Hospital News December 2023 Edition

Inside: From the CEO’s Desk | Ethics | Safe Medication | Nursing Pulse | Special Focus: Radiology

December 2023 Edition

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Contents December 2023 Edition

IN THIS ISSUE:

Enhancing patient care: The success of the support services attendant (SSA) in clinical units

Inside: From the CEO’s Desk | Ethics | Safe Medication | Nursing Pulse | Special Focus: Radiology

December 2023 Edition

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FEATURED

10

Solving the Opioid crisis Page 14

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▲ Cover story: Developing non-opioid, nonaddictive pain medication

14

▲ Special Focus: Radiology

20 ▲ Let’s make 2024 the year of cybersecurity in Canadian healthcare

COLUMNS Guest editorial .................4 In brief ..............................7

12

Nursing pulse ................15 From the CEO’s desk .....18 Ethics .............................28 Safe medication ............29 Long term care ...............30

▲ Health literacy tool helps bridge barriers between patients and care providers

First-of-its-kind smart clothing monitors glucose levels through sweat

16

5

▲ Pandemic sees hospital staffing challenges grow and rates of unintentional harm increase

17

Canada could be a world leader in precision medicine cancer treatments if governments remove barriers to access

W

www.hospitalnews.com Editor

Kristie Jones

By Louise Binder ith top cancer research institutes and a public healthcare system, Canada is poised to be a world leader in researching and providing innovative life-saving cancer treatments, called precision or targeted therapies. But this can only happen if federal, provincial and territorial governments remove barriers and allow more cancer patients access to both treatments and the tests necessary to determine if they are candidates for precision therapies.

This is the conclusion from a new report on precision medicines published by CONECTed, a network of oncology patient groups, where my organization is a member. The report, Getting Better, Faster: The Case for Optimizing Access to Precision Medicines in the Wake of the Revolution in Cancer Care provides 23 recommendations to overcome roadblocks for accessing care.

With cancer being the leading cause of death in Canada – accounting for about 28 per cent of all deaths – precision oncology treatments are desperately needed to reduce mortality and improve quality of life.

Precision medicine, a form of personalized medicine, uses diagnostics called biomarker testing which allows the cancer to be examined for genetic mutations that identify specific characteristics about a person’s tumour; the testing helps diagnose the cancer, plan individually tailored treatments and assess treatments or make a prognosis.

The most common treatments in precision oncology are small molecule drugs, biologics, monoclonal antibodies and immune-oncology.

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Precision medicine has resulted in significant advances in survival rates for many cancers, including chronic myelogenous leukemia, lung cancer, colorectal cancer and malignant melanoma.

Advanced staged cancer patients who receive personalized treatment based on their tumour’s biomarker results not only live longer but may well achieve a better quality of life due to fewer treatment serious side effects.

Unfortunately, not all patients have access to biomarker testing and, for those that do, not all results are being reported promptly to help inform clinical decisions in a timely manner. This means that patients do not know if precision medicine would help them. In addition, even those patients who do get biomarker testing in a timely manner often cannot access the treatments they need because public government reimbursement plans will not pay for them.

The role that precision medicine should play – ensuring the best treatment for the right patient when they need it – is still out of reach for so many.

“When I was diagnosed with melanoma in 2003, there were no treatment options. In 2007, melanoma was one of the first cancers to get precision medicine, saving my life,” says Kathleen Barnard, Founder and President of Save Your Skin Foundation. “Precision oncology marks a major advancement in cancer treatment from the days of cut, burn and chemo; it is like moving from oil lamps to high-efficiency light bulbs, transforming the way we diagnose and treat cancer, offering patients targeted therapies with fewer adverse side effects,” she says.

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NEWS

First-of-its-kind smart clothing monitors glucose levels through sweat BATTERYLESS SMART GARMENT PRODUCES ITS OWN ELECTRIC W CHARGE FROM EVERYDAY MOVEMENTS hile visiting a long-term care residence in 2016, chemical engineer Reza Eslami couldn’t help but notice a senior struggling to perform their finger prick diabetes test. He immediately thought there had to be a better way and pivoted his electrochemical research to investigate.

Now, seven years later, his startup – called Sensofine – is on the verge of revolutionizing diabetes management for the nearly 30% of Canadians living with the disease, by making blood-glucose monitoring as easy as putting on a shirt.

The groundbreaking work has earned Eslami the Mitacs Award for Outstanding Innovation – PhD, awarded by Mitacs, a national innovation organization that connects industry to the top talent they need to achieve their business goals and drive economic success. Delivery of Mitacs programs and partnerships is supported by the government of Ontario. The award will be presented at a ceremony at the National Arts Centre in Ottawa on November 22.

Eslami – who started his company as a PhD student at Toronto Metropolitan University (TMU) under the supervision of chemical engineering professors Dr. Hadis Zarrin and Dr. Mehrab Mehrvar – is being recognized for developing a first-of-its-kind smart garment that continuously measures blood sugar levels from sweat, using sensors and a body-adapted self-powered system that produces their own electric charge from everyday movements like walking. The innovation accurately measures blood-glucose levels from just microlitres of sweat (one-millionth of a litre), and if more sweat is required, it will automatically stimulate the skin to produce it. Readings are sent to any paired device, such as a smartphone, smartwatch or tablet.

As Eslami explained, the approach builds on earlier research into using sweat to measure glucose levels and

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LIKE WALKING

Photo credit: Adnan Larijani

is intended to be a precise, continuous and pain-free alternative to blood monitoring devices, like those that mount on an arm. “Because glucose is 100 times less concentrated in sweat than in blood, we expect our device to be more sensitive than existing blood-glucose monitors,” he said.

“We’re also removing the need to worry about battery life because only one to two hours of small, typical movements will provide enough energy to power the device for 24 hours.”

With his proof-of-concept complete – a wrist brace that is worn on the hand – Eslami is expecting to start user testing within the next year and is currently collaborating with Toronto-based OCAD University and WIMTACH (Wearable, Interactive and Mobile Technology Access Centre in Health) at Centennial College to develop the first batch of the beta version of the wearable device, which will be an undergarment. The company is also investigating more function-

al clothing as well as a wristband, with the goal of going to market in 2025.

A Governor General’s Gold Medal recipient who achieved a perfect grade point average, Eslami credits Mitacs for providing the funding and motivation required to see his idea through to fruition. “Mitacs has supported me through six collaborations, including the hiring of four full-time research interns, and has been instrumental in spring boarding my company’s launch, growth and path to commercialization,” he said, emphasizing the value of transferring scientific knowledge out of academic circles into industry, where it can positively impact people’s lives.

Moving forward, Eslami aims to further develop the platform to monitor as many as 13 health parameters, including joint movement, temperature and cortisol levels for stress manage-

ment. “We see this as a general health monitoring device, where you can rely on your sweat or skin, your clothing and an app on your phone to keep you healthy,” he said.

The Mitacs Award for Outstanding Innovation – PhD is presented to a Mitacs intern who has made a significant achievement in research and development innovation during their Mitacs-funded research. Mitacs is supported by funding from the Government of Canada and provincial and territorial governments across the country.

Eslami is one of nine Mitacs award winners nationally, chosen from thousands of researchers who take part in Mitacs programs each year. The remaining eight recipients were recognized for outstanding innovation, commercialization or exceptional H leadership in other areas of research. ■

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IN BRIEF

Reducing cyberattacks on Canadian health systems yberattacks targeting health information systems can cause considerable damage and stress, but there are ways to reduce the risk of these events, write authors in CMAJ (Canadian Medical Association Journal).

