Shining the Light on St. Michael’s Best Practice Spotlight Organization Achievements - Fall 2021

Shining the Light on St. Michael’s Best Practice Spotlight Organization Achievements FALL 2021

This annual newsletter highlights some of St. Michael’s best practice achievements with examples of how our nursing teams are implementing, evaluating and sustaining best practice guidelines into standardized processes that support evidence based nursing practice.

Using Best Practice Guidelines to Foster a Safe and Inclusive Workplace

Who Were 1 Our 2020/2 BPG Nurse Champions and more inside...

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Nicole Levesque and Malcolm Bessong, RN’s Mental Health and Addictions Unit (Credit: Yuri Markarov)

A collaborative approach to support Women’s and Children’s Program (pg.4)

Highlights from 2020-2021 Communities of Practice (pg.7)

BPSO stands for Best Practice Spotlight Organization, the designation awarded by the Registered Nurses’ Association of Ontario to organizations upon successful implementation, evaluation and knowledge translation of established nursing best practice guidelines. St. Michael’s has been a proud designated BPSO since 2012.

A few words from Murray Krock Senior Director, Nursing Practice and Education

ninth year as a designated Best Practice This year recognized St. Michael’s Hospital’s implementation of 45 best practice Spotlight Organization® (BPSO®) and the 23 BPG quality improvement initiatives guidelines (BPGs) since 2009. There were s from October 2020 to March 2021. implemented across 21 different clinical area e Champions and supported by Unit and These initiatives were led by 31 BPG Nurs Professional Practice mentors.

unprecedented COVID-19 pandemic, The 2020-2021 cohort was faced with the ite the pandemic, Nurse Champions which created unique challenges. Desp BPG initiatives were achieved. This and their Mentors persevered and their ce placed on evidence based practice. demonstrates commitment and the importan tice (CoP) were all held virtually. BPG For the first time, the Communities of Prac succeeded in carrying out their quality Nurse Champions thrived, persevered and Nurse Champions and their mentors improvement initiatives. The 2020-2021 BPG tor pins, and their work was showcased were recognized with Champion and Men tice Guideline Sustainability Poster during the Nursing Week Virtual Best Prac e Champions and mentors for their Gallery. Congratulations to all BPG Nurs ion to advancing safe quality care! outstanding work, dedication and contribut Ontario (RNAO) launched the BPSO® The Registered Nurses’ Association of e translation strategy and is targeted designation in 2003 as a key knowledg learning and evidence based practice to support BPG implementation, rapid ed across Ontario and throughout the sustainability. BPSOs have been establish idacy toward designation began during world. St. Michael’s three-year BPSO cand spring 2012. We continue to endeavour Nursing Week 2009 and was achieved in clinical care, while implementing and to integrate the best possible evidence into BPSO designation is aligned with our sustaining new BPGs into our practice. Our nce nursing and clinical practice that commitment to using best evidence to adva ultimately raises the standard of care. inue to raise the standard of care by We maintain our designation and cont annual CoPs. The 2021/22 BPG CoP will mentoring BPG Nurse Champions during mpions along with their mentors. As a welcome new and returning BPG Nurse Cha ledge, advice, tools and problem solving CoP, they will come together to share know ent that facilitates the implementation strategies in a supportive learning environm e time developing their leadership skills. and sustainability of BPGs, while at the sam supporting them on their journey!

We look forward to welcoming everyone and

Murray

2 I FALL 2021

Using Best Practice Guidelines to Foster a Safe and Inclusive Workplace

By Elizabeth Benner Nicole Levesque and Malcolm Bessong, registered nurses in the St. Michael’s Inpatient Mental Health and Addictions Unit, were troubled by the inappropriate treatment of their racialized colleagues on a regular basis. Some patients used derogatory language to refer to racialized nurses. Others requested to be cared for only by people of particular backgrounds, suggesting they were more competent.

Levesque and Bessong decided to become Best Practice Guideline (BPG) Champions to address the knowledge and resource gaps nurses experience when these types of incidents occur and to help create a safe and inclusive workplace in accordance with Unity Health’s commitment to anti-racism, equity and social accountability.

Of those working in the unit, 50 per cent of the nurses reported experiencing racial harassment from patients during a given week. According to published research, incidents of racial harassment were linked to feelings of emotional distress, decreased job satisfaction, role confusion and intent to quit. Levesque witnessed an incident where another nurse was the target of such harassment.

