The Interview: July - September 2018

THE

Clinical Ethicist

INSIDE THE ISSUE •

Turks and Caicos Islands Hospital unveils state of the art ventilator equipment.

•

Interim CEO Gaston Levac completes his assignment as Daniel Carriere returns.

•

Employees compete in a weight loss challenge for the biggest loser title.

•

Facilities Management introduce more ecofriendly practices at TCI Hospital.

•

Two highly skilled doctors share their love story and passion for patient care.

US BOARD CERTIFIED SURGEONS

LIVE ABOVE THE LINES.

Call +1 649 941 2800

3

THE INTERVIEW

Energy efficiency is particularly important in  hospital settings with 24 hours a day, 365 days a year services.

Ecofriendly Decisions  Hospitals consume large amounts of energy due to the nature of their operations and high utilization by employees, patients and visitors. Sophisticated heating, ventilation, and air conditioning systems control the temperatures and air flow. Several energy intensive activities also occur within the building. These include laundry, medical and lab equipment use, sterilization, computer and server usage, food services, and refrigeration.

The concept of Corporate Social Responsibility upholds that companies have a degree of responsibility not only for the economic consequences of their activities, but also for the social and environmental implications. The department responsible for the physical infrastructure at InterHealth Canada - Turks and Caicos Islands Hospital adheres to numerous environmentally friendly practices. In recent months, more robust energy-efficient measures were introduced to save on health care expenditure. Thousands of traditional light fixtures have been replaced across both medical centers with safer, cooler and energy efficient LED incandescent alternatives.

4

THE INTERVIEW

the adoption of more sustainable practices.

New industrial chilled-water systems were installed last year, which helps to reduce the hospital’s carbon footprint by a large percentage compared to its predecessor. These systems provide air conditioning across the hospital’s two medical centers.

Energy efficiency reduces running costs for hospitals, lowers carbon emissions and shows the public that a company is environmentally aware.

Operating rooms are typically among hospitals’ heaviest users of supplies and a large producer of waste. Creative ideas are being sought to recycle sterile wrappers and other items in an effort to promote environmental stewardship in the coming years.

One of the most cost effective means of reducing energy consumption is by setting the temperature back on air handling units when a department is unoccupied or closed.

The same best practice is enforced at TCI Hospital along with conservation efforts to encourage staff to turn off lights and any equipment after use. The hospital’s industrial plant has stringent planned preventative maintenance strategies to ensure any equipment used is the most efficient possible and there are several contractual requirements to monitor the building’s utility efficiency as part of the project agreement between InterHealth Canada and the Turks and Caicos Islands Government.

5

Additional practices implemented to create a more eco-friendly operation include the selection and use of cleaning products with minimal environmental impact. The chemicals in many cleaners are common pollutants. The company has also switched from conventional products to locally produced recyclable toilet paper and hand towels.

InterHealth Canada - Turks and Caicos Islands Hospital hosted a Medical Ethics Symposium for nearly 70 health care professionals at the Cheshire Hall Medical Centre on September 14th, 2018 under the theme “Informed Consent - Recommended Best Practices.�

Claire Horner, a Clinical Ethicist, Lawyer and Assistant Professor at the Centre for Medical Ethics and Health Policy at Baylor College of Medicine gave a keynote presentation. Horner stressed that informed consent is a process and not simply a form.

This process involves several critical elements including disclosure of information, effective documentation, a patient’s right to refuse treatment and exceptions to the informed consent rule in cases of emergency, incapacity, waiver or therapeutic privilege. The presentation provided an overview of the ethics of informed consent, shared decisionmaking, cognitive biases, decision aids, the difficulties associated with hard cases and what health care professionals should avoid.

Informed consent is based on the moral and legal premise of patient autonomy and their right to make decisions about a particular treatment or test with an understanding of the risks and benefits. The symposium was developed to exchange knowledge on the latest best practices, common challenges and pitfalls associated with soliciting informed consent from patients.

6

Other speakers based at the medical facility included Dr. Henry Blythe, General Practitioner who provided a regional perspective in partnership with Dr. Dionne Ranglin-Robinson, Anesthesiologist, who evaluated several key findings from a unique study on informed consent. The event was chaired by TCI Hospital Chief of Medical Services, Dr. Denise BraithwaiteTennant.

ADVANCE HEALTHCARE DIRECTIVES, OR A LIVING WILL THAT PRE-DOCUMENTS A PATIENT’S WISHES CONCERNING MEDICAL TREATMENTS AT THE END OF LIFE OR INCAPACITATION IS A GROWING PRACTICE IN MANY JURISDICTIONS. Persons are encouraged to make decisions ahead of time so their care is aligned with their preferences and/or nominate a relative or friend to be their alternate decision maker in cases where informed consent is required. During the visit to the medical facility, Horner also conducted a special CME session and reviewed the hospital’s current policies and standards of practice related to informed consent. The expert’s recommendations will be used to further strengthen the existing framework. Other areas examined included practices related to Do Not Resuscitate (DNR) Orders and the withdrawal of LifeSustaining Care. The symposium is held every two years, and is extended to health care practitioners from across the country to promote standardized practices across community medical facilities to benefit the patient’s continuum of care.