“With respect to cybersecurity, a bit of prevention is worth a terabyte of cure,” writes Vinyas Harish, MD/PhD candidate at the University of Toronto’s Temerty Faculty of Medicine, with coauthors, in an article outlining the impact of cyberattacks on Canadian health information systems and how clinicians in hospitals and individual clinics can improve their cybersecurity practices.

This advice is particularly relevant, with several hospitals in southwestern Ontario reporting a recent cyberattack that has caused substantial disruptions in patient care.

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“PREVENTING CYBERATTACKS INVOLVES NAVIGATING TRADE-OFFS BETWEEN KEEPING WORKFLOWS EFFICIENT AND REDUCING RISK AMID THREATS THAT ARE GROWING IN FREQUENCY, SEVERITY AND SOPHISTICATION.” The authors outline stages to help navigate cyberattacks, based on the US National Institute of Standards and Technology’s Cybersecurity Framework: • Prevention – be vigilant for phishing emails, use strong password and 2-factor authentication, ensure adequate network protection and other actions. This includes creating a cyberattack plan to use in case of an event.

• Detection – use antivirus software and be alert to suspicious activities, such as barred access to files, instal-

Continued from page 4

World leader “And it’s wonderful to see these advances expanding into other cancers.”

The truth is, Canada is under resourced when it comes to making our clinical trial and approval processes work at the speed needed by patients, resulting in delays on a number of fronts, according to experts. We need to better streamline and support our health research ecosystem in Canada.

The report found that Canada’s fragmented health care delivery is another barrier because each province/territory makes its own decisions about which treatments to fund, leaving Canadians with unequal access to the medications they need with some cancer patients struggling to pay for life-saving therapies on their own.

Federal and provincial/territorial governments must work with cancer patient groups to assess health systems across the country to ensure alignment and prevent duplication and inefficiencies across the various systems, the report concludes.

The report also calls for a change in focus for health care funding. Value-based health care is a new vision of the health care system where the focus of every stakeholder is on improving value for patients relative to the dollars spent, providing better patient outcomes and a more cost-effective health care system.

The number of people diagnosed with cancer is rising each year. In 2021, it was estimated that in Canada, 44 per cent of men and 43 per cent of women would develop cancer in their lifetime, and about 26 per cent of men and 22 per cent of women were expected to die as a result.

Timely access to precision medicines can transform the lives of people in Canada with cancer. This report presents a realistic path forward for making the changes necessary for precision medicine to leap forward in Canada. It offers great promise not only for cancer patients and their families, but the H health care system as a whole. ■

Louise Binder is the health policy consultant for Save Your Skin Foundation.

6 HOSPITAL NEWS DECEMBER 2023

lation of unrecognized software and more.

• Response – immediately disconnect devices from the Internet, activate your cyberattack plan and notify individuals affected by the attack.

• Recovery – this depends heavily on having health information systems

that allow for restoration from backups, ensuring external vendors help with data recovery and conducting an internal debrief on the response.

“Preventing cyberattacks involves navigating trade-offs between keeping workflows efficient and reducing risk amid threats that are growing in frequency, severity and sophistication. As national and regional policies develop, health organizations, practices and individual clinicians must take a proactive approach to improving their cybersecurity posture,” the authors conclude.

“Cyberattacks on Canadian health information systems” was published H November 20, 2023. ■

New “Pink Zone” project catching attention of area hospitals oyal Victoria Regional Health Centre’s (RVH) new Minor Conditions Booking Portal “Pink Zone” is attracting attention from hospitals around the province eager to replicate the success of the health centre’s homegrown Emergency Department (ED) project. Collingwood General and Marine Hospital (CGMH) recently launched a pilot of the RVH model this week.

For this initiative, which is being tracked by a rigorous research protocol, patients with minor limb ailments such as a sprain, strain, or a simple break, or those exhibiting cold, or flu symptoms are eligible to prebook same or next-day appointments. Before confirming their booking, patients must take a quick self-assessment to ensure their condition does not require immediate attention. Once they arrive for their appointment, they enter the health centre through a designated entrance and wait in a separate area away from the Emergency Department called the “Pink Zone.”

The purpose of the project is to help mitigate ED challenges such as long wait times and overcrowding. Early data indicates it’s working. Giving low-acuity, symptom-specific patients

R

an alternative to seeking care in the ED reduces the number of people in ED waiting rooms. Further, patients in the “Pink Zone” are being seen within half an hour of arrival and out the door, complete with necessary imaging or labs, in less than 1.5 hours instead of waiting four or more in the ED while physicians attend to sicker, more acute patients first.

To date, 500 patients have not had to seek treatment in the ED by booking an appointment in the “Pink Zone.”

“Recognizing both the importance of healthcare access for those in Simcoe County and the severe challenges faced by EDs across the province, our team worked hard to develop this unique approach,” says Dr, Christopher Zanette RVH’s Chief of Emergency. “Our hope is that other organizations can utilize what we have learned in their communities, resulting in better quality and access to care in the region and across the province.”

Data from this new system, including data from CGMH’s pilot, is being compiled until April 30, 2024.

Patients can book next and same day appointments Monday to Friday from 9 a.m. to 5 p.m. The booking link can be found on the RVH website (rvh.on.ca) H under Emergency Department. ■ www.hospitalnews.com

IN BRIEF

Pharmacogenomic testing:

promising treatment for depression P

harmacogenomic testing of adults with moderate or severe major depressive disorder (MDD) shows promise in helping select the right antidepressant, which could save health systems millions of dollars and improve survival and quality of life, according to a study from that province published in CMAJ (Canadian Medical Association Journal).

“Major depressive disorder is common, recurrent and a large driver of health care costs and burdens in Canada and other jurisdictions that is increasing, especially since the COVID-19 pandemic,” writes Dr. Shahzad Ghanbarian, Vancouver Coastal Health Research Institute, and The School of Public and Population Health, University of British Columbia (UBC), Vancouver, BC, with coauthors.

The World Health Organization predicts that depression will be the leading cause of disability worldwide by 2030.

However, only about 40–60 per cent of patients respond to the first antidepressant prescribed, and as much as 42 per cent of variation in response to these medications relates to genetic factors that affect medication metabolism.

“Pharmacogenomic testing, therefore, is theoretically compelling; using a blood, saliva or buccal swab sample, the test identifies genetic variants involved in drug metabolism and response, which can guide prescribing,” the authors write.

In close collaboration with patient partners, clinicians and other stakeholders, researchers developed a microsimulation model to evaluate the effectiveness and cost-effectiveness of pharmacogenomic testing for patients with MDD in British Columbia (BC).

The model simulated a population of 194 149 people based on administrative data and incorporated 40 different antidepressants as well as other treatments, such as electroconvulsive therapy (ECT) and psychotherapy. They compared treatment pathways for people with and without pharmacogenomic testing over a 20-year period. www.hospitalnews.com

THE WORLD HEALTH ORGANIZATION PREDICTS THAT DEPRESSION WILL BE THE LEADING CAUSE OF DISABILITY WORLDWIDE BY 2030.