“When I witnessed that situation, it wasn’t clear to me what my role was in supporting my colleague or addressing that patient,” Levesque said. “You want to make sure you’re empowering your colleague and validating their concerns and experiences, but also you don’t want to overstep and insert yourself between a nurse and their patient nor do you want to leave them alone in that experience.”

Bessong was also frustrated with the prevalence of racial harassment towards nurses.

“You know something has to change but you don’t know what to change or what to do. Becoming a BPG Champion was a way for us to make those changes.”

Due to the lack of published research on this topic, Bessong and Levesque sought out techniques used to handle episodes of general violence and tailored those interventions to match their specific circumstances and needs. Within their workplace, they were able to develop tools to aid in the education, training and reporting of incidents of racial harassment.

Nicole Levesque, RN and Malcolm Bessong, RN (Credit: Yuri Markarov)

After an incident of racial harassment, the staff involved would use a follow-up system consisting of a process map to guide the nurses through the steps of reporting the incident and a debrief tool to help unpack the mental and emotional impact following the event. During the debrief stage, the nurses would not only discuss what had unfolded, but also their initial thoughts and feelings.

Following the implementation of the Best Practice Guideline – Preventing Violence, Harassment and Bullying Against Health Workers, there was a 33 per cent reported increase by staff on the availability of adequate tools and resources and a 47 per cent reported increase by staff in perception of adequate support. They hope that people will apply these techniques in other units and beyond.

“We felt a lot of gratitude for the opportunity because without this initiative, we wouldn’t have known how to move forward to make change,” Levesque said.

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A collaborative approach to support hand expression and OIT in the Women’s and Children’s Program

Sansan Ward, RN, Joy Baguisa, RN and Ashley Carr, RN (Credit: Katie Cooper)

By Elizabeth Benner Joy Baguisa, a registered nurse (RN) in the Neonatal Intensive Care Unit (NICU) at St. Michael’s hospital, saw that a little over half of preterm infants in her unit were receiving Oral Immune Therapy (OIT). Efforts were already in place to educate mothers on hand expression to aid in the production of breast milk for their preterm infants, but a more consistent and widespread effort was needed to increase the frequency and ensure babies in the NICU were receiving their mothers’ milk.

OIT is a technique by which a mother’s expressed breast milk is administered into the infant’s mouth through a syringe or swab. Intake of breast milk allows for maternal antibodies within the milk to be absorbed in the infant’s mouth, throat and respiratory system, providing a strengthened immune system and multi-system benefits.

Baguisa was paired with Sansan Ward and Ashley Carr, RNs from the Post-Partum and Labour and Delivery units at St. Michael’s, to work together as Best Practice Guideline (BPG) Champions. Their goal was to increase hand expression rates in breastfeeding mothers with 4 I FALL 2021

preterm infants in the NICU, as well as to increase the frequency of OIT administration when breast milk was available and clinically appropriate. These goals were based on recommendations from the RNAO Best Practice Guideline – Breastfeeding – Promoting and Supporting the Initiation, Exclusivity, and Continuation of Breastfeeding in Newborns, Infants and Young Children.

The team worked collaboratively across the three units to overcome barriers to provide education to nurses and mothers and also make broader policy changes regarding teaching and implementation of hand expression. To aid in the education of hand expression and resource accessibility, the team created a hand expression kit which contained supplies such as syringes, medicine cups, spoons and closed-lid containers to help mothers collect their breast milk. The kit also included a pamphlet which provided step-by-step instructions on how to hand express and also a QR code which mothers could scan to access videos demonstrating the technique.

“All you want to do as a new mom is to feed your baby,”

Ward said. “When moms have the tools, they’re so happy that they’re able to provide for their baby.”

During Transfer of Accountability, Labour and Delivery and Post Partum nurses discuss each mother’s hand expression progress.

Documentation sheets in patient charts were updated to include whether the mother had received education and a kit. In addition to improving education for mothers, Ward, Baguisa and Carr worked with the nurses in their respective units to provide education and support adherence on the updated OIT policy.

