TMH patient motivated to recover by ―fantastic‖ staff Lorna Doucette has had a tough 18 months. After undergoing femoral bypass surgery in Kingston, her condition declined and she spent nearly six months there recovering. Shortly after going home, she came down with pneumonia and spent some time recuperating at Belleville General Hospital. And for the past couple of months she’s been in Trenton Memorial Hospital’s Complex Continuing Care (CCC) unit working on getting stronger after being admitted for breathing troubles and physical deconditioning. “When I came here I couldn’t breathe, I couldn’t walk – I was bedridden,” said Lorna. “The staff here is fantastic. They’ve all done wonders to help me.” Lorna admits she wasn’t doing much to improve her condition when she first arrived. She was afraid to get out of bed and do the work required to build her strength. But she credits Susan Bird, Personal Support Worker (PSW), for encouraging her. “Susan has been my motivation for getting my backside moving,” said Lorna. “She’s tough but just as loving. She’ll give me the dickens and be real tough with me until I do what I’m supposed to do. Then she’s very encouraging and makes me feel like I’ve succeeded.”
Trenton Memorial Hospital patient Lorna Doucette (right) is grateful for the care she’s received while in hospital and she credits Susan Bird, Personal Support Worker (left), for encouraging her to take part in her own recovery.
“We all need a little push sometimes,” said Susan. “I explained that if she wants to get home she has to get out of bed and participate in her rescue. We are all here to help her. Lorna decided to grab that life jacket and now she’s sitting up all day, giggling and doing great.” Lorna says she had a talk with herself because “if you want to get better, who better to help you than you?” Now, every time she falters she says to herself, “move, move, move,” and it keeps her on track. “I say to myself, ‘Lorna, what hill are you going to climb today? How high up are you going to go?’” Jessica Melchiorre, Occupational & Physiotherapy Assistant, has been working with Lorna to build her strength Continued on Page 8
Physician Standard Work in the BGH Emergency Department – Great work, team! A lot of work has been done in the past year to improve patient flow in the Belleville General Hospital Emergency Department. As the subject of multiple Grassroots Transformation Kaizen events, the department has implemented many changes – some of which have played an important role in improving patient care. The most recent Kaizen event (June 19-22) focused on physician standard work in the Emergency Department. At the outset of the event, the team of 40 participants from various departments and professions, looked at some of the problems – including variability in physician practices, beds tied up with patients waiting for consults or reassessment, and inadequate communication. Together, they looked for solutions and are now trialing some changes that they anticipate will help. Some of the trials include:
Implementing 3-minute, physician-led rounds (6 times per day) to coordinate care between the entire team.
Moving some yellow zone patients to chairs in the ED while they await follow up—allowing more patients to be seen and treated.
Having patients be seen by the physician assistant immediately after being triaged, getting care started quicker. This should help improve Left Without Being Seen (LWBS) and Physician Initial Assessment rates.