Pharmacogenomic-guided treatment resulted in 23 216 (37%) fewer patients developing refractory depression, a key driver of health system cost-savings, as well as fewer patients using ECT and psychotherapy. This would save the BC health system $956 million over 20 years, according to the model.

“The availability of pharmacogenomic testing resulted in patients spending 15 per cent more time in the well state and 18 per cent less time in the MDD state (recurrent episodes or refractory depression),” write the authors, who added that this would mean 1869 fewer deaths and 21 346

fewer all-cause hospital admissions over 20 years.

“The analyses presented here point toward pharmacogenomic testing, focused on adults with moderate-to-severe MDD, offering the opportunity for a major value-promoting investment by health systems. Pharmacogenomic testing, focused in this way, has the potential both to reduce costs and improve health outcomes,” the authors conclude.

“Cost-effectiveness of pharmacogenomic-guided treatment for major depression” was published November H 14, 2023. ■

Patient support programs for prescription drugs are common, especially for expensive drugs atient support programs offered by drug manufacturers are common in Canada, especially for expensive drugs, but greater transparency and independent evaluation is needed to understand their impact, according to research published in CMAJ (Canadian Medical Association Journal).

About one-in-10 prescription drugs – mainly brand-name and expensive drugs and those for rare diseases – has a manufacturer-sponsored patient support program, which usually includes financial, nursing and educational supports.

“In an era where policy-makers are grappling with escalating drug prices and budgetary impacts globally, the pharmaceutical industry promotes patient support programs as adding complementary value to a drug through supporting medication adherence and enhancing clinical outcomes, patient experience or quality of life,” writes Dr. Quinn Grundy, a registered nurse and assistant professor at the Lawrence Bloomberg Faculty of Nursing, University of Toronto, with coauthors.

To understand the range of prescription drugs with patient support

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ABOUT ONE-IN-10 PRESCRIPTION DRUGS – MAINLY BRAND-NAME AND EXPENSIVE DRUGS AND THOSE FOR RARE DISEASES – HAS A MANUFACTURER-SPONSORED PATIENT SUPPORT PROGRAM. programs, researchers quantified and evaluated patient support programs for drugs on the market as of August 2022. Of the total 2556 prescription drugs marketed by 89 companies, they identified programs for 256 drugs (10%). Almost two-thirds of companies (55; 62%) offered patient support programs. Although only about 10% of drugs on the market are biologics, they represent more than half of drugs that have a patient support program.

Patient support programs most frequently existed for drugs that are expensive. Of the 2214 drugs dispensed through retail pharmacies, 1632 (74%) cost $10 per unit or less whereas those with a patient support program had a median cost per unit of $208.40.

The researchers note that they may have underestimated the number of support programs, as their analysis relied on publicly available information

and they may have missed patient support programs for very specialized, rare drugs.

While financial supports, nursing support and counselling are valuable to patients, the researchers found duplication of services across companies marketing drugs with the same active ingredients, and lack of transparency around what programs offered and their impacts.

“Whether manufacturer-sponsored patient support programs are the optimal model to provide care related to medicines is an open question. Models of care should be designed around people’s health needs, not a particular product,” says Dr. Grundy.

“Prevalence and nature of manufacturer-sponsored patient support programs for prescription drugs in Canada: a cross-sectional study” was H published November 27, 2023. ■ DECEMBER 2023 HOSPITAL NEWS 7

NEWS

New CHEO building

will reduce wait times and improve patient care journey n Nov. 7, 2023, CHEO marked an exciting milestone for families and caregivers served by CHEO as the organization unveiled the renderings of the CHEO Integrated Treatment Centre, also known as 1Door4Care.

The new 6-storey, approximately 200,000-square-foot building will be connected by a link to the main hospital and offer services for children and youth living with complex medical, developmental, behavioural and mental health needs.

“The 1Door4Care dream began 16 years ago as we recognized the challenges faced by families with children and youth with special needs, mental health challenges and complex medical conditions. We wanted to create programs and spaces that help every child and youth live their best life - through an innovative, individualized model of care that centers around the child and their family,” says Alex Munter, CHEO President and CEO. Expected to be completed in 2028, the new building will serve more than 40,000 families yearly and provide an improved new model of care being co-created by clinicians and patients.

Inspired by Indigenous Peoples’ connection to the land, the new building incorporates elements of nature such as native plants in the landscaping, biophylics representing flora and fauna from the Algonquin lands. The building will include a multi-use clinic space, a physiotherapy rehab gym, expanded mental health clinics, an indoor and outdoor multi-use space, a space for children and youth with complex emotional needs, state-of-the-art treatment rooms, advanced technology to enable virtual care, family support and community spaces as well as a new parking structure.

The unveiling of the new CHEO 1Door 4Care Integrated Treatment Centre design is an exciting time for people in Eastern Ontario. This

O

8 HOSPITAL NEWS DECEMBER 2023

project is an excellent example of an innovative, modern service delivery model that will support better outcomes for tens of thousands of children and youth with special needs and their families,” said Michael Parsa, Minister of Children, Commu-

nity and Social Services. “The new Centre will bring together many specialized services under one roof and provide a safe and welcoming space for all.”

This multi-year project is funded by the Ministry of Children, Community and Social Services (MCCSS), and CHEO and will be built by EllisDon H Infrastructure OCH Inc. ■

Patients experiencing homelessness:

better data for better care patient’s housing status impacts not only their health outcomes, but where and how they access health care and manage chronic conditions. People experiencing homelessness (PEH) have a high level of need for health care services due in part to the higher incidence of physical, mental and social challenges. They rely more on hospital services than the general public.

The Canadian Institute for Health Information (CIHI) along with key stakeholders identified an opportunity to improve the identification of PEH when they access hospital services. Better data on services used by this group of patients can facilitate improvements in their care, as well as health system planning that responds to their care needs.

As of 2018-2019, it became mandatory for hospitals to include ICD-10CA code Z59.0 Homelessness in their data when the patient’s record showed they were homeless upon admission.

ICD-10-CA (International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada) is a national standard maintained

by CIHI. CIHI released a report in July 2023 on trends in documenting the Z59.0 code over a 6-year period. The report also describes the important roles that different health system stakeholders have in creating and using quality data to improve outcomes for PEH – from

A

asking a patient about their housing status to assigning ICD-10-CA codes in the data to reporting on findings to guide improvements.

“With more consistent use of the ICD code, Z59.0, there’s a genuine opportunity to get better data to fully understand the unique needs of this population. But hospital coders who assign the code can only use it if homelessness is noted in the patient record, and at present housing status is not consistently gathered during patient registration or health care encounters,”says Keith Denny, Director of Population and Indigenous Health, and Classifications and Terminologies, CIHI.

INCREASED RECORDING OF HOMELESSNESS Mandatory use of code Z59.0 Homelessness represented a step in improving care for PEH in Canada. The first year the requirement was in effect (2018– 2019), there was an 84% increase in the number of hospitalizations in Canada with recorded homelessness using the code, compared with the previous year. More information can be found in the figure “Trends in hospitalizations with recorded homelessness”.

OPPORTUNITIES TO IMPROVE CONSISTENCY Challenges remain for comprehensively recording homelessness. For example, some patients may not identify

themselves as experiencing homelessness due to a concern about stigma or for other reasons. Another limitation is that hospital information management staff may not have sufficient time allocated to review all parts of the patient record where housing status may be documented.