By the end of the initiative, 100 per cent of preterm infants in the NICU were receiving OIT, surpassing the initial 80 per cent goal up from 61 per cent. Labour and Delivery saw a 70 per cent increase in the number of mothers who were taught hand expression starting from 0%, while the number of mothers taught in Post Partum saw an increase of 100 per cent.

“I really enjoyed the experience of being a BPG Champion,” Baguisa said.

“I would highly recommend it to my other colleagues because it just gives you another perspective of nursing that’s not bedside. We had access to resources, networking opportunities, and training opportunities such as workshops which we otherwise may not have had.”

For their work, Baguisa, Ward and Carr were awarded the Piera Cardella Scholarship, which provides funding to support quality improvement initiatives to enhance nursing care and services.

“I was shocked but also very humbled and grateful that we were recognized for the work that we did,” said Carr. “It gives us the opportunity to continue with this initiative and acquire enough data to, hopefully, publish our work.”

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Who Were Our 2020/21 BPG Nurse Champions?

Daniel Dyer

Balraj Singh

Joy Baguisa

Jessica Diep

Chinnie Edradan

Angelica Rojas

Jennifer Predhomme Tatyana Nichkasova

Lobsang Lhadon

Erin Hardy

Liana Garcia

Maribel Abarrientos

Imelda Chua

Michelle Robinson

Malcolm Bessong

Maria Pataunia

Monica Snider

Mark Pablo

Nicole Levesque

Ronald Ordinario

Naomi Marasigan

Shirley Bell

Sansan Ward

Tina King

Kinza Malik

Not pictured: Ashley Carr, Victoria Hillsley, Stacey Lew, Brittany Lyn, Jenna Richards

A BPG Nurse Champion is a nurse selected to lead, facilitate and inspire the BPG implementation and evaluation process in their local unit. From October to March 2021, there were 31 BPG Nurse Champions from 21 clinical areas who led BPG initiatives in their local areas.

To learn more about our 2020/21 BPG Nurse Champions visit the St. Michael’s BPSO intranet page.

6 I FALL 2021

Sarah Moffat

What are key qualities of a BPG Nurse Champion?

•

A nurse who demonstrates initiative and commitment to best practices in their current role;

•

Passionate about a BPG topic, patient population and the potential outcomes that can be achieved;

•

Has the ability to lead, coordinate and facilitate an initiative and, role models positive clinical leadership.

2021 Nursing Week Virtual BPG Sustainability Poster Gallery Facilitating Workplace Wellness and Health in a Co m m u n i t y M e n t a l H e a l t h S e tt i n g Jenna Richards, RN, BScN, MScN INTERVENTION/ PROCESS

Implement a 12-week Wellness Wednesday Program to increase Community Mental Health (CMH) staff resilience and wellbeing.

RNAO BPG: Workplace Health, Safety and Well-being of the Nurse (2010) Recommendation 3.3: Organizations/nursing employers promote and support initiatives related to the physical and mental health and wellbeing of the nurse. This includes, but is not limited to, fitness programs, health promotion and wellness activities, and fitness-towork initiatives.

BACKGROUND

RESULTS

• CMH Staff were surveyed to understand interest in specific wellness activity options. Wellness activities were selected based on survey results. Experts were contacted for price quotes.

40

• An itemized budget for the wellness activities was created in Excel and sent to manager for approval. Once approved, items were purchased and experts were booked.

• Resilience Survey (CD-RISC) was sent to Community Mental Health Staff (N=32) to retrieve baseline/pre-test resilience scores of staff. In total, 21 staff completed the pretest Resilience Survey.

Opportunity for improvement: Interventions that focus on reducing stress and promoting self-care have been shown to have a positive impact on health care workers’ resilience and stress level (Alexander, 2013; Kunzler et al., 2020).

PURPOSE & OBJECTIVES Aim: To increase resilience among Community Mental Health Staff by 7% through a 12-week "Wellness Wednesday" program.

Process indicators • Number of staff attending weekly wellness sessions.

• Weekly feedback survey after each wellness session.

