, who’s also is a member of the Trust’s board of directors, joined after using many pieces of equipment the Trust has funded at the facility over the years. “They’re amazing. We wouldn’t have what we have, over and above the normal, if it weren’t for the Health Trust,” he says.

“Being born and raised here, I feel comfortable knowing that my kids and my elderly parents can be looked after in my own community, and the fact that we have top-notch equipment at our hospital is so meaningful to me.”

Funding equipment like this is about providing the best possible care in the community adds Jim Dixon Jr., board chair for Lacombe Health Trust.

“We are proud to be able to make it possible for the Lacombe Hospital and Care Centre to provide the community with better healthcare outcomes,” he says. “This new equipment will have a profound impact on patients in long-term care, people living with multiple sclerosis, and those recovering from spinal cord injuries or significant fractures.”

Vaillant and her team have seen firsthand the positive impact that community support brings to the services they provide.

Amelia Schofield is a Senior Advisor, Foundation Relations, Alberta Health Services. www.hospitalnews.com

Jason Lunn, a board member of Lacombe Health Trust as well as a patient of Lacombe Hospital and Care Centre, demonstrates the LiteGait lifting device.

“If you look around our department, there are many things that have come from the Health Trust,” she says. “They recognize the need, and they have a de-

sire, to provide the best that they can for the community. We’re really thankful as a group of therapists. All of us are H impacted by the support given to us.” ■

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