To further improve data quality, hospital leaders could consider implementing formal procedures to ensure that health care providers ask about and document housing status – something that will be required by 2024 of all United States hospitals that report to the Centers for Medicare & Medicaid Services’ quality reporting program. Implementing a patient screening tool that covers social needs is one way to support consistent identification of PEH. Hospital leaders could also support staff to build their skills for assessing patients’ social needs, including housing, in safe and appropriate ways. In addition, they could use data on recorded homelessness at the organization level to plan and improve services such as discharge supports. Organizations such as regional authorities can also leverage the data collected in the hospital setting to inform initiatives to improve care and outcomes for PEH. Please visit https://www.cihi.ca/en/ better-quality-hospital-data-for-identifying-patients-experiencing-homelessness for additional information on H patients experiencing homelessness. ■

This article was submitted by the Population Health Department, Canadian Institute for Health Information”. www.hospitalnews.com

NEWS

Enhancing patient care: The success of the support services attendant (SSA) in clinical units

By Michelle Lee Hoy n the ever-evolving landscape of health care, the emphasis on patient-centred care has become paramount. The role of support staff in clinical units has transformed significantly in recent years to better address the needs of patients and improve overall hospital efficiency. One remarkable shift at Oak Valley Health’s Markham Stouffville Hospital has been the transition of environmental services attendants (ESAs) to the newly created role of support services attendants (SSAs). The implementation of this new role and model of care has demonstrated impressive success, contributing to higher standards of care, improved patient experiences, and increased operational efficiency.

“Patient care is at the heart of almost every decision we make at the hospital,” said Maria Pavone, senior director, facilities & corporate services. “When we explored the idea of a revised model of care that enabled us to elevate the ESA role to have more direct patient interaction, we knew it would lead to positive impacts from both the quality of clinical care and the overall patient experience.”

The traditional role of the ESA primarily focused on housekeeping duties within clinical units, including tasks such as cleaning and disinfecting the physical environment. While these responsibilities were crucial to ensuring a clean and safe environment for patients to recover, free from the risk of hospital acquired infections (HAI), they often did not participate in direct patient care. The introduction of the SSA role sought to expand the scope of responsibilities to include additional clinical support functions in addition to their disinfecting responsibilities, creating additional capacity for the clinical teams to spend more time at the patient’s bedside.

The SSA role employs a new, enhanced model of care and standardized work that provides clinical staff, such

Manny Crisostomo is a support services attendant at Oak Valley Health.

I

as personal support assistants (PSAs) and nurses, with additional time to care for the patients at the bedside.

This enhances the team-based model of care that allows clinical staff to successfully do their jobs by assigning the SSA with responsibilities that better support the clinical team in streamlining patient care.

SSAs are trained to collaborate closely with clinical staff. They assist clinical staff with internal bed moves, minimizing delays with cohorting patients while creating additional room vacancies for incoming admissions.

SSA staff are also responsible for stocking bedside emergency kits, consumables on medication carts as well as replenishing unit-based PPE dispensers. This synergy between clinical and support staff has streamlined operations and improved patient throughput, resulting in reduced wait times and better resource allocation and as a result, increased time for patient care.

Given the heightened importance of infection control in health care, SSAs play a pivotal role in maintain-

ing clean and germ-free environments.

Their duties include routine cleaning and disinfecting of surfaces and equipment, ensuring that clinical units remain safe for patients and staff. Cleaning audits showed that on average, clinical units with SSAs had an eight per cent improvement, and over 90 per cent of patients surveyed agreed that their room and bathroom were kept clean during their stay.

“As a former ESA, the SSA role is a new experience where I get to learn more on the job, and have the ability to help the units with additional responsibilities,” says Manny Crisostomo, support services attendant, Oak Valley Health. “In this new role, I am more involved in the patient discharge care process, and I am also able to support some patient needs, such as getting them water or a blanket. I feel even more fulfilled now when I come to work.”

Clinical staff also have felt that since the SSA implementation, there has been improved capacity to perform clinical patient care, complete their

standard of work for their daily tasks, and sufficient time to provide quality patient care at the right time.

To successfully execute their expanded roles, SSAs received comprehensive training and education, including learning about infection control, patient privacy, and safety protocols. This investment in training is a critical component of the program’s success.

The transformation from environmental services attendants to support services attendants reflects our honoured to care mission. The SSA role has not only enhanced the overall patient experience but also improved hospital efficiency.

The success of this transition has showcased the adaptability and innovation at Oak Valley Health in responding to the evolving needs of our patients. As the health care industry continues to evolve, the SSA model is a shining example of how progress and innovation can optimize and revolutionize patient care and experience H for the better. ■

Michelle Lee Hoy is a Senior Corporate Communications Specialist at Oak Valley Health.

10 HOSPITAL NEWS DECEMBER 2023

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NEWS

Let’s make 2024 the year of cybersecurity in Canadian healthcare

By Paul-Émile Cloutier 023 marked another high-water mark for the use of digital healthcare in Canada. However, as waves of optimism grow concerning how growth in the use of virtual health, telemedicine, wearables, and electronic health records can improve access to care and outcomes, so too do fears of a sinister danger in our brave new digital health world: Cyber attacks.

Major cybersecurity incidents continue to occur in healthcare across Canada. Just a few months ago five hospitals in southwestern Ontario were victims of a cyber-attack affecting email and patient records, leading to delays and cancellations for patients. In December 2022, SickKids Hospital was targeted by a partner of the LockBit ransomware, leading to patient treatment delays. While in October 2021, a ransomware attack in Newfoundland & Labrador delayed thousands of appointments and medical procedures, exposed sensitive data, and resulted in $16 million in damages. These are just a few of recent healthcare cyber-attacks in Canada.

Cyberthreats are among the greatest fears of healthcare leaders. Patient data held hostage, computer systems frozen in limbo and thousands of procedures cancelled, just some of the worst-case scenarios that churn in their minds. HealthCareCAN has taken the concerns identified by our member institutions very seriously, working since 2017 to develop policies, recommendations for action, and tools to help hospitals, health authorities, healthcare and health research institutions reduce the risk of cyber threats.

What we learned from our cybersecurity work with health leaders from coast to coast to coast was that Canada’s lack of healthcare-specific cybersecurity standards was significantly increasing the risk to healthcare institutions. To correct this situation, HealthCareCAN provided leadership to determine that a standard was need-

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ed, then developed the project with the Digital Governance Council and support from Public Safety Canada’s Cyber Security Cooperation Program.

Entitled Cybersecurity: Cyber Resiliency in Healthcare, the new national standard of Canada leverages HealthCareCAN’s extensive network of healthcare leaders across Canada and the Digital Governance Council’s wide-ranging network of digital and information technology experts. Hundreds of thought leaders, cybersecurity experts, health leaders and stakeholders brought their unique perspective to the creation of the standard through a rigorous standards development process.

The standard incorporates guidelines and best practices that healthcare organizations can use to improve cybersecurity within their institutions.

From healthcare organizations and research institutes to medical clinics and virtual care providers, the standard is designed to help organizations across Canada’s healthcare system manage the risks associated with the use of health information and infor-

mation technology and protect their organizations from cybercrime.

Addressing a broad range of topics and considerations, from organizational risk management, leadership and education to cyber incident response and contingency planning, the standard provides guidance on how to identify, assess, and manage cyber risks in Canada’s healthcare organizations.