CD-RISC Resilience Score Legend 0 - 29 = Lowest quartile (1-25% of population) 30 - 32 = Second quartile (26-50%) 33 - 36 = Third quartile (51-75%) 37 - 40 = Fourth quartile (76-100%)

29.78

28.38

30

20 15 10 5

Wellness Wednesday Program Week 1 – Resilience in Uncertain Times Presentation Week 2 – Yoga Class Week 3 – Art Therapy Class Week 4 – “Game Night” Week 5 – Mug Glazing Week 6 – “Game Night” Week 7 – Elevate Your Day Presentation Week 8 – “Paint Night” Week 9 – Music Therapy Class Week 10 – Origami Flower Craft Week 11 – Yoga Class Week 12 – Clay Pottery Class

Before Wellness Participated in 4 - 6 Participated in 7 - 12 Wednesday Sessions Wellness Wednesday Wellness Wednesday (n=21) Sessions (n=9) Sessions (n=7)

Overall, there was a 5% increase in resilience scores for staff who attended 4 – 6 wellness sessions. For staff who attended 7 – 12 wellness sessions, there was a 10% increase in resilience scores from the baseline resilience score.

Qualitative Staff Feedback

“I liked that we got to spend some time being creative and share an activity in a non-work environment with colleagues.”

 A pet picture board and gratitude tree were also integrated into the wellness program. As well, online wellness resources were periodically sent to staff.

Photos from Wellness Sessions

“It was great to have a very relaxing, and active, activity in the middle of the work week! Really forced us to feel calm and joyful.”

“I look forward to Wednesdays now!”

Outcome indicators • Pre and post-test measures using a Resilience scale (CD-RISC).

• Percent attendance across the wellness series.

• Percent of staff that report feeling engaged and satisfied in their own wellness through the wellness series.

Survey results and staff feedback suggest an improvement in resilience and wellness among Community Mental Health staff through the Wellness Wednesday program.

Angelica Rojas RN, BScN, CPMH (C) INTERVENTION/ PROCESS

• Patients with mental illness have a higher morbidity and mortality level compared to the general population (Pettipher et al., 2015; Zhang et al., 2018) • Cardiovascular diseases, viral diseases and metabolic disorders such as obesity and diabetes are found to be of higher prevalence in patients with mental illness (Munshi et al., 2017; Zolezzi et al., 2017) • Due to the prevalence of medical comorbidities amongst mental health patients, it is important to conduct a physical health assessment on patients presenting with a primary mental health concern

FOCUS This BPG is aligned with the following RNAO Best Practice Guidelines: 1. Stroke Assessment Across the Continuum of Care 2. Management and Assessment of Foot Ulcers for People with Diabetes 3. Assessment and Management of Pain

CONCLUSION

RESULTS Attitudes and perception of focused assessments in MHESA. (Pre survey n= 23, post survey n = 12)

Agree

Neutral

Disagree

Pre

Post

Pre

Post

Pre

I feel comfortable in completing a full head-to-toe assessment on patients in MHESA.

65%

92%

17%

8%

18% 0%

Post

I understand the nursing accountability on completing head-to-toe physical assessments.

74%

92%

13%

0%

13%

8%

I am knowledgeable in all aspects of physical assessments.(i.e. GCS, pupils, head-to-toe assessments, vital signs, etc.)

56%

100% 35%

0%

9%

0%

The MHESA secondary form captures health information I need to assess my patients.

9%

73%

22%

18%

70%

9%

The MHESA secondary assessment guides my clinical decision making in developing care plans for my patients.

22%

67%

17%

17%

61% 16%

RECOMMENDATIONS/ NEXT STEPS • Continue conducting monthly audits on the MHESA Focused Assessment form with the goal of 80% completion rate • Continue to provide education to staff on the importance of conducting physical assessments • Future consideration – embedding the assessment onto the electronic medical record

REFERENCES

Figure 2: Perception and Attitudes of Focused Assessments in MHESA

PURPOSE & OBJECTIVES Purpose: • Improve the completion rate of Focused Assessment Mental Health forms in the Mental Health Emergency Service Area (MHESA) Aim: • Increase the completion rate of Focused Assessment Mental Health forms (also known as secondary assessments) in full from an average of 25% to 80% by March 31st, 2021 Objectives: • Conducted pre and post survey and semi-structured interviews • Development of a new MHESA Focused Assessment form and clinical guideline • 82.6% of FT/PT RNs received in-service education on physical assessments and how to complete the new focused assessment form

• Results from the survey indicated an improvement in nurse’s comfort in conducting head-to-toe assessments on patients in MHESA • There was an 18% increase in nurses understanding of their accountability in conducting physical health assessments.

