10 minute read
QEII Foundation TRIC grant
By Erin Elaine Casey
Imagine you’ve just woken up from surgery. You’re sleepy, confused and probably a little worried about how everything went. A nurse approaches to check on you and your first instinct is to ask for reassurance: “Was my surgery a success? Where is my family? How long do I have to stay here?” Now, imagine the nurse doesn’t understand what you’re saying and can’t offer any information in your own language. Maybe you don’t have to imagine — maybe it’s happened to you or someone close to you.
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In perioperative care — the journey from pre-admission assessment to surgery to recovery and discharge — at the QEII Health Sciences Centre, those days are over. In the fall of 2019, perioperative care teams at the QEII received Interpreter on Wheels equipment and technology, thanks to funding from the QEII Foundation Comfort & Care grant program.
Comfort & Care grants were established in 2005 by the QEII Foundation to directly enhance care for patients and their families. These grants support projects that typically would not receive funding from operating or capital budgets.
“In the Post Anesthetic Care Unit (PACU) our patients are in crisis and it can be hard to communicate with a patient whose first language isn’t English,” explains health services manager Patricia Jennex. “With the Interpreter on Wheels, physicians and nurses can ask questions about things like pain and post-surgery concerns.”
“It can follow patients into pre-admission assessment, into the ORs if needed, into recovery and then help with discharge teaching,” adds perioperative nurse Heather Aikens.
But what exactly is an Interpreter on Wheels and how is it different from an in-person interpreter?
“It’s an iPad locked into a stand with wheels,” says Patricia. “You turn it on and select the language you want on a touchscreen. Interpreters are on call all over the world, 24 hours a day. They receive specific training in a variety of scenarios, including health care.” Heather Aikens, a registered nurse with the QEII’s perioperative care, guides a patient through communication using the Interpreter on Wheels. With 400 available languages, the Interpreter on Wheels — provided by a QEII Foundation Comfort & Care grant — allows QEII healthcare teams to communicate with all patients, 24 hours a day. QEII Foundation
If it sounds simple, it is — and quite amazing. Four hundred languages are available through a service called LanguageLine, most with both live video and audio interpretation. Declining video streaming is always an option if the patient wants more privacy. “But most people find it reassuring to have a face to talk to,” says Patricia.
Before Interpreter on Wheels, interpreters had to be booked in advance through the Nova Scotia Health Authority’s Interpretation and Language Services.
“This works well, but has limitations,” says Patricia, “such as emergencies, surgical delays and a limited menu of languages. If we needed immediate interpreting, we would sometimes ask staff members. They’re more than happy to do it, but it means removing a staff member from their other patients or duties. This can impact the flow of patients in and out of the PACU and care of patients in the unit.”
Interpretation and Language Services supports the Interpreter on Wheels program by providing software, staff training and support.
Interpretation is now available at any point in the patient’s perioperative care journey.
“The consent leading up to surgery is so important,” says Heather. “Things with your health status can change between pre-admission and the actual surgery and patients need to understand all the things they can and can’t do before surgery.” Patricia points to a more diverse population as a key reason for improving interpretation services at the QEII. Even if the patient or family speaks English as an additional language, they might not be familiar with medical vocabulary and they might feel stressed. “In addition to welcoming immigrants and refugees, there are university students from all
It’s reassuring to know we can provide the safest, most holistic care we can for our patients. — Heather Aikens over the world and cruise ship patients on a regular basis.”
The Nova Scotia population is also aging, which can pose challenges in the recovery room. “Maybe the patient doesn’t have their glasses or dentures or hearing aids,” adds Patty. “The Interpreter on Wheels provides a sense of comfort and security.”
The benefits extend to nurses and other healthcare providers as well.
“It’s a comfort because if I’m sending patients home and I am unsure if they understand what they need to do for post-operative care, that’s not a good feeling,” says Heather. “It’s reassuring to know we can provide the safest, most holistic care we can for our patients. Patients are thanking the interpreter and you can see the relief and feel the anxiety coming down when they know they can communicate and get the help they need.”
Local study improving access to HIV care QEII Foundation TRIC grant supporting community-based research
By David Pretty
In 2018, the number of new HIV infections in Halifax Regional Municipality (HRM) doubled among those who use injection drugs, compared to the previous two years. This is a trend that deeply concerns Matt Bonn, a frontline harm reduction support worker with Mainline Needle Exchange.