Fundamentally, communication is the foundation of an effective cybersecurity program. Health leaders can demonstrate their commitment to cybersecurity by ensuring that policies and objectives are established and aligned with the strategic direction of the organization.

As COVID-19 stretched healthcare capacity, we are reminded of how critical it is for our healthcare infrastructure to be resilient in times of crisis.

With the confidentiality of patient data and the availability of medical devices and treatments at stake, cyber hygiene must be regarded as a basic and essential component of our healthcare system.

Cybersecurity: Cyber Resiliency in Healthcare can help health leaders

navigate and address vulnerabilities in their digital infrastructure and prevent cyberattacks. A clear framework and enhanced cybersecurity capabilities will better protect Canada’s healthcare organizations from cybercrime and allow them to respond more effectively to evolving threats and defend critical infrastructure.

While it is impossible to completely eliminate cyber threats from Canadian healthcare, HealthCareCAN and our partner, the Digital Governance Council, are committing to supporting the spread and use of the standard and we encourage all health leaders to apply it in their institutions.

We will also continue to share key findings and lessons learned from this project with health leaders across Canada to help ensure that the people of Canada can depend on their healthcare system to be resilient and safe in the face of cyber threats.

The standard is available in English and French on both the HealthCareCAN and Digital Governance Council H websites. ■

Paul-Émile Cloutier is President & CEO HealthCareCAN 12 HOSPITAL NEWS DECEMBER 2023

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CLARITY

COVER

Developing non-opioid, non-addictive pain medication ach day in Canada, 21 people on average will die from opioid overdose, a growing problem that represents a serious health care challenge in this country. Yet, the drugs remain a popular choice for the nearly 30 per cent of Canadian adults living with chronic pain.

This reality has led a Calgary research team to develop revolutionary medication that could have a significant impact on millions of people who suffer from chronic pain.

Thanks to a groundbreaking partnership funded by Mitacs and the Government of Alberta between Calgary researcher Dr. Ketul Patel and a Calgary-based biopharmaceutical company whose work is aimed at developing pain therapies that do not have the drawback of opioids that has led to the opioid crisis – a first-of-itskind alternative medication is in the works to treat neuropathic pain.

“It’s a huge issue. In North America, up to 30 per cent of people are suffering from chronic pain, and right now opioids are still the main treatment. If our drug comes onto the market, we believe this could be ground-breaking,” said Patel, a postdoctoral researcher working under the supervision of Professor Darren Derksen in the Faculty of Science at the University of Calgary.

This groundbreaking work has earned Patel the Mitacs Award for Outstanding Innovation – Postdoctoral, awarded by Mitacs, a national innovation organization that fosters growth by solving business challenges with research solutions from academic institutions and supported by the Government of Alberta. The award was presented at a ceremony at the National Arts Centre in Ottawa on November 22, 2023.

Patel was recognized for making a major advancement in pain management by developing a new small molecule that targets a newly discovered pathway for pain relief. Highly addictive opioids such as Vicodin®, OxyContin® and Percocet® rely on opioid receptors (protein-coupled re-

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Dr. Ketul Patel won the Mitacs Award for Outstanding Innovation – Postdoctoral.

FIRST-OF-ITS-KIND NON-OPIOID ANALGESIC THAT ALLEVIATES CHRONIC PAIN WITHOUT THE SIDE EFFECTS OR DRUG DEPENDENCY THAT PLAGUE CURRENT OPIOID USERS, COULD HELP SOLVE OPIOID CRISIS ceptors) in the human body to inhibit pain, whereas Patel’s compound targets another receptor, T-Type calcium channels, providing a non-opioid dependent avenue for effectively mitigating pain without the detrimental side effects of opioids.

“We synthesized dozens of molecules before identifying our current lead molecule,” explained Patel, who has since designed, synthesized and characterized a lead compound group that is now being used to test new drug formulas in animal models with promising results. “This is truly transformative work. Our goal is to bring safer, more effective pain treatments to market,” he said.

“We believe this medication will lead to an effective therapy to help get us out of this increasingly challenging crisis of addiction and overdose,” said Patel, who credits Mitacs for helping to accelerate the team’s success. “The

14 HOSPITAL NEWS DECEMBER 2023

opportunity to collaborate with an industry partner from my academic lab is allowing us to bring our innovation closer to real-world application.”

Patel is working collaboratively with Zymedyne Therapeutics, which is focused on developing non-opioid treatments for chronic, neuropathic pain.

Building on their successful collaboration, in addition to a full patent on the novel pain mechanism, the company has now filed two U.S. provisional patents on these newly developed drugs and is expecting to start clinical trials within the next few years.

The biggest benefit is that so far none of the common detrimental side effects shared by most opioids, including drug dependency and buildup of drug tolerance, are being observed.

Once clinical trials are underway, Zymedyne will be looking to outsource manufacturing of the compound and partner with Big Pharma, to help get

the drugs to market in order to provide a safe and effective alternative for chronic pain sufferers.

The Mitacs Award for Outstanding Innovation – Postdoctoral is presented to a Mitacs intern who has made a significant achievement in research and development innovation during their Mitacs-funded research. Mitacs programs are funded by the Government of Canada and provincial and territorial governments across the country.

Patel is one of nine Mitacs award winners nationally, chosen from thousands of researchers who take part in Mitacs programs each year. The remaining eight recipients were recognized for outstanding innovation, commercialization or exceptional leadership in other areas of research.

In congratulating the winners, Mitacs CEO John Hepburn reflected on Mitacs’ 25-year history of providing Canadian innovators with opportunities for experiential skills development through strategic partnerships between industry, government and academia. “Mitacs is honoured to play a pivotal role in empowering industry leaders across Canada to foster game-changing ideas, and we couldn’t be more pleased to celebrate their significant achievements with these awards,” Hepburn said.

For more information about the Mitacs awards and a full list of winners, visit www.mitacs.ca/newsroom.

ABOUT MITACS Mitacs is a not-for-profit organization that fosters growth and innovation in Canada by solving business challenges with research solutions from academic institutions. It is funded by the Government of Canada, along with the Government of Alberta, the Government of British Columbia, Research Manitoba, the Government of New Brunswick, the Government of Newfoundland and Labrador, the Government of Nova Scotia, the Government of Ontario, Innovation PEI, the Government of Quebec, the Government of Saskatchewan and the H Government of Yukon. ■ www.hospitalnews.com

NURSING PULSE

NPs in primary care: The innovation we need

By Doris Grinspun ttention has been focused recently on an Ottawa primary care clinic charging a $400 fee – plus a per visit fee – for access to health care. There’s another such clinic in Toronto that promises “all access health care” that comes to you for $1200 + HST. It’s located in Yorkville, convenient for those who can afford to pay such fees.

It hasn’t attracted the same attention as the Ottawa clinic – which the government has promised to investigate – but is the product of the same problem: access to primary care.

The clinical director of the Ottawa clinic tells us that 10,000 people have signed up, ready and willing to pay $400 – and then some – for access to care. It’s no wonder. Recent research tells us that 2 million people in Ontario do not have a primary care provider.

In addition, Health Quality Ontario tells us that only one-third of Ontarians have timely access to primary care when they’re sick. It’s one obvious reason that hospital emergency rooms are overwhelmed – the ER is where the vast majority of people have to go when they’re sick.

