Vital Signs Summer 2019

Putting family first in the Quinte 7 Special Care Nursery

It takes a village — Q7 care providers surround new parents and their baby in the Special Care Nursery. From left: Michelle Demill, RN; Kristy Lawson, UCC; Amanda McLennan, RN; Jenn Faulkner, RN and professional practice specialist; parents Kahentiio Maracle and Jordan Lindsay-Campbell; baby Jordan (in isolette); Dr Sarah Waterston; Ceilah O’Prey, Public Health Nurse; Shawna Raymond, RN; Theresa Plane, RN.

Imagine you’ve just delivered your baby. He’s a beautiful baby boy but a little premature and he’s not quite ready to breastfeed. He needs a feeding tube and some extra time in QHC’s Special Care Nursery. Maybe this isn’t how you pictured your baby’s first days – you thought you’d both be home by now – but this is a common scenario and QHC’s Quinte 7 Maternal Child Unit staff are doing everything they can to ensure you’re a partner in the planning and care of your baby, even if you can’t be with him every minute.

The goal of QHC’s “Person- and Family-Centred Care” Best Practice Spotlight Organization Guideline is to make patients and families partners in care. The Guideline is being implemented on Quinte 7, starting with the Special Care Nursery, and then will spread to Pediatrics, followed by the Mother-Baby unit.

“Quinte 7, as a whole, really focuses on parents being involved because babies can’t speak for themselves and having someone advocating for them is really important,” explained Jennifer Faulkner, the professional practice specialist who is leading this Best Practice Guideline (BPG). “We want parents to feel they’re a part of the decision-making process. We want them to have input and not feel like we’re dictating their baby’s care.”

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Continued from page 1 — Putting family first in the Quinte 7 Special Care Nursery

Some of the tools and initiatives being implemented in the Special Care Nursery include: 

A flexible visitors’ plan that doesn’t dictate that one of the baby’s parents must be present when other visitors come to see the baby. For example, if the parents have three other children at home and they feel they need to be home with them for a stretch of time, they can give permission for another family member or friend to spend time with the baby and/or provide care in their place.

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A Family Integrated Care Checklist that helps ensure parents have the knowledge and skill needed to care for their baby while in the Special Care Nursery (e.g. understanding signs of stress or pain, being comfortable taking baby out of the isolette, taking baby’s temperature and recording it, etc.). This allows parents to be more hands-on in the care of their baby.

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Providing parents with a journal that they can fill out with information about their baby’s health and progress. They can also write questions in the journal for the pediatrician to answer in the case where busy schedules prevent a face-to-face conversation.

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Parents fill out a survey that asks about the care of their baby, communication, teamwork, emotional support from the staff, respect, satisfaction with decision making, and consistency of information received. This informs the team on what they’re doing well and areas to improve.

“The nurses have all been really great,” said Kahentiio Maracle, new mother of a baby boy named Jordan. “They’re educating us and explaining everything going on with him. I’ve been discharged and am coming back every three hours for feedings and it’s comforting to know that family members can come visit him too.”

“Person- and family-centred care is so important in health care and it feels like a given,” said Jennifer. “But if you step back and look, you see so many opportunities for improvement. The Maternal Child Program is all about families so it was really natural to bring this Best Practice Guideline to our department.”

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When every minute counts during a Code Stroke, we find ways to go faster!

Time is brain. The speed in which a stroke patient receives clot-busting tPA (aka the door-to-needle time) undoubtedly impacts their future quality of life. Upon ambulance arrival to hospital, the goal is to get the patient assessed by the physician and down for a CT scan as quickly as possible to determine whether they are a candidate for tPA (only 1 in 5 patients qualify, as it depends on the type of stroke).

At QHC, we do this well, but there’s room for improvement. During a two-day Kaizen event in July, a large group of highly-engaged QHC staff, physicians and community partners explored how we can make small changes to improve door-to-needle times.

“Belleville General Hospital is a Telestroke site, meaning we don’t have a neurologist on site so we connect to one via video conference,” explained Derk Damron, District Stroke Coordinator. “Since we already have a good process for this, we just need a few tweaks to shave 12-15 minutes off to reach our goal of a 30-minute median door-to-needle time.”

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Participants of the Code Stroke Kaizen event in July do a mock Code Stroke that incorporates the process changes they plan to implement to improve the median door-to-needle time.

