Our Shared Purpose newsletter: October 2018

OUR SHARED PURPOSE October 2018

Finding the right number of tests New project provides doctors with an opportunity to reflect (pg. 8)

Protecting our communities Naloxone now available in Emergency Department (pg. 2)

HONOURING A LIFE NOT LIVED How a small gift is making a big difference to patients (pg. 4)

Risky business An interactive session is helping teens come to grips with trauma (pg. 7)

Butt out Quitting smoking may be the latest benefit of receiving rehab (pg.3)

FIT TO QUIT Research at Providence helps patients with smoking cessation

HELPING PREVENT DEATH

BY OVERDOSES

BY ANA GAJIC

BY SELMA AL-SAMARRAI

These Naloxone nasal spray kits will be distributed to individuals using opioids who require care in our network’s two emergency departments

A smoking cessation trial at Providence was effective and worthy of implementing for all patients, say James Lam, director of Clinical Services, and Vivian Li, a pharmacist specialist.

(Photo by Ramon Syyap)

Naloxone, a drug that helps reverse an opioid overdose,

support the journey of recovery,” says Leighanne MacKenzie,

is now available for free to individuals using opioids and

program director of Inner City Health at St. Michael’s.

seeking care in the emergency department at St. Joseph’s.

If naloxone is administered as soon as an individual shows signs

Naloxone will also be available soon at the St. Michael’s

of an opioid overdose it can temporarily reverse the opioid’s

For a patient admitted to an in-patient unit at a rehabilitation

patients in-hospital and co-ordinated follow-up calls after

emergency department.

effects. But emergency medical attention is still needed and

hospital, that hospital becomes home for at least a couple of

discharge.

it’s essential that a call is also made to 911 immediately.

weeks, and sometimes months. A patient in this setting will

often have the opportunity to focus on accomplishing key

rates were significantly higher for those who had received

goals – both rehab-related and otherwise.

the intervention than those who had not participated in the

OMSC. “Our original business case was to demonstrate that

“We send an explicit message to our patients and their

friends, family and contacts when we hand them naloxone kits upon discharge - we’re telling them this is a dangerous condition and one that can represent repetitive behaviour,” says Dr. Glen Bandiera, who recently wrapped his term as chief of Emergency Department Services at

“

The process of

dispensing naloxone

keeps people alive so

we can connect them

St. Michael’s.

with services to support

the journey to recovery

“We will emphasize that there are

treatments available, but also that until they access successful addictions treatment, we want to prevent death by overdose.”

LEIGHANNE MACKENZIE PROGRAM DIRECTOR

Substance use treatment is multifaceted: it includes

A large majority of opioid overdoses

seen in emergency departments are from using street drugs.

“We know addiction issues are seen

across all socioeconomic status groups,” says Paula Podolski, administrative director for St. Joseph’s Emergency Department.

“Many who struggle with addictions

are either not aware of resources available, or may require multiple attempts to engage them in recovery before they are ready to

take the first step.”

Other resources currently offered at St. Joseph’s and

medication, pharmacological support, medical support, and

St. Michael’s include treatment services such as Rapid Access

psychosocial support.

Clinics, harm reduction services such as needle exchange

programs, and specialized programs such as the Toronto

“The process of dispensing naloxone keeps people alive

so that we can connect them with the services available to Our Shared Purpose is a monthly newsletter highlighting our people and the ways they are improving care, patient experience and the health of our communities.

Centre for Substance Use in Pregnancy.

At Providence Healthcare, James Lam, director of Clinical

Services, saw the opportunity to help patients tackle smoking cessation.

He teamed up with the University of Ottawa Heart Institute’s Ottawa Model for Smoking Cessation (OMSC) program to pilot a study at Providence and help patients who identified as smokers quit during their stay.

“The OMSC is the gold standard for

smoking cessation in hospital settings,” Lam says. “We tailored the approach

“

At three months after discharge, self-reported abstinence

a pharmacist-led intervention in a rehab

This will give the OMSC more data to inform them of current trends.

We are contributing to a collective dataset that will benefit patients JAMES LAM DIRECTOR OF CLINICAL SERVICES

setting could work, and our research proved that it did,” Lam says.