What isn’t obvious is why the Ontario government allows this to persist.

There’s a solution to Ontario’s access problem – a really good one – that’s staring this government in the face: the publicly-funded nurse practitioner (NP). It’s no coincidence that the Ottawa and Toronto clinics mentioned above are charging for access to NP care. NPs are advanced practice nurses with master’s level clinical education and specialized licensing with the regulatory college for nurses. Given their expertise, advanced education and expanded scope, they have been begging this government for years to put in place public funding models to let them practise independently in primary care settings.

To improve health equity and increase access to care, the NP role was

THERE’S A SOLUTION TO ONTARIO’S ACCESS PROBLEM – A REALLY GOOD ONE – THAT’S STARING THIS GOVERNMENT IN THE FACE: THE PUBLICLYFUNDED NURSE PRACTITIONER (NP).

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established in Ontario in 1997. Over the years, NPs have been deployed in clinical settings across the health system – from hospital settings to nursing homes – with great success. In 2007, the first NP-led clinic (NPCL) in Canada opened its doors in Sudbury. It was an example of innovation in primary care. NPLCs are publicly funded and led by NPs working with an interprofessional health team. Twenty-six of these clinics were established in 2007-2008 – and not a single one since, in spite of the wonderful, holistic approach to care that is the hallmark of NP practice.

For some time now, the government has made vague promises about establishing more NPLCs in the province.

Even in the absence of a formalized process, NPs from across the province have submitted applications to

the Ministry of Health, investing their own time, energy and resources to demonstrate the desperate need, the value and the potential of NPLCs in their communities. As family physicians continue to quit and retire across the province and waiting lists for care continue to grow, the government still isn’t moving.

More recently, the government solicited expressions of interest for funding innovative models of care. Again, NPs came forward with innovative, practical proposals, responsive to the primary care needs of their communities. Some expressions of interest point to the need for NPLCs based in marginalized populations such as First Nations. Others highlight the need for mobile clinics for dispersed communities that have a history with the health

system that is rooted in trauma. Still, no response from the government as the waiting lists continue to grow.

What is clear is that NPs, deeply rooted in and committed to their communities, have answers to the government’s calls for innovation. Indeed, they are the answer. They have the education, skills and ambition to wrestle Ontario’s primary care crisis to the ground and respond to the primary care needs of all of us who live in this province. There are 10,000 people on the list for privatized health care at an Ottawa clinic because there has been no new funding for NPs in primary care, and no new funding models for NPs in primary care, since 2007.

Enough talk of innovation in health care. Let’s “do” innovation and fund H NPs to provide primary care. ■

Doris Grinspun, RN, O.ONT. is CEO, Registered Nurses’ Association of Ontario. www.hospitalnews.com

DECEMBER 2023 HOSPITAL NEWS 15

NEWS

Health literacy tool

helps bridge barriers between patients and care providers roper disease management for people with chronic airway conditions can be the difference between staying symptom-free and needing an emergency visit to the hospital.

Research led by Vancouver Coastal Health Research Institute researcher Dr. Iraj Poureslami underscores the crucial role of health literacy in supporting patient adherence to prescription medications and treatment regimen suggested by respiratory doctors.

“Self-management practices mean that a person should be able to manage their condition from home,” explains Poureslami. “As such, care providers need to ensure that each patient has a level of understanding, trust in health care recommendations and the necessary skills to properly take their medication and follow instructions to control their chronic condition.”

A relatively new area of research, health literacy can be defined as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.”

Despite the importance of health literacy in disease management, over 60 per cent of Canadian adults aged 19 and older – and 88 per cent of seniors – are impacted by low levels of health literacy that can affect their ability to make informed health decisions, according to the Public Health Agency of Canada.

For his study, published in the journal Respiratory Care, Poureslami and the Canadian Airways Health Literacy Study Group, led by late Dr. J. Mark FitzGerald, developed a performance-based, disease-specific Vancouver Airways Health Literacy Tool (VAHLT) with input from patients and health care professionals. VAHLT is specifically designed to evaluate the level of health literacy skills among people with chronic airway conditions that involve airway and breathing restriction, such as that found in asthma, emphysema, bronchitis and chronic obstructive pulmonary disease (COPD).

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“HEALTH LITERACY IS ESSENTIAL TO EFFECTIVE CHRONIC AIRWAYS DISEASE MANAGEMENT AND DESIRABLE OUTCOMES.” Three hundred and eighty patients with chronic airway conditions from six specialty care clinics in British Columbia and Ontario were given the VAHLT health literacy evaluation measurement tool in the form of a scenario-based questionnaire. Participants’ health literacy scores were compared against the severity of their chronic airway condition, medication adherence, disease control and quality of life.

The research team found no significant correlation between VAHLT scores and disease severity or quality of life. However, age and level of education were highly correlated with health literacy skills. The latter finding “emphasizes the importance of addressing these factors and their impact on self-management practices in health literacy interventions among patients

16 HOSPITAL NEWS DECEMBER 2023

with chronic airways disease,” the study team reports.

CLEAR HEALTH CARE MESSAGING IS NEEDED TO SUPPORT BETTER HEALTH OUTCOMES Low health literacy is often associated with decreased health outcomes, including a greater likelihood of being readmitted to an emergency department, as well as medication non-adherence and poorer self-care.

Health literacy can not only improve health outcomes, it can also promote equal access to appropriate care, according to the World Health Organization. Additionally, it can eventually reduce disparities and inequalities in obtaining needed care. This includes

bridging barriers that may impede access to quality health care among marginalised and equity-deserving groups, such as the elderly, low-income individuals and people with mobility and language needs.

B.C.’s aging and increasingly multicultural social landscape requires swift action by provincial health authorities to support optimal levels of health information comprehension, states Poureslami. This can mean respecting patients’ cultural beliefs and practices related to health and disease, as well as translating health information into different languages, providing educational videos on self-care management and spending more time explaining treatment recommendations to patients during office visits.

Involving family members in discussions about treatment plans is another approach that can help break down barriers and ensure that patients have understood treatment recommendations, such as how many doses of an inhaler to take each day and when to increase the doses.

“Proper communication between care providers and patients is an essential stepping stone to improve patient adherence to prescribed medications and treatment regimens,” states Poureslami. “A suggested approach to foster open and interactive patient-provider communication is to complement plain language resources with a ‘teach-back’ approach that involves asking a patient to repeat aloud what was understood about the treatment recommendations to ensure that the patient understood the information correctly. This also stimulates dialogue and question-asking.”

“One of the key questions that a care provider can ask their patient is: ‘Can you please repeat that back to me? I want to make sure that you understand the treatment plan’,” states Poureslami.

In the long run, those extra minutes during the office visit can add up to better patient health outcomes, quality of life and reduced emergency visits or hospital admissions, Poureslami H says. ■ www.hospitalnews.com

NEWS

Pandemic sees hospital staffing challenges grow and rates of unintentional harm increase uring the COVID-19 pandemic, hospital staffing challenges such as sick time, overtime and the use of agency workers grew dramatically, while at the same time rates of potentially preventable harm to patients increased, according to a report released today by the Canadian Institute for Health Information (CIHI). The report,Hospital staffing and hospital harm trends throughout the pandemic,uses costing and administrative data to compare pandemic trends with pre– COVID-19 times.