• 44% increase in nursing knowledge • Audits conducted for February and March 2021 indicated a completion rate of 78%. An overall, 53% increase from 25%

Alam, A., et al. (2017). "Emergency Department Medical Clearance of Patients with Psychiatric or Behavioral Emergencies, Part 1: Special Psychiatric Populations and Considerations." The Psychiatric Clinics of North America 40(3): 411-423.

College Nurses of Ontario Practice Standard: Documentation, Revised 2008.

Chennapan, K., et al. (2018). "Medical Screening of Mental Health Patients in the Emergency Department: A Systematic Review." The Journal of Emergency Medicine 55(6): 799-812.

Druss, B.G., vAon Esenwein, S.A., Compton MT, Zhao, L., Leslie, D.L. (2011). Budget impact and sustainability of medical care management for persons with serious mental illnesses. The American Journal of Psychiatry 168:1171-8.

Gadalla et. al., (2008). Association of Comorbid Mood Disorders and Chronic Illness with Disability and Quality of Life in Ontario, Canada. Chronic Diseases in Canada 28, (4): 148-154.

Gregory RJ, Nihalani ND, Rodriguez E. (2004). “Medical screening in the emergency department for psychiatric admissions: A procedural analysis.” General Hospital Psychiatry 26: 405-10.

Munshi, T., Asmer, M.S., Penfold, S., Pikard, J., Mauer-Vakil, D., & Banwell.(2017). Physical exam in mental health: implementation of a form to guide medical assessment. Clinical Audit, 9, 1- 7.

Munroe, B., Curtis, K., Murphy, M., Strachan, L., & Buckley, T. (2015). HIRAID: An evidence-informed emergency nursing assessment framework. Australian Emergency Nursing Journal, 18, 83-97 Melamed, O.C., Wong, E. N., LaChance, L.R., Janji, S., & Taylor, V.H. (2019). Interventions to improve metabolic risk screening among adult patients taking antipsychotic medications: A systematic review. Psychiatric Services,70 (12), 1138-1156 Penninx, B., & Lange, M.M.S. (2018). Metabolic syndrome in psychiatric patients: Overview, mechanisms and implications. Dialogues in Clinical Neuroscience, 20(1), 63-73 Pettipher A, Ovens R. (2019). The psychiatric inpatient physical health assessment sheet (PIPHAS): a useful tool to improve the speed, efficiency, and documentation of physical examination in new psychiatric inpatients. BMJ Open Quality ,4:u206294.w2558. doi: 10.1136/bmjquality.u206294.w2558

ACKNOWLEDGEMENTS Figure 1: Phases of the Process for Best Practice Guideline

Figure 3: Percentage of Forms Completed in Full

Ifat Witz, Clinical Leader Manager; Stephanie Lucchese, Clinical Nurse Specialist; Rachel Lodge, Clinical Educator – Nursing; Susan Beswick, Manager, Evidence Based Nursing Practice; MHESA RNs; Emergency department physicians; MHESA psychiatrists; Addictions team.

The Care and Maintenance of Vascular Access Devices to Promote Patency, Reduce Workload and Improve Patient Health and Satisfaction Carolyn Horn, R.N., B.Sc.N & Victoria Hillsley, R.N., B.Sc.N FOCUS Our initiative aligns with the RNAO Best Practice Guideline (BPG) Care and Maintenance to Reduce Vascular Access Complications.

INTERVENTION/ PROCESS

RECOMMENDATIONS/ NEXT STEPS

RESULTS

Post education survey demonstrated the need for education reinforcement and to continue to engage nursing staff.

Figure 1. Process Map to identify gaps

Moving forward and to assist with sustainability:

Specific recommendations include: - The nurse to maintain catheter patency using flushing and intravenous (IV) locking techniques.

- Nurse to understand client factors, device characteristics, and infusate factors that can contribute to catheter occlusion.

- Nurse to document the condition of vascular access devices; site assessment; functionality.

Table 1. Pre and Post Education Chart Audit Results

BACKGROUND Helm et al (2019), states that: - Anywhere from 60-90% of patients admitted to hospital will require an IV access device.

- Peripheral vascular access devices (PVADs) have a high overall failure rate of 35% to 50% and are costly to patients, caregivers, and healthcare.