So, what did you think of the Kaizen and the outcomes of this event? “I’m impressed that what would normally take six months has taken two days. The Kaizen has empowered change that would normally take so long. It’s nice to have a lot of voices and eyes from other departments.” – Dr. Eric Bruder “The goal is improvement, not perfection. These changes will make it better but sustainability will be key. We need to make sure we’re building on a stable structure.” – Dr. Lois McDonald “This is a very complex process and it’s taken a wide range of people – diagnostics, pharmacy, lab, physicians, nurses and clinicians to get the big picture and figure out what’s not working and how to fix things. There are a lot of changes being thrown at people all at once. I think staff is receptive but a little hesitant as well.” – Rob Wisniewski, RPN
Making headway to address staffing issues in the Intensive Care Unit (ICU) Creating an exceptional workplace is one of QHC’s two “Wildly Important Goals” for 2017/2018. Achieving better work life balance is one factor that will help us realize this goal. For units that have been chronically understaffed – like the ICU – the aim is to reduce the number of uncovered shifts when schedules are posted, thereby improving working conditions for staff. Throughout the fall and winter, the ICU was struggling to fill its RN schedules due to numerous long-term leaves and difficulties recruiting. Some six-week RN schedules were posted with more than 50 holes – or up to 7 per cent – of shifts unfilled. That doesn’t even take into account sick calls that come in after schedules are posted. “Staff members were extremely frustrated by larger than normal assignments, and the shortage even caused us to close two beds for three months,” explained Sarah Corkey, ICU Manager. Over the past few months, Sarah and Human Resources have been working proactively to reduce these unfilled shifts. One tactic has been to orient and train Transition Pool nurses to cover ICU shifts – but only after they’ve first spent time training in another BGH inpatient unit. Historically, Transition Pool nurses (typically new grads – hired to cover shifts on various units where needed) weren’t trained in ICU because of the acute nature of the unit. But after first being properly trained on BGH Quinte 4 and Quinte 5, they arrive in the ICU more confident and able to develop the skills required to care for some of the less acute ICU patients. This has helped fill some holes in the ICU schedules but is not a permanent solution. The Transition Pool nurses can’t all be tied up in high-need areas like the ICU – other areas need to also be able to pull from the Transition Pool to fill short-term sick time. So, another solution has been QHC’s RN Specialization Internship Program. Through the internship program, RNs without the experience or education to qualify for permanent positions in the ICU (or other specialized care areas like OR, Labour & Delivery and Emergency) apply for permanent internship positions and receive the training and education required – Belleville General Hospital’s Intensive Care Unit (ICU) paid for by QHC. “The internships are great because instead of always recruiting externally, it allows us to train our own people and give them the opportunities to work in these specialized areas,” said Bree Gaber, Director of Human Resources. With the influx of new staff in the ICU, extra resources must be dedicated to training – causing new hurdles for the unit. But overall, these strategies have helped fill baseline needs and improve work life balance. The most recent RN schedules have been posted with only two holes each, creating more stability in the department. Human Resources is also working with Korn Ferry Hay Group consultants to look at our staffing needs across the organization and create a predictive tool that will help QHC actively plan for our needs now and in the future.
Ambula ng safely – During CEO Mary Clare Egbert’s month hly gemba safety walk, she was impressed with physiotherapist Ed Dowling’s ICU pa ent saffety ideas. For example, when ge ng pa ents up from bed and into a chair (which is reallyy good for the pa ent) he ensures there is a ceiling li sling in the chair. This allows paa ents to spend the maximum me in the chair while not compromising staﬀ safety while moving the (now exhausted) pa ent from chair to bed, because they can use the sling! Another great idea is to provide a portable treadmill for thee ICU so that those pa ents who are a ached to several machines can ambulate safely aat the bedside with li le risk to staﬀ or pa ent because they are so close to the bed. They can be quickly and safety assisted back to si ng on the edge of the bed. (In photo, fro om le : CEO Mary Clare Egberts, ICU Manager Sarah Corkey, Dr. Roger Leong and Ed d Dowling, Physiotherapist. Look for a story about QHC’s safety program in the next issu ue of Vital Signs.
#AlwaysStriveToImprove #AlwaysStriveToImprove A friendly face – Pauline VanNess has been volunteering at Belleville General Hospital on Wednesdays for more than a year. She par cipates in kitchen group and meal me assistance on Sills 3, but has also recently started volunteering on Quinte 5 – a unit that un l now hadn’t had volunteers due to the acute nature of the pa ents. Pauline does friendly visits with pa ents and chats with them about their experience at the hospital. “Having Pauline spend me with the pa ents has benefited both the pa ents and the communica on that she is providing back to the unit staﬀ,” said Pam Melanson, Quinte 5 Manager. “She is fabulous!”
#WeAllProvideCare Technology heroes – QHC was lucky to avoid much of an impact during last month’s global ransomware a ack – however it wasn’t all just luck. Because of the Informa on Services (IS) department’s quick response, they were able to take measures to protect our systems and avoid what could have been a devasta ng blow to our organiza on. “Thank you to the IS department for protec ng our hospitals,” said Mary Clare Egberts, President & CEO, at an apprecia on lunch for the group. “I’m so impressed you knew exactly what to do. Your quick reac on was so appreciated by myself, the board of directors, and all of QHC. On behalf of everyone, thank you!”