Overtime and sick time use among hospital staff in Canada increased significantly in 2021–2022 compared with the previous year. Staff working on inpatient units in Canada’s hospitals logged more than 14 million hours of overtime, which equates to about 7,300 full-time positions . More than 12 million hours of sick time were also logged, which translates to a shortfall of about 6,500 full-time positions. In

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www.hospitalnews.com

addition to staffing challenges, other factors that can influence hospital harms were also present during the pandemic, such as caring for sicker and more medically complex patients and adapting to infection control precautions. In 2022–2023, the pan-Canadian rate of unintentional hospital harm was 6 per cent, the third year in a row there was an increase compared with pre-pandemic numbers. Prior to 2020, the rate had been stable at 5.4% since 2014.

“We know that the pandemic put a tremendous amount of pressure on front-line staff, and we can now start to quantify that. Nurses and other health care providers on hospital inpatient units logged a 17% increase in reported sick time and a 50% increase in overtime hours,” explains Deborah Cohen, CIHI’s director of Health Human Resources. “While there are many things that impact hospital harm rates, we know there is a link between staff well-being and patient safety.”

The data shows increases in harms that are generally associated with care provided by health professionals who work on inpatient units. These harms include where patients developed conditions such as urinary tract infections (UTIs), pressure ulcers and pneumonia.

“The COVID-19 pandemic brought to the forefront conditions that made staff retention in hospitals a challenge,” explains Canadian Nurses Association president Sylvain Brousseau.

“Nurses working in the hospital sector have increasingly reported feeling moral distress when they believe they can’t care for their patients to the best of their abilities, resulting in high levels of burnout and a desire to leave the profession.”

These health workforce challenges were seen not only in hospitals but across care sectors. In 2022, Statistics Canada reported 95,800 vacant nursing, personal support worker and health care worker jobs – a record high

for the industry. In the same year, the number of registered nurses (RNs) who were self-employed or working for private nursing agencies increased by 6 per cent (867 more RNs).

“While life-threatening harm in hospitals is rare, more than 1 in 17 patients have their stay extended or treatment plans changed due to unintended harm,” explains Mélanie Josée Davidson, director of Health System Performance at CIHI. “The data released by CIHI provides a high-level picture of patient safety in Canadian acute care hospitals. It is meant to complement information – like staffing data – to help organizations find ways to further reduce potentially preventable harm by implementing eviH dence-based practices.” ■

DECEMBER 2023 HOSPITAL NEWS 17

FROM THE CEO’S DESK

Improving lives

by advancing understanding of mental health and addiction

By Dr. Nadiya Sunderji s the world grappled with the unprecedented challenges posed by the COVID-19 pandemic, another alarming crisis quietly emerged - a surge in cases of intimate partner violence (IPV). While the coronavirus significantly impacted our health care system, economy, and daily life, it also illuminated the vulnerabilities of those trapped in abusive relationships.

Intimate partner violence is a pervasive and growing concern, and the Canadian government and an increasing number of municipalities recently declared intimate partner violence an epidemic.

Collaborative efforts spearheaded

by Dr. N. Zoe Hilton and the Waypoint Research Institute (WRI) are contributing to addressing this immediate crisis while also laying the groundwork for a future in which a unified response strategy becomes a cornerstone in tackling IPV. Working with police services and universities in Alberta, New Brunswick and Ontario, this team of researchers are working to establish a common language for assessing and discussing IPV risks, using a data-driven approach to prevent and mitigate their impacts.

Dr. Hilton is a Full Professor at the University of Toronto whose on-line educational program supporting the use of the Ontario Domestic Assault Risk Assessment tool attracts over 1,000 professionals per year across six continents. She regularly consults to organizations nationally and internationally to support their efforts to reduce the occurrence of domestic violence.

Her latest study is one of a number of groundbreaking studies the WRI is undertaking to improve lives locally and around the world, in this case through a focus on social conditions and prevention of trauma, a risk factor that can lead to or exacerbate mental illness and addictions.

Waypoint’s Research Institute is celebrating its 10th anniversary, and it is with immense pride and gratitude

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Dr. Nadiya Sunderji that I reflect on the remarkable work underway to advance understanding of mental illness and addictions, the progress we’ve made, and the countless lives impacted by the unwavering commitment to pioneering research and compassionate care.

Founded on a strong legacy of more than 40 years of research excellence at the hospital, WRI consistently pushes the boundaries of knowledge, fostering innovation and collaboration, and forging partnerships across the globe.

Our initiatives have advanced access to evidence-based treatments and

18 HOSPITAL NEWS DECEMBER 2023

influenced global policy-making and health care practices. I am particularly proud of the increasing integration of patient perspectives, co-leadership and co-design into our research activities, which aligns with our organizational values of Caring, Respect, Innovation and Accountability and ensures the relevance and impact of our research.

Looking ahead, artificial intelligence (AI) is emerging as a game changer in health care and research. With studies showing a decline in overall mental health since the pandemic, and the growing acuity and complexity of the

patients we serve in hospital, Dr. Andrea Waddell and her research team are leveraging AI to make care safer for mental health inpatients through the development of an early warning score.

Early warning scores are tools used by hospital care teams to recognize the early signs of clinical deterioration.

The integration of machine learning algorithms and natural language processing is transformational for psychiatric care, offering the potential to predict crises before they unfold and intervene earlier, ultimately leading to improved patient outcomes. Dr. Waddell’s research beautifully illustrates the value of collaboration between clinicians and researchers to yield new insights and lay the groundwork for successful implementation of a new tool. At Waypoint we believe the whole hospital is the research institute, and we’ve been thrilled to launch new a new program supporting health professional scholars throughout the hospital.

The spirit of discovery and innovation at WRI extends far beyond advancing safety. From brain imaging studies to launching a preventative online mental health program for youth, we have a broad commitment to understanding and improving mental health and addiction innovating treatments and service delivery models, breaking down barriers and fostering resilience.

Looking back on our 10-year journey, the establishment in 2020 of a Research Chair in Forensic Mental Health Science is another accomplishment that stands out. One of the first of its kind in Canada and among only a handful in the world, the position is a collaboration between Waypoint and the University of Toronto Faculty Of Medicine. Our forward-thinking approach to forensic mental health research is shedding light on how to improve services and patient outcomes in a field where knowledge gaps – and the double stigma of mental illness and justice system involvement – sadly persist.

Continued on page 26 www.hospitalnews.com

SPONSORED CONTENT

Join us in Montreal for CAR 2024:

Embracing a new era re you ready to take your radiology practice to new heights? The CAR invites you to join us at our highly anticipated Annual Scientific Meeting (ASM) from April 11-14, 2024 at Le Westin Montreal – where innovation, collaboration, and excellence converge! This year’s theme is CAR 2024: Embracing a New Era. CAR 2024 will offer four days of high-quality, didactic educational programming, thoughtfully curated by the Scientific Planning Committee in collaboration with the CAR Affiliate Societies to specifically target the most in-demand topics.

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fellow radiologists, opinion leaders, and industry experts. Build valuable relationships that can lead to collaboration, knowledge-sharing, and new career opportunities.

• Scientific Sessions: Dive deep into the latest research, clinical guidelines, and case studies. We will cover pitfalls, best cases, and feature modality specific presentations.

Gain practical insights and strategies that you can implement in your practice.

• Keynote Presentations: Be inspired by renowned keynote speakers who will share their expertise and vision for the future of radiology.