7

"AS PART OF OUR QUALITY IMPROVEMENT, WE WANT PATIENTS TO BECOME MORE INVOLVED IN THEIR CARE. IT IS OKAY TO ASK WHY, OR DISAGREE WITH A PROPOSED TREATMENT. IT IS IMPORTANT TO REQUIRE FULL DISCLOSURE. MEDICAL CARE SHOULD NO LONGER BE APPROACHED IN A PATERNALISTIC MANNER AND PATIENTS HAVE THE RIGHT TO QUESTION THEIR CARE."

DR. HENRY BLYTHE CHAIRMAN OF THE MEDICAL ETHICS COMMITTEE AT TCI HOSPITAL

8

THE INTERVIEW

Informed consent represents one of the major tenets of medical ethics. This consent may be in the form of a consent document, verbal or implied. There are some cases that require written consent such as invasive procedures. It is important for our staff to be knowledgeable of the different scenarios where each of these cases apply.

INTERHEALTH CANADA A MAJOR SPONSOR OF CLINIC EXPLORATION PROGRAM 2018

9

TCI HOSPITAL TRAINING CENTRE

THE INTERVIEW

10

TCI Hospital has been tasked with providing a series of refresher training in CPR and First Aid to members of the Royal Turks and Caicos Islands Police Force. The sessions are scheduled to continue into October 2018. Participants have displayed great care and competence in the application of these life saving skills.

11

inspiration

THE BIGGEST LOSER MATCH The Human Resources Department at the TCI Hospital

EACH DAY IS A NEW OPPORTUNITY TO IMPROVE YOURSELF. TAKE IT AND MAKE THE MOST OF IT.

launched several initiatives during the third quarter of 2018 to promote continuous learning, health and wellness among employees.

‘Lunch and Learn’ is an informal opportunity for employees to learn at work. It is a one-hour session comprised of interactive discussions over a

The program is a combination of healthy eating tips,

complimentary lunch. The program was officially

weekly aerobic sessions held on property and group

launched on June 24, 2018 and is held twice per quarter.

exercises. All registrants were provided with a Biggest

The topics covered include an introduction to the

Loser Fact File, which include information on their

Employee Assistance Program called Inova, eating for a

personal weight loss record, healthy meal choices and

healthy life, work station ergonomics and building a

additional tips to accelerate weight loss.

culture of trust.

In addition, the program is supported by the Facilities The second initiative launched is a resurrection of a

Management division of the company, which has

weight loss challenge dubbed the Biggest Loser. The

agreed to offer discounted low calorie meals on Trim

initiative was launched on July 2, 2018 and will conclude

Down Thursdays in the hospital’s cafeteria. The first

on October 5, 2018. The primary objective of the

place prize is $500.00 and $200.00 for the second

program is to help employees reach their individual

participant to lose the most weight.

fitness goals and maintain a healthy eating ritual as part of a permanent life style change.

12

ST KITTS AND NEVIS DELEGATION TOURS HOSPITAL

delegation from the Government of St. Kitts and Nevis visited the Turks and Caicos Islands Hospital on August 14, 2018 to learn more about the health care facility in pursuit of a similar National Health Insurance (NHI) program. The group conducted a tour of the Cheshire Hall Medical Centre and met with the senior management team to discuss the benefits and lessons learned from the perspective of the preferred acute secondary healthcare provider.

The delegation included the Permanent Secretary in the Ministry of Health and Gender Affairs and Chairperson for the National Commission for Universal Health Care in St Kitts and Nevis. The NHI is a proposed national system of shared contributions and prepayment by all persons for a package of health services to meet the health needs of the population. The Government of St. Kitts and Nevis unveiled a National Health Insurance Commission earlier this year.

13

Discussions with representatives from the National Health Insurance Board in the Turks and Caicos Islands was a major part of the exploration.

The St Kitts and Nevis Ministry of Health is the national entity charged with the responsibility for the organization and management of health services and for formulating health policy. The public sector provides both population and personal health services through its subsidiary 20-year-old Marianne Teigen divisions. recently published her first young adult novel, and in only a month, it has reached the New York Times Bestsellers list.

NEWS

TCI HOSPITAL UNVEILSÂ NEW STATE-OF-THE-ART VENTILATORS The ventilator improves the ease of breathing and has additional safety features.

14

advanced, safe, and smart design. The software is a breath type that better manages a patient’s work of breathing and supports more natural breathing compared to conventional mechanical ventilation.

15

. e v o l y it n u m Com

16

Thrombosis Awareness

Turks and Caicos Islands Hospital is planning to join the global movement to raise awareness of venous thromboembolism (VTE).

Recognised on 13 October, World Thrombosis Day (WTD) focuses attention on the often overlooked and misunderstood condition of thrombosis. With thousands of educational events in countries around the world, WTD and its partners place a global spotlight on thrombosis as an urgent and growing health problem.

17

THE INTERVIEW

STAFF BID FAREWELL TO

GASTON LEVAC, INTERIM CEO THE INTERVIEW

18

BEST WISHES.