Awesome improvement – Unhappy with how long it was taking for outpa ent pregnant mothers to receive Rhogam injec ons at 28 weeks gesta on, the Quinte 7 Quality Commi ee and Laboratory staﬀ (members of each pictured) put their heads together to improve the process. Pa ents were wai ng an average 120 minutes – with some wai ng up to four hours. Their new goal was that pa ents would wait no longer than 90 minutes and now the team is averaging 47 minutes! An added kudos goes to Quinte 7 from Laboratory staﬀ member Barb Terry. She explained that when the lab’s blood gas analyzer went down one evening, they asked Quinte 7 if they could use theirs. “They were great, helping us with passwords and even oﬀering one of their nurses if we needed someone to help out and run our samples back and forth. They’re the best,” said Barb.
Passing the torch – On June 2, Ka e Cudmore, Psychometrist in the Children’s Treatment Centre (le ), passed the QHC psychometry torch to new staﬀ member Sandra Ward (right) during Ka e’s re rement tea. Psychometrists assess children for their learning development in order to support their learning needs at school. “Ka e has been well respected by her colleagues, community partners, physicians, early learning programs, schools and school boards,” said Margo Russell‐Bird, Manager of the Children’s Treatment Centre. “Most importantly, she has made a las ng impression on many children and families with her knowledge and understanding of their needs and her compassion, support and advocacy for what was essen al for their success.”
Who inspires you? Anyone can share in celebra ng our teams – staﬀ, pa ents, physicians and volunteers. Contact Carly Baaxter at ext. 2677, email@example.com.
Community supports the existing site as the location of the new PECMH Feedback received from the community about where the new Prince Edward County Memorial Hospital should be located was overwhelmingly in favour of the existing site. Community engagement efforts were held in May and included in-depth discussions with a focus group consisting of 35 community leaders, health care partners, and staff and physicians. A month-long survey was open to all community members in May — netting 339 responses. A community open house provided the opportunity for any community member to ask questions, share feedback and complete the survey; approximately 120 attended. “PEC residents have always been great supporters of their local hospital, so we were not surprised by the excellent community participation in this decisionmaking process,” said Susan Rowe, QHC Senior Director. “While most people tend to prefer the existing hospital site, we also heard loud and clear that the number one priority is to see a new PECMH built, regardless of exactly where it is located.” The most common reasons for supporting the existing site:
The proximity to the family health team and other services Closer for walking to the hospital and a less expensive taxi ride Easier to find and easier to see from the main road Familiarity with existing site Closer for emergency services
The minority supporting the greenfield site by the H.J. McFarland Memorial Home saw the benefits of the idyllic setting– close to nature and less road traffic. They also felt it was easier for construction and would have less impact on the existing hospital during construction. Concerns about both sites were expressed. Some felt the existing site offered less room for parking and future expansion, and expressed concern about the disruption on hospital operations during the construction. Concerns with the greenfield site included the distance, harder for people to find, and the single access road. The project steering committee are taking a wide range of factors into consideration, including input from 450 residents as part of the community engagement process, and will present the findings to the QHC Board at the June 27th meeting. If approved, the QHC Board will recommend the existing site to the Ministry of Health and Long Term Care as part of the ‘stage 1b’ submission—which is the next step of the capital planning approval process.