2012 study done by Rickard et al. found that: - 10% to 25% of catheters lasted more than 5 days; only 3% lasted after 7 days.

- Majority of patients required an IV restart in a 3.5 day period.

- Up to 90% of IVs fail before patients complete their IV therapy.

PURPOSE & OBJECTIVES The aim of the initiative was to increase the longevity of peripheral vascular access devices on the 6Bond Respirology unit by 25% from 83.6 hours to 104.5 hours by March 31, 2021.

- Develop and increase the nurses knowledge on best practice guidelines surrounding vascular access devices.

- Ensure proper communication and documentation being completed surrounding site assessment and functionality.

REFERENCES

Table 2. Pre and Post Education TOA Audit Results

Table 3. Post Education Survey Results

CONCLUSION Our initial post education chart audits showed a 34% increase in peripheral vascular access devices (PVADs) longevity to an average of 112.2hrs.

- Our most recent chart audits demonstrated a 27% increase in PVADs longevity from 83.6 hours pre-education to 106.11 hours, reaching our original goal of 25% or 104.5 hours.

As for documentation audits, we noted an increase in the completion of nearly every category being looked at. With some sections noting as high as a 46% increase.

TOA audits showed improvement in nurse to nurse communication regarding IV condition, site and functionality.

Brady, T., Bruno, F., Marchionni, C., & Paquet, F. (2016). Prevalence and Maintenance Practices of Peripheral Intravenous Catheters. Vascular Access, 10(2), 11–19.

Canadian Vascular Access Association. (2019). Canadian Vascular Access and Infusion Therapy Guidelines. Pembroke, ON: Pappin Communications Helm, Robert, Klausner, Jeffrey, MD, MPH, Klemperer, John, Flint, Lori, BSN, RN, et al. (2019). Accepted but Unacceptable: Peripheral IV Catheter Failure. Journal of Infusion Nursing, 42, 151-164. https://doi.org/10.1097/NAN.0000000000000326 Lavery, I., & Smith, E. (2007). Peripheral vascular access devices: risk prevention and management. British journal of nursing (Mark Allen Publishing), 16(22), 1378–1383. https://doi.org/10.12968/bjon.2007.16.22.27767 Registered Nurses Association of Ontario. (2008, April). Care and Maintenance to Reduce Vascular Access Complications. Retrieved from https://rnao.ca/sites/rnaoca/files/Care_and_Maintenance_to_Reduce_Vascular_Access_Compl ications.pdf Rickard CM, Webster J, Wallis MC. Routine versus clinically indicated replacement of peripheral intravenous catheters: a randomized controlled equivalence trial. Lancet. 2012;380(9847):1066-1074.

ACKNOWLEDGEMENTS Barb Hooper, Clinical Leader Manager, Respirology Laxmi Devi, Registered Nurse Nida Irshad, Clinical Educator - Nursing Susan Beswick, Manager Evidence Based Nursing Practice

RECOMMENDATIONS/ NEXT STEPS Recommendations • Choose Wellness Activities based on what staff identify as important.

• Send out Calendar invites one week in-advance to allow for planning.

• Activities that involve creating and participation overall garnered more positive feedback and higher numbers in attendance.

Next Steps • Create a Workplace Wellness Working Group to sustain wellness activities in the workplace.

• Apply for funding opportunities to support workplace wellness initiatives.

• Continue to survey staff and request feedback on wellness sessions to optimize workplace wellness.

• Disseminate findings to other health care settings to promote the implementation of wellness initiatives.

REFERENCES Alexander, G. (2013). Self-Care and Yoga—Academic—Practice Collaboration for Occupational Health. Workplace Health & Safety, 61(12), 510–513. https://doi.org/10.1177/216507991306101202 Bonamer, J., Aquino-Russell, C. (2019). Self-Care Strategies for Professional Development: Transcendental Meditation Reduces Compassion Fatigue and Improves Resilience for Nurses. Journal for Nurses in Professional Development, 35, 93-97. https://doi.org/10.1097/NND.0000000000000522 Kunzler, A. M., Helmreich, I., Chmitorz, A., König, J., Binder, H., Wessa, M., & Lieb, K. (2020). Psychological interventions to foster resilience in healthcare professionals. The Cochrane Database of Systematic Reviews, 7, CD012527. https://doi.org/10.1002/14651858.CD012527.pub2 Registered Nurses Association of Ontario. (2010, February).