APPRECIATION GATHERING FOR OUTGOING CEO

"I want to thank all TCI Hospital partners for having made my stay an interesting and learning experience. I wish you all the best.�

19

Love and Medicine

20

21

The promotion is as a result of ongoing succession planning within the nursing division and recognition of their hard work and dedication. The lead nurses will be coached and mentored, and will gain support from the team in their new role.

22

By Mikette Been Current Chief of Clinical Services Since Anne's departure to the UK three years ago, she had been doing well until four months ago when she was diagnosed with a terminal illness and was given 4 months of survival. On August 24th 2018 at 6:00am UK time, Anne passed away peacefully surrounded by family members. On behalf of all of us here at TCI Hospital, I have taken the liberty of sending our most heartfelt condolences and sympathy to Anne’s family. The InterHealth Canada board of directors have also conveyed their heartfelt sympathy to the family.

Anne Males will be deeply missed here and now leaves behind only those fond memories we have of her. Prior to her eminent death, she had asked me to congratulate the team on gaining diamond accreditation status for the third time and indicated that she was happy for TCI Hospital on such an achievement.

Anne always enjoyed working here and also enjoyed snorkeling in the turquoise water of the Turks and Caicos Islands. She certainly lived life to the fullest with a positive outlook, which she even said was contagious. She was a woman of valor and was committed to ensuring that nurses maintain high standards of practice. She was highly regarded by everyone who ever had the opportunity to work with her.

REMEMBERING ANNE MALES ANNE MALES SERVED AS CHIEF OF CLINICAL SERVICES AT TCI HOSPITAL DURING THE PERIOD APRIL 2012 MARCH 2016. SHE PASSED AWAY ON AUGUST 24TH 2018.

23

Back in 2012, after the departure of Kathleen Brea, the Chief of Clinical services at the time, Anne was appointed to the position where she worked tediously with the Nursing staff and provided coaching and mentoring to myself and other managers and staff until her departure in March 2016. Regardless of the challenges she might have had along the way, everyone who have ever had the privilege of working with her, always deemed it a special pleasure to work with Anne.

Anne was such an extraordinary person. This is truly a great loss to our Nursing profession, a friend and to our InterHealth community as a whole. Anne will be profoundly missed by everyone whose lives she have touched.Â

THE INTERVIEW

PROFESSIONAL DEVELOPMENT

24

Thank you for your service.

The Interview

25

THEINTERVIEW

BUILDING LOCAL CAPACITY THROUGH SUMMER OBSERVERSHIPS Glenae Stone Nursing Student and Providenciales Native, Glenae Stone recently participated in an observership at Cheshire Hall Medical Centre.

Glenae gave a presentation on ‘reducing the prevalence of kidney disease’ to highlight why the kidney’s are important and how the organ functions. She is currently pursuing a Bachelors degree in Adult Nursing at The University of Southampton in the UK, and intends to specialise in dialysis nursing thereafter.

Danielle Baptiste Science student and Grand Turk Native, Danielle Baptiste recently participated in an observership at Cockburn Town Medical Centre.

RYESHA HIGGS

MENTORING THE NEXT GENERATION Science Student and Providenciales Native, Ryesha Higgs recently participated in a two-week observership at Cheshire Hall Medical Centre. Ryesha gave a presentation on ‘Establishing an organ donor network in the Turks and Caicos Islands’.

The growing number of patients currently on Haemodialysis in need of a kidney transplant inspired the topic. Several areas were highlighted during the presentation. These included the different type of organ donations, benefits and risk analysis, network development and the importance of developing an organ procurement and transportation network.

She is currently pursuing a Bachelors degree in Neuropharmacology at Kings College in England.

The enthusiastic learner selected Antibiotic Associated Encephalopathy, a medical condition associated with abnormal brain function due to its connection with antimicrobial resistance, which is a global health care concern. Danielle is currently pursuing a Bachelors degree in Psychology with Cognitive Neuroscience at Leicester University in England.

Dasheya Been Biomedical Science student and Middle Caicos native, Dasheya Been recently participated in an observership at Turks and Caicos Islands Hospital.

On her final day, the inquisitive student gave a visual presentation to members of the hospital’s clinical team on the knowledge she has garnered about Haemodialysis during the observership. The presentation was titled “United, Believe in Cure to Promote Kidney Donations”. Been is currently in pursuit of a Bachelors degree in Biomedical Science at the University of Sheffield in England.

SANADIA FORBES Former participant of the TCI Clinic Exploration Program (TCICEP) and Biomedical Science student, Sanadia Forbes recently participated in an observership at TCI Hospital.

Forbes gave an impressive presentation on Fetal Surgery inside a board room of health care professionals on Friday. She provided a step-bystep overview of the surgical procedures involved in open fetal surgery, the conditions treated via this procedure with a focus on Myelomeningocele, post-operation recovery, and the future of fetal medicine.

Forbes is pursuing a Bachelors degree in Physiological Science at the University of Bristol in England.

26

"PERFECT FOR PARTIES AND CELEBRATIONS"

WORLD BREAST FEEDING WEEK

"BREAST MILK THERE IS LOVE AND THE PERFECT NUTRITION IN EVERY DROP"

27

28