Living our QHC values — Introduction of Behaviour at Work policy Staff and physicians created our values in 2011 and we’ve come to know them well. Imagine it's you Respect everyone Always strive to improve Take ownership We all help provide care They speak to what matters most about how we treat our patients and families…and each other. Many great examples of staff, physicians and volunteers living the values are featured each month in our #4MyTeam section of Vital Signs and through social media. This year we are focused on improving the patient experience and being an exceptional workplace - including promoting workplace wellness. We need to ensure we have the structures, tools and education in place to support these priorities. One such tool is the “Behaviour at Work” policy, which replaces the QHC Code of Conduct and outlines what it means to live our values for new and existing members of our teams. It better supports leaders and staff to acknowledge those (vast majority) who live our values daily and to hold those accountable when they don’t. It also ensures we can hold both staff and physicians accountable for violations to the policy. The policy outlines appropriate and inappropriate behaviours, as well as the process for reporting violations. A whistle-blower hotline has been launched for staff and/or physicians that have exhausted all other avenues or need an anonymous way to raise concerns. Confidential or anonymous concerns can be reported by calling: 1-866-921-6714 (answered by a trained operator, 24 hours a day), or online at www.integritycounts.ca. The Behaviour at Work policy is linked to all QHC policies and applies to everyone employed by or associated with QHC, including Board Members, employees, credentialed medical staff, volunteers, students and contract workers. #4MyTeam prize draw: How do your coworkers live our values at work? Do they go above and beyond for their patients/team? Who deserves some recognition from your team? Contact Carly Baxter at firstname.lastname@example.org or ext. 2677 to share examples of how someone you work with is living QHC’s values. Everyone who submits a #4MyTeam moment in the next three months will be entered into a prize draw for September. To learn more about the Behaviour at Work policy, speak to your manager or visit the HR Centre section of the MyQHC Intranet for: A Behaviour at Work booklet. Scenarios that will help you determine when and how to report a violation. You may also view the full policy on the MyQHC Intranet in the Policies section, under Section 4—Human Resources.
Successful pharmacy accreditation visit
Continued from Page 1
and get her walking again. “There was a time when she was anxious and afraid to step forward and then one day – in a real statement of self-reflection The accreditors were pleased with everyone’s participation and willingness – she went from anxious and afraid to persistent and to show them and tell them about our programs and processes. A few determined. She is diligent with commendable areas include: her exercises and proud of her Our inter-professional collaborative approach. accomplishments. She has a The time, effort and dedication to our medication reconciliation bright and indomitable spirit – program. some would even call that The high-quality, interdisciplinary nature of our anti-microbial stubborn.” stewardship work. Great interplay between pharmacy and other health care providers Both Lorna and Jessica credit the including physicians. entire CCC unit for Lorna’s Excellent policies and procedures (ie MAID, medical marijuana). recovery. “Her improvement is a Implementation of insulin pens initiative into the organization. testament to the PSWs, nurses, Great communication by using huddles and making sure medication allied health and support staff incidents and safety are part of Pharmacy huddles. who have helped her as well. We RFID tech for crash carts, code system. all work together to achieve Gap analysis for sterile compounding and moving towards the successes like these.” implementation of all the NAPRA standards to be in place by January 2019. “This has been one story of the Very good job in keeping everything unified. No disparity in process, many here on the Trenton even between hospitals. Great work seen in Medication Safety and Pharmacy and Therapeutics Memorial Hospital CCC unit that needs to be celebrated,” said Committees. Ruthann Hubbs, Manager. “The Auditors greatly appreciated efforts of Karen Smith, Director of entire multidisciplinary team has Pharmacy, and rest of the pharmacy team. coached and supported Lorna and worked hard to get her to Three main recommendations: where she is today.” Configuration of drug distribution through Omnicell to update order verification process and maximize the safety of the Omnicells by Lorna has documented a whole limiting overrides. list of people on the unit who Continue to work towards meeting the new NAPRA standards for sterile compounding for both hazardous and non-hazardous products have helped her towards her goal of going home. She’s to meet the Jan. 1, 2019 deadline. looking forward to returning to Increased auditing of narcotics in the patient care areas. her husband Andrew and, if she keeps progressing as she is, she “Thank you to all staff for their contributions, not just during the three days the accreditors were here, but each and every day,” said Mary Clare should get there soon. Egberts, President & CEO, QHC. “Great things happen when the whole team comes together and everyone is part of our success.” The Ontario College of Pharmacists (OCP) wrapped up its three-day accreditation session at QHC on June 1. The accreditors spent time at each of our four hospitals touring and examining pharmacy, oncology and inpatient units.
QHC Vital Signs Newsletter, June 2017: Published by QHC Communications Department Editor: Carly Baxter (613) 969-7400, ext. 2677, email@example.com