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#4MyTeam

#TakeOwnership A life saved – “When I was taken to Belleville General Hospital Emergency Department last April with a swollen leg, Dr. LeClerc sent me for an X‐ray for my knee. As I had been coughing, he also sent me for a chest X‐ray. They found two small nodules in my le lung. Dr. Leclerc referred me for a CT Scan and to a lung doctor in Kingston. He even followed up with a personal phone call to me. I have since received Radia on Therapy and I’m on the mend. I want to recognize this great doctor for his thoroughness and caring. Dr. LeClerc saved my life. Thank you forever and always to a doctor who cares so much for his pa ents.” – Joan Minnis

#RespectEvveryone A touching gesture – “I work in thee Transcrip on Department at Quinte Health Care, and was blown n away when listening to Dr. Raistlin Majere dictate on a pa entt’s passing. He men oned that he led the team in a moment of silence, no ng that the pa ent was someone’s mother, daughter, and aalso a fellow ci zen of our community. I was so touched by th his simple, but extremely profound gesture. He also thanks us, the Transcrip onists, at the end of ALL of his dicta ons. He’s an extremely th hough ul and kind person. It is a privilege to have him as a colleaguee and care provider at QHC. He truly stands out in the crowd.” – Krristy Kno , Transcrip on

#WeAllHelpProvideCare A tremendous help – “Volunteer Cheryl Hosking knew from the previous week that we were busy and did not have full clerical coverage in the ICU this weekend. She came in on Saturday (her day off) to help answer the family phone calls and direct traffic for two hours. This was a tremendous help to the ICU staff and we were all very grateful to her. She helped make a busy day a li le more manageable. Thanks Cheryl!” – Emma Holmes, RN, ICU

(Pictured from le : Emma Holmes, RN and Cheryl Hosking, volunteer)

Feeling blessed at BGH – “I went to Belleville General Hospital for the first me (pre‐op and then day surgery) and wanted to share my experience. I’ve been to a number of hospitals in Ontario during my 65 years on this earth and all have been great but I must say that my experience in Belleville surpassed all of my other experiences. The hospital was incredibly well maintained and excep onally clean. The staff that I encountered in pre‐op, day surgery and post‐op were the absolute best – everyone was pleasant, cheerful, helpful and comfor ng. I cannot say enough good things about my experience. So many mes I hear people complain about our health care system when all I feel is blessed that I live in this great country and that I have access to these facili es when needed. Thank you to the staff that saw to my every need – your comfort and support will never be forgo en.”

– Trudy Wheeler

#ImagineItsYou

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Who inspires you? Anyone can share in celebra ng our teams – staff, pa ents, physicians and volunteers. Contact C Carly Baxter at ext. 2677, cbaxter@qhc.on.ca.

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QHC surgeons „Cut the Count‟ to help with opioid crisis Maybe it starts with a prescription of Tylenol 3 to help you through a back injury, or perhaps it’s a prescription of Hydromorphone after surgery. Opioid addiction is a growing problem in North America and can begin with something as simple as a prescription of pills meant to help you cope with acute pain.

Prescribing opioids to manage pain is a common practice across North America. Canadians are the second largest per-capita users of prescription opioids after the U.S. Sadly, every day in Canada, an average 11 people die of opioid overdose.

Ontario’s surgical community recognizes the important role surgeons can play in reducing opioid-related harms. If patients are prescribed more pills than they need at discharge, they may end up taking many or all of them and developing a dependency. Or, if they don’t take all the pills prescribed to them—which studies show is often the case—this can add to the supply of opioids in the public domain that may be used inappropriately.

QHC is part of Health Quality Ontario’s ‘Cut the Count’ campaign to reduce the number of opioid pills we prescribe to surgical patients at discharge. The goal of the 47 hospitals involved in the campaign is to reduce the number of opioids prescribed after surgery by 30% from April 2019 to March 2020.

Quinte Health Care is off to an amazing start! So far, four surgical divisions at Belleville General Hospital (General Surgery, Orthopedics, Gynecology and Urology) have made changes to their standard post-surgical prescriptions for many procedures and have reduced their narcotic prescriptions by 36%!

This was achieved by:  Educating health care providers – including surgeons, who often prescribe more opioids than their patients actually need. 