Now, the intervention is available

to all patients who enter Providence’s doors and identify as smokers. Li continues to support and follow-up with patients, contributing information to the OMSC’s larger database that will inform future studies and practices across Canada.

for our setting. It was most logical to have pharmacists lead

the initiative as they take an active role in medication-related

which means we have a lot of data,” Li says. “This will give the

activities at Providence.”

OMSC more data to inform them of current trends. We are

contributing to a collective dataset that will benefit patients

Vivian Li, a pharmacist specialist who had been trained as

a Certified Tobacco Educator, provided cessation intervention

“We are one of the largest rehab hospitals in the province,

in our hospital and beyond.”

at the bedside for the one-year pilot study. She consulted with

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WHAT’S IN

GABRIEL’S GIFT?

GABRIEL’S

GIFT

helping parents create memories after stillbirths and neonatal loss

A hand written letter from Crozier

A book titled: “Wherever you are: My Love Will Find You”

Hand knit blanket

by Jennifer’s mother Joni Asboth

Candle

Book about parenting through loss named “Loving Your Baby” by Shari Morash

Tiny baby bereavement outfit

Towels and toiletries should the parents want to bathe their baby

Keepsake hand-prints or foot-prints kit

Photo album to remind families to take pictures

Soft bunny plush toy

Information guide

High-quality paper and ink set for hand and foot prints

Capsule for hair clippings

Memory book

Journal

BY SELMA AL-SAMARRAI

Pictured here are Crozier’s two other sons: five-year-old Nathaniel, who was born before Gabriel, and two-year-old Joshua Gabriel, who was born almost exactly a year after.

Jennifer Crozier was nine months pregnant when she

says. Through this painful experience, and through hearing

experienced the unimaginable. She noticed a change in her

similar experiences from other mothers coping with the

unborn baby’s movement, and was told at a subsequent

aftermath of stillbirths or neonatal loss, Crozier came up with

appointment that his umbilical cord had wrapped around

the idea of creating a box of items to help mourning parents

his neck and stopped his breathing.

gather memories of their babies in the short time they get to

spend with them. She named the box Gabriel’s Gift.

Crozier was admitted to St. Michael’s knowing that her

delivery of Gabriel would be a stillbirth.

“I didn’t believe he was dead. I just

kept hoping they were wrong,” says Crozier of her initial reaction to the news.

“After the birth, you’re just in a state

of shock and you’re not thinking very clearly. I had prepared very well for a living baby but I had no idea what to do with my baby now.”

When she left St. Michael’s, Crozier

found her grieving was compounded by the fact that she had very few mementos

“I learned that an important part in many people’s healing is memorializing their child in some way.

“

After the birth, you’re just in a state of shock...

I had prepared very well for a living baby but I had no idea what to do with my baby now JENNIFER CROZIER GABRIEL’S GIFT

I didn’t get beautiful pictures or enough of Gabriel’s hair. Gabriel’s Gift was born out of that, as a place for people to touch

and hold the memories of their child,” says

and neonatal intensive care unit at St. Michael’s, has often

families right off the bat that they’re not alone.”

Crozier.

witnessed the huge impact that Gabriel’s Gift has on parents

dealing with a stillbirth or neonatal loss.

Nathaniel, who was born before Gabriel, and two-year-old

including a handwritten letter from

“Everyone reacts so differently in their grief, but one

Joshua Gabriel, who was born almost exactly a year after.

Crozier explaining why she started this

common theme I see over and over again is this paralysis that

She creates and delivers a Gabriel’s Gift box to St. Michael’s

box, a book titled “Wherever You Are: My

comes after loss, of really not knowing what you need, and

whenever the supply is low.

Love Will Find You,” a blanket, baby outfit,

that’s where I see that Gabriel’s Gift has been such a gift for

organic toiletries should the parents want

families,” says Hignell.

of our lives is to leave behind a legacy of good and love in the world. That’s what I’m trying to do for Gabriel,” Crozier says,

Gabriel’s Gift contains 15 items

Amanda Hignell, a social worker at the maternity unit

of Gabriel.

to bathe their baby, and a clay set for handprints or footprints.