Workplace health, safety and well-being of the nurse.

Retrieved from https://rnao.ca/sites/rnaoca/files/bpg/HWE._Workplace_Health_Safety_and_WellBein g_0.pdf Restauri, N., & Sheridan, A. D. (2020). Burnout and Posttraumatic Stress Disorder in the Coronavirus Disease 2019 (COVID19) Pandemic: Intersection, Impact, and Interventions.

Journal of the American College of Radiology : JACR, 17(7), 921–926. https://doi.org/10.1016/j.jacr.2020.05.021

ACKNOWLEDGEMENTS

CONCLUSION

Improving Completion Rate of Focused Assessments in MHESA BACKGROUND

31.14

25

0

Problem Statement: Health care workers are facing unprecedented levels of stress and uncertainty in their workplace due to the COVID-19 pandemic (Restauri & Sheridan, 2020). High levels of stress in the workplace is associated with lower job satisfaction, burn-out, poor patient outcomes, and higher rates of turnover among staff (Bonamer & Aquino-Russell, 2019).

Resilience Scores in Community Mental Health Staff

35

Resilience Score

FOCUS

Thank you to all the Community Mental Health Staff, Nicole Kirwan (CLM), Jenna Gourdeau (Team Lead), Susan Beswick (Professional Practice Mentor), Chantal Sinclair (Wellness Coordinator), Nursing Practice and Education, and RNAO.

In May 2021, St. Michael’s celebrated our ninth year as a designated RNAO BPSO and the implementation of 45 BPGs since 2009. Annually during Nursing Week, BPG Nurse Champions showcase their work during the BPG Poster Gallery Walk. This Gallery Walk demonstrates quality improvement initiatives that are informed by RNAO BPGs and contribute to quality patient care.

For the second year in a row, we have had to celebrate virtually, and recognize the many nurses and teams who were instrumental in implementing, spreading and sustaining 23 BPG quality improvement initiatives across 21 different clinical areas from October 2020 to March 2021. A Virtual BPG Poster Gallery Walk was posted on the intranet to share the excellent work done by this year’s champions.

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Highlights from 2020-21 Best Practice Guidelines Communities of Practice Photo of BPG Champion, Chinnie Edradan, RN

From October 2020 until March 2021 23 BPG quality improvement initiatives were implemented across 21 different clinical areas. These initiatives were led by 31 BPG Nurse Champions and supported by 26 BPG Unit Mentors and 3 Professional Practice Mentors.

This year more than ever, due to the focus on COVID-19, it was important to support the Best Practice Guideline (BPG) Nurse Champions to ensure success as we continued our Best Practice Spotlight Organization (BPSO) sustainability and designation with the Registered Nurses’ Association of Ontario (RNAO). Communities of Practice (CoP) have been used not only as a form of mentorship, but also an opportunity to support the development of BPG Nurse Champions and teams in implementing and sustaining BPGs. This year, the CoPs were held virtually. The first half of the CoP was dedicated to round table discussions that gave BPG Nurse Champions the opportunity to share experiences, including successes and challenges related to implementing their BPG initiatives. The second half focused on methodologies of quality improvement and education in support of the professional development of BPG Nurse Champions, providing them with strategies and tools that could be applied to the implementation of their BPG initiatives. Despite the virtual format, the BPG Nurse champions demonstrated their adaptability and resilience during a challenging time, and persevered to complete their BPG initiatives.

The evaluation and feedback received from BPG Nurse Champions who participated in the 2020/21 Communities’ of Practice was positive. Here are a few comments from BPG Nurse Champions.

Loved the comradery and dedication from everyone on their topics. Had fun participating and working on my initiative!

“Thank you, Nursing professional practice team. This was a great learning experience.”

45 BPGs and Counting…

1.

2.

Adopting eHealth Solutions: Implementation Strategies Assessment and Management of Pain

3.

Assessment and Device Selection for Vascular Access

4.

5.

6.

7.

8.

Assessment and Management of Foot Ulcers for People with Diabetes Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition Assessment and Management of Venous Leg Ulcers Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour Breastfeeding Best Practice Guidelines for Nurses

9.