“I hear about unsafe using patterns from people first hand and I see more and more people contracting HIV,” he says. “A lot of youth as well, which is alarming.” This sentiment is echoed by Dr. Lisa Barrett, an infectious diseases specialist at the QEII Health Sciences Centre and an assistant professor at Dalhousie University.
“HIV is a chronic infection and once you get it, you have it for life,” she explains. “While we can treat the infection well, we have to know about it. In the early days of the infection, a person may not know they have it, so getting tested is important.” The medications that treat HIV are typically quite successful and, about 10 years ago, a medication became available to prevent future infection. When taken daily and combined with other harm reduction strategies — a process known as pre-exposure prophylaxis, or PrEP — it’s highly effective for preventing HIV from sex or injection drug use. “PrEP is not just a pill; it’s a whole plan to reduce exposure to infections,” Dr. Barrett says. “This includes having safer sex, harm reduction if you inject drugs, as well as understanding your risk for infections spread through blood and sexual encounters. PrEP is a plan and an important part of that plan is this medication.”
With funding from a QEII Foundation Translating Research Into Care (TRIC) grant, Dr. Barrett and her team are monitoring the effectiveness of a communitybased PrEP rollout in the HRM. QEII Foundation TRIC grants fuel direct and positive changes for health care, such as better patient outcomes and improved access to care.
Dr. Barrett’s innovative approach in combating HIV infection embodies the uniqueness of the grants — closing the often decades-long gap between research and practice. Matt is particularly enthused by the prospects. “I’m excited for the QEII Foundation TRIC grant to give access to providers in a communitybased setting because we lose so many people while trying the referral method,” he notes.
Dr. Barrett’s study involves a three-pronged strategy to target those most at risk.
“PrEP involves education around HIV, easy testing for a patient to know their status and then access to PrEP if they need the medication,” she says.
Dr. Barrett first needed to understand what people in the at-risk community knew about
— Matt Bonn
HIV — from how it’s contracted to how to prevent it. With Matt’s help she was able to engage people in the community and provide awareness cards urging people to get tested.
The second part of the study saw Dr. Barrett and her team using a “point-of-person” blood test in the community. Approved by Health Canada but not normally offered for routine testing in Nova Scotia, the test is similar to a diabetes blood sugar test, with results available within minutes. But before treatment can start, the results need to be confirmed in a more comprehensive lab at the QEII, presenting another challenge unique to the high-risk community. “The point-of-care finger prick test gives HIV results within five minutes,” Dr. Barrett says. “But if a random person gets a positive test, how do we make that part of the public health reporting and make this practical for patients with no health card, no driver’s licence and no fixed address?” As Charles Heinstein, the manager of the QEII’s microbiology lab, can attest, these challenges extend into his realm as well.
“We’ve got incredible testing mechanisms and equipment
Charles Heinstein (left), manager of the QEII’s microbiology lab, and Dr. Lisa Barrett (right), QEII infectious diseases specialist, demonstrate a point-of-care finger prick test that gives HIV results within five minutes. This test is an important part of PrEP, a prevention and treatment program for HIV infection. QEII Foundation
Local study improving access to HIV care Continued from Page 14
and staff, but there are groups of the population that can’t access that,” he says. “With no health card number or social insurance number, there are no unique lab identifiers to ensure we’ve got the right person tested.”
Charles’ solution for this was the creation of unique codes that can be referenced back to individuals. “Typically, it’s done with testing for sexually transmitted infections,” Charles says. “We get a code that has no other identifiers, which allows us to get around that barrier of identification while still maintaining the safety that’s required for this type of testing.” The need for standard forms of identification to treat marginalized people is also frustrating for Dr. Barrett, especially when it concerns obtaining PrEP medications for those who need it most.
One aspect of the QEII Foundation TRIC grant’s two-year timeline is trying to reconcile these traditional administrative criteria for the people who need it most.
PrEP is not just a pill; it’s a whole plan to reduce exposure to infections. — Dr. Lisa Barrett “This research let us identify that availability is accessibility and then work toward changing a system to allow access,” Dr. Barrett says. “We haven’t changed that barrier yet, so part of the research will be to see if we make progress with that barrier still in place and other barriers removed.”
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