Crozier started Gabriel’s Gift at St. Michael’s in January

forever even if they haven’t lived beyond birth and so having

felt that I needed to hold something of Gabriel’s but I hadn’t

2016, only five months after Gabriel was delivered. Dozens of

an opportunity to create these memories to hold on to and

collected enough memories of him to be able to do so,” Crozier

families have since received the box.

to honour their child In memory is so important. The impact

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“My home felt so empty and I had nothing to touch. I

OUR SHARED PURPOSE

“As awful as this moment is, the baby is part of the family

of Gabriel’s Gift that I’ve witnessed is monumental. It reminds Crozier is now a mother to two sons, five-year-old

“I think that the best that we can all hope for at the end

“give him a legacy of compassion and love for other people.”

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WHO ARE YOU PROTECTING?

QUALITY IN ACTION

The flu is a serious illness – it causes more than 12,000 hospitalizations and 3,500 deaths in Canada every year. While everyone is at risk, there can be additional complications for children under five years old, people over 65, pregnant women and people with underlying health conditions including asthma, heart disease or diabetes – people we see as patients in our hospitals every day.

You can help keep yourself, your loved ones, patients and colleagues safe this flu season by getting your flu shot – vaccination remains the single most effective way to protect the people around you. The shot will be available at all three sites during flu season, including at mobile clinics – keep an eye on your site’s internal communications for more details.

SIMULATING CONSEQUENCES

BY MARY DICKIE

NEW PYXIS MEDSTATIONS SAVE TIME AND IMPROVE SAFETY New automatic drug dispensing cabinets called Pyxis MedStations are rolling out to positive reviews on hospital units at St. Michael’s. In April, 7 Cardinal Carter South became the first of four units to get one. Eventually, they’ll be found hospital-wide. The cabinets improve patient safety by limiting access only to drawers with medications prescribed for each patient. Nurses log in with their ID and then call up patient profiles to request drugs tied to active physician orders that have been validated by pharmacists. The cabinets also save time and improve efficiency by proactively tracking usage, supply and expiry dates – enabling nurses to be at the bedside instead of performing inventory-related functions.

High school students participate in a hands-on trauma simulation scenario as part of St. Michael’s Think First Injury Prevention Strategy for Youth.

The TIPSY program, which uses the Allan Waters Family Simulation Centre labs and mannequins, starts up again Oct. 12.

Helping teenagers lose their assumptions of invincibility,

Waters Family Simulation Centre, where students participate

face the realities of traumatic injuries and learn to avoid risky

in a hands-on trauma simulation scenario using a high-tech

behaviours are the aims of a popular educational program

mannequin.

offered through the school year at St. Michael’s.

ordinator Vasuki Paramalingam.

The ThinkFirst Injury Prevention Strategy for Youth

(TIPSY) offers interactive sessions with critical care and emergency nurses,

Registered nurse Yvonne To accesses medications from the Pyxis MedStation on 7 CCN while RNs Kim Le and Kiley Hunt witness.

(Photo by Yuri Markarov)

trauma victims, simulation teams, Toronto Police and Mothers Against Drunk Driving. A collaboration between St. Michael’s Trauma and Neurosurgery

SHARING MEDICAL DATA SHARING MEDICAL IMAGING DATA TO CUT RADIATION DOSES TO CUT RADIATION DOSES Patients might expect radiation doses for CT scans to be Patients might expect radiation doses for CT scans to be comparable comparable from one hospital to the next, but a team at from one hospital to the next, but a team at St. Michael’s Hospital St. Michael’s Hospital says the dose variance can be startling. says the dose variance can be startling. The team is collecting and The team is collecting and analyzing data from eight hospitals analyzing data from eight hospitals for the Medical Imaging Metadata for the Medical Imaging Metadata Repository of Ontario (MIMRO) Repository of Ontario (MIMRO) to help reduce the province’s to help reduce the province’s average radiation dose per scan. average radiation dose per scan. Using artificial intelligence to Using artificial intelligence to sort the hospitals’ data, the team sort the hospitals’ data, the team generated comparative data by generated comparative data by facility, scanner and exam to help facility, scanner and exam to help determine best practices. MIMRO determine best practices. MIMRO is funded primarily by is funded primarily by St. Michael’s and was created by two of its St. Michael’s and was created by two of its radiologists, radiologists, Drs. Timothy Dowdell and Bruce Gray.