Breastfeeding – Promoting and Supporting the Initiation, Exclusivity, and Continuation of Breastfeeding for Newborns, Infants, and Young Children

10.

11.

12.

13.

14.

15.

16.

17.

18.

Caregiving Strategies for Older Adults with Delirium, Dementia and Depression Care and Maintenance to Reduce Vascular Access Complications Care Transitions Client Centred Care Client Centred Learning Crisis Intervention Decision Support for Adults Living with Chronic Kidney Disease Delirium, Dementia and Depression in Older Adults Developing and Sustaining Effective Staffing and Workload Practices

19. Developing and Sustaining Interprofessional Health care: Optimizing patients/clients, organizational and system outcomes 20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

39.

40.

41.

42.

43.

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45.

End of Life Care During the Last Days and Hours Engaging Clients Who Use Substances Embracing Cultural Diversity in Health Care Establishing Therapeutic Relationships (ETR) Intra-Professional Collaborative Practice Among Nurses Integrating Smoking Cessation into Daily Nursing Practice Interventions for Postpartum Depression Managing and Mitigating Conflict in Health Care Teams Nursing Management of Hypertension Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease Person and Family Centred Care Preventing and Managing Violence in the Workplace Preventing Falls and Reducing Injuries from Falls Prevention of Falls and Fall Injuries in the Older Adult Preventing and Mitigating Nurse Fatigue in Health Care Preventing Violence, Harassment and Bullying Against Health Workers Professionalism in Nursing Promoting Safety: Alternative Approaches to the Use of Restraints Promotion of Continence using Prompted Voiding Risk Assessment & Prevention of Pressure Ulcers Screening for Delirium, Dementia and Depression in Older Adults Strategies to Support Self Management in Chronic Conditions Supporting and Strengthening Families through Expected and Unexpected Events Stroke Assessment Across the Continuum of Care Woman Abuse: Screening, Identification and Initial Response Workplace Health, Safety and Well-Being of the Nurse FALL 2021 I 9

with Rosalyn Espiritu

Evidence Based Nursing Practice Leader

What does being a BPSO mean to you?

What is one memorable BPSO moment for you?

Being able to work at Unity Health and to be part of St. Michael’s Hospital, a designated Registered Nurses’ Association of Ontario (RNAO) Best Practice Spotlight Organization (BPSO) makes me so proud. The hard work that goes into implementing, spreading and sustaining all the Best Practice Guidelines throughout these years demonstrates our ongoing commitment to our patients, families and broader community. Being a BPSO means that we strive to provide the highest standard of care for our patients and that we are dedicated to mentoring nurses to be clinical leaders in their areas who are committed to expanding an evidence based practice culture.

I know COVID-19 has taken up a lot of our space over the last year, but for me, what sticks out in my mind as a memorable BPSO moment is the BPG Nurse Champions resilience and perseverance as they worked on their initiatives. With the many competing priorities that this roster of Champions experienced this year, they remained committed to participating in the Communities of Practice despite it being virtual, committed to learning and developing their Quality Improvement skills, and committed to carrying out their BPG initiatives. Their resolve to implement their BPG and see their initiatives through, and having them share their work with not only their BPG Nurse Champion peers and mentors, but also with the wider organization via the Poster Gallery was so rewarding for me to witness, and the positive impact of these initiatives for our patients, families and staff is just the icing on the cake!

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Did you know...

You can access BPG Nurse Champion Tools on the BPSO intranet site under Tools and Resources.

Stay tuned...

Starting in October, a new group of nurses will take on the role of BPG Nurse Champion to lead the implementation, evaluation and sustainability of BPG initiatives in their local units.

FAST FACTS Over the course of our 2016-2020 BPSO Designation Term…

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160 RNs

112 BPG

participated in the BPG Communities of Practice

initiatives implemented

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107

BPG Sustainability Posters displayed during the Nursing Week BPG Sustainability Walk

Please send your comments or story ideas to Rosalyn Espiritu rosalyn.espiritu@unityhealth.to Shining the Light on St. Michael’s Best Practice Spotlight Organization Achievements is an annual newsletter created by the Nursing Practice and Education Department at Unity Health Toronto, St. Michael’s Hospital.

Design and Photography by Medical Media Centre, Unity Health Toronto