Surgical divisions looked at what surgeons currently prescribe and came to a consensus on a new, multimodal post-operative prescription that includes more acetaminophen and Ibuprofen and smaller prescriptions of opioids, only to be filled if required.

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Prescribing split prescriptions of opioids that only permit the patient to pick up a small number of pills from the pharmacy at a time. Then returning for more, if necessary.

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Anesthetists have altered the narcotics given to the patient during surgery to help decrease the pain patients are in afterwards. 

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Educating patients about the dangers of opioids and helping them understand that some pain after surgery is normal. Zero pain isn’t the goal – tolerable pain that allows patients to

complete daily activities is the goal. This education is happening with all surgical patients at BGH and TMH. 

Encouraging patients to return unused opioids to the pharmacy so they’re not sitting in medicine cabinets or making their way to the streets.

“The surgeons have been very keen to participate,” said Kristina Cruess, QHC’s Program Director of Surgery. “The opioid crisis cannot be ignored. QHC’s surgeons are taking an active role in reducing the number of opioids available in our communities. I am very proud that the Surgical Program supported this initiative as one of our 19/20 goals.”

Studies have shown that when reducing the opioids prescribed post-surgery, patients are just as satisfied with their pain control.

And with the increased education about the potential hazards of opioids, patients are less likely to fill their opioid prescriptions.

When they do fill their opioid prescriptions, patients take fewer pills.

“Congratulations to the surgical team on making strides with this excellent initiative to reduce the number of opioids available in the community,” said Jeff Hohenkerk, QHC Vice President. “This is definitely a success story!”

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Code Stroke

One simple but impactful change is being implemented by Paramedics.

After their initial call to the hospital to inform that a stroke patient is on the way, they will call back again when they are 10 minutes away from the hospital so an overhead page can go out, letting the stroke team know to take their places. The paramedic will give the patient’s health card number during the call so patient registration can begin and the physician can review the patient’s medical history in advance.

New, dedicated phone lines in the rooms where stroke patients are assessed will expedite discussions with Telestroke, leading to speedier decisions on tPA. Once the decision has been made, the nurse can start mixing tPA even while the physician is still in discussion with Telestroke.

“The team learned that a lot of processes can be done in parallel,” said James Russell, Director of Process Improvement. “The more time we can save upfront, the more time we have for the tPA decision.”

Role clarity was also established for physicians and nurses, helping to ease frustration that can occur between Emergency and ICU. “We had amazing representation from every group,” said Derk.

“Everyone was really positive and had the clear focus of improving to be able to meet our door-to-needle goal.

Even a small improvement can mean so much to our patients’ lives.”

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BGH staff who donated to the “I‟m in” campaign are making care better for patients through the Patient Experience Fund By embracing the QHC values, staff who support the Belleville General Hospital Foundation “I’m in” campaign are defining how we go about doing business each and every day. Whether it’s always striving to improve, taking ownership or imagining it’s you, staff are going the extra mile to provide exceptional care.

In 2018, $8,235 from staff giving was directed to the Patient Experience Fund!

The Patient Experience Fund committee is happy to announce that nine pieces of minor equipment have been approved for funding and will make a major impact for our patients and their families.

We are thrilled to provide funding for the following departments:     

Q5 Medicine will purchase a Lumax Medical Recliner Chair and a Rehab Shower Commode Chair Nuclear Medicine will purchase contoured leg rests and head cushions Q6 Surgical will purchase a Lumex Geri Chair ICU will purchase 2 proning pillows ACTT will purchase exercise equipment

Thank you to everyone who submitted applications and we encourage all departments to apply for the Patient Experience Fund again next year. A huge thank you to everyone who said “I’m in”! You are making care better for BGH patients and their families!

Kudos to the Transcription team for always striving to improve!

“For the past year we’ve been watching the enthusiastic and engaged Transcription team steadily improve productivity since their Kaizen event last summer. They’ve reduced their cycle time drastically (from 18 days down to 4 days) as well as their discharge summary turnaround time (from 6 days down to an average 19 hours)! These faster turnaround times lead to better patient care. The approach the team took to improvement is inspiring and I have no doubt they will sustain the changes they’ve made in the department. Kudos to the team on their impressive achievements!”

– James Russell, Director of Process Improvement

QHC Vital Signs Newsletter, Summer 2019: Published by QHC Communications Department Editor: Carly Baxter (613) 969-7400 ext. 2677, cbaxter@qhc.on.ca.

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