Drs. Timothy Dowdell and Bruce Gray.

Radiologist Dr.and Bruce Gray and data analyst Lianne review Concepcion Radiologist Dr. Bruce Gray data analyst Lianne Concepcion data review data submitted toto MIMRO. (Photo

by Katie Katie Cooper) Cooper) submitted MIMRO. (Photo: 6

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Program and the Allan Waters Family Simulation Centre, TIPSY challenges

We really want the students to understand that there are consequences to everything they do and every decision they make.

high school students to think twice before taking risks and to face the realities of traumatic injuries and disabilities.

“

“They love it, because it’s very interactive,” says TIPSY co-

VASUKI PARAMALINGAM TIPSY CO-ORDINATOR

St. Michael’s treats about 1,000 trauma patients a year.

Young people aged 15 to 19 are

at the highest risk of being killed by motor vehicle collisions, the leading cause of death for this age group. These crashes can also leave survivors needing permanent breathing or feeding tubes and with no control over their bladder or bowels.

TIPSY presents the consequences of

risky behaviours to the students through videos and first-person stories.

“Some of them feel light-headed, because it can be

Motor vehicle crashes and falls are the main causes of injury,

overwhelming,” admits Butorac. “But we really want the

while texting and driving has now surpassed alcohol as the

students to understand that there are consequences to

leading cause of collisions.

everything they do and every decision they make. We give

them tangible information so they can make better choices

Elizabeth Butorac, interim program director of Trauma/

Neurosurgery, and her late colleague Julie Mauceri started

— and not end up here.”

TIPSY in 2006. In 2014, the team added activities at the Allan

The TIPSY program starts up again this month.

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HERE’S HOW MANY TESTS YOU ORDERED

BY EMILY DAWSON

Members of the BPiM team (L-R): Dr. Ajay Kapur; Sharon Mulsant; Mallory Jackman; Elizabeth Wooster; Dr. Donna Arab-O’Brien; and Dr. Maria Pasic Not pictured: Craig Barnes; Dr. Raheem Kherani; Dr. Jerry Maniate; Dr. Rishie Seth; Dr. Jennifer Taher; Dr. Victor Tron

An interprofessional research team at St. Joseph’s recently

collected through hospital records, the team stratified the

launched the Best Practices in Medicine (BPiM) project,

data to present 66 practitioners with a personal “scorecard”

which marries a personalized audit and an online learning

comparing their own order rates within a specific period

tool to help practitioners ‘right-size’ their laboratory and

against the entire hospital, their department, and their

diagnostic imaging test utilization rates.

division.

“The impact of over-utilization on health-care costs and

patient care has been a hot topic in the medical community,”

After reviewing their results, practitioners can voluntarily

take an e-learning course about best practices in test ordering.

says Dr. Ajay Kapur, chief medical information officer at St. Joseph’s. “We saw an opportunity to help practitioners reflect on their own practices and offer education to support behavioural changes.”

A key differentiator of the St. Joseph’s

research is that it examines both overutilization and under-utilization and it occurs in a community hospital.

“This is about guided self-reflection

“

The purpose is to ensure that the right test is ordered for the right patient at the right time.

ELIZABETH WOOSTER RESEARCH ASSOCIATE

with a goal to improve patient care,” says Wooster. “The purpose is to ensure that the right test is ordered for the right patient, at the right time.” Dr. Kapur says the feedback about the project has been excellent.

“The majority have said this is a

useful tool. Even if people choose not to

“While not as widely discussed, under-utilization of

complete the e-learning, they’re talking about it and informally

tests is also cause for concern. It can result in insufficient

learning from each other,” he says, adding he’s excited by the

information being available for diagnosis and patients not

opportunities to leverage BPiM for other tests, and across

receiving appropriate care,” explains Elizabeth Wooster,

health disciplines.

research associate in St. Joseph’s Department of Medical

Education and Scholarship.

patient care. Now we can focus on expanding it beyond the

department of medicine.”

The research team started with two commonly ordered

tests: Thyroid Stimulating Hormone and Vitamin D. Using data

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“The BPiM methodology can be applied to any aspect of