JOIN US AT OUR ANNUAL SCIENTIFIC MEETING (ASM) FROM APRIL 11-14, 2024 AT LE WESTIN MONTREAL – WHERE INNOVATION, COLLABORATION, AND EXCELLENCE CONVERGE! With so much to look forward to at CAR 2024, you can’t pass up the chance to attend!

• Stay Ahead of the Curve: Explore cutting-edge techniques, technologies, and emerging trends. Our expert speakers will share their insights on the latest advancements, covering a breadth of topics including sessions on teleradiology, climate, equity, and diversity.

• Networking Opportunities: Connect with your colleagues, peers, www.hospitalnews.com

THE SERIES OF INVITED PLENARY SESSION SPEAKERS INCLUDES: Friday, April 12 • Musculoskeletal Infection – Manickam Nicks Kumaravel, McGovern Medical School, UT Health, Houston, TX • Non-invasive Detection of Liver Fibrosis with Quantitative Imaging Methods – Bachir Taouli, Icahn School of Medicine at Mount Sinai, NY Saturday, April 13 • Climate Plenary – Kate Hanneman, University Medical Imaging Toronto, Department of Medical Imaging, University of Toronto Sunday, April 14 • Best Cases of the AIRP: Cardiac – John Lichtenberger, ACR Institute for Radiologic Pathology

dio-thoracic, abdominal, emergency and trauma, pediatric, interventional, musculoskeletal, neurological, and breast radiology, and will also feature

a pre-conference, hands-on workshop focused on Emergency Radiology.

Check out the preliminary agenda H at car-asm.ca today! Q

• Exhibit Hall: Explore a diverse range of products and services in our bustling exhibition hall. Discover the tools and resources that can streamline your practice and enhance patient care.

• CAR Awards Ceremony: Celebrate excellence in radiology as we recognize outstanding achievements, research, and contributions within our field.

The program highlights the entire spectrum of specialties including carDECEMBER 2023 HOSPITAL NEWS 19

CANADIAN ASSOCIATION OF RADIOLOGISTS

The evolution of radiology in Canadian healthcare s the development of artificial intelligence (AI) continues to accelerate in the healthcare sector, it is becoming increasingly evident that these cutting-edge solutions hold immense potential for enhancing radiology and the broader healthcare sector. Not only can AI significantly improve workflows, thereby boosting productivity, but it also presents a viable solution for addressing the ongoing challenge of providing comprehensive health coverage and expanding access to medical imaging for Canadians.

A variety of AI solutions have found their way into radiology departments both within Canada and internationally. The extent of AI solutions being utilized in Canada is an unknown.

Nevertheless, the CAR supports the incorporation of these technologies within radiology departments and clinics across the country, provided there are proper checks and balances which are contingent on human oversight.

While deploying AI solutions, it is important to proceed with caution giv-

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en their evolving learning capabilities.

The CAR strongly believes that there needs to be national oversight for AI applications, particularly as they relate to patient care. Best practices, rules, and regulations are necessary and should be monitored at a federal level.

Despite the numerous benefits that AI could bring to patients and healthcare professionals, we must also remain cognizant of the potential risks associated with its application.

THE CAR’S RESPONSE TO AI In response to the introduction of this new type of technology in healthcare, the CAR has set up a Radiology AI Validation Network (RAIVN). This assembly consists of AI specialists in the field of radiology tasked with assisting with post-market assessment of AI applications.

As a resource, RAIVN would serve as the national body responsible for evaluating the performance of these technologies and pre-identifying any potential issues that may affect pa-

tient care. While this program is still in its infancy, we are hopeful its integration will be smoothly executed in the months ahead. We also believe that the RAIVN framework can and should be applied more generally to all AI based solutions in healthcare.

Dr. Jaron Chong, Chair of the CAR’s Standing Committee on Artificial Intelligence, is leading the charge on the RAIVN project. He has authored many publications on AI and has also been a contributing author on CAR’s five white papers focused on AI. Dr. Chong also sits on Health Canada’s Scientific Advisory Committee on Digital Health Technologies (DHT). He is an Assistant Professor at the Department of Medical Imaging at Western University and completed his diagnostic radiology residency training at McGill University with an Abdominal Imaging fellowship at Yale New-Haven Hospital and a master’s in health informatics at the University of Toronto. His clinical interests include cross-sectional abdominal imaging, Abdominal/GI oncologic imaging in

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MRI and CT modalities, with research interests in the appropriate utilization of medical imaging and AI-assisted augmented radiology.

“AI has the capacity to impact healthcare delivery in a positive way.

There are currently many AI applications specific to radiology that show promise in terms of enhancing workflows and streamlining medical imaging procedures,” said Dr. Chong. “Many of these technologies have been integrated into healthcare systems outside of Canada with favourable results. However, before broadly introducing them to the Canadian healthcare system, it is essential that a national regulatory framework has been developed which includes expert oversight to maximize safety and value.”

The CAR has been in discussions with the Ministry of Innovation, Science, Economics and Development Canada and Health Canada regarding RAIVN and is exploring how RAIVN can assist these federal branches of government in the validation process H of emerging technologies. ■

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CANADIAN ASSOCIATION OF RADIOLOGISTS

Raising the standard of care with the CAR’s CT accreditation program A

cquiring knowledge is often a critical first step in making meaningful change within a health care organization. The purpose of the CAR’s new CT Accreditation Program (CTAP) is to help organizations and facilities analyze data to better understand their own processes, policies, and technologies, with the aim of ensuring the highest possible standard of CT care.

The CTAP is nearing the end of its pilot stage at Niagara Health under the leadership of Diagnostic Imaging Director Dr. Julian Dobranowski (McMaster University). He believes that maintaining a high standard of imaging care is a critical responsibility.

“The medical imaging department at Niagara Health is focused on providing high-quality medical imaging care to all our patients,” said Dr. Dobranowski. “We have a duty to perform the right test safely and efficient-

ly. Being leaders in quality is a privilege and we are thrilled to be helping the development and piloting of CT accreditation with the CAR.” Investigating equipment or procedures that are dated or have been taken for granted over time, like monitor specifications or testing processes, is an exercise in preventing risk instead of reacting to it. For Niagara Health, the CTAP has unearthed the need to create a standardization of policy across their health network and an awareness of the differing needs within that network.

“Taking part in the CTAP was a great opportunity to step back and to review all aspects of the patient’s journey having a CT scan examination,” said Dr. Dobranowski. “It gave us a chance to identify any gaps in our policies and processes and to fill them in where necessary. It was a chance to compare the standards we had in place

Project to improve patient monitoring in the ICU has promising initial results Looking to find an alternative medical imaging option that can be easily implemented and provide extra clinical information for the ICU population at the bedside, KA Imaging and Grand River Hospital (GRH) have partnered on an innovative commercialization project.

GRH has added KA Imaging’s Reveal 35C, a device that can simultaneously produce both conventional chest X-ray at low dose and higher-contrast spectral radiographic images for improved patient monitoring and faster, more accurate bedside imaging in its ICU. The hospital has been measuring success metrics around image quality, impact on work processes, and whether follow-up imaging was needed after Reveal’s images.

“A preliminary analysis comparing the six weeks preceding the pilot period and the 6 weeks in which KA Imaging’s 35C Reveal detector was in use demonstrates a decrease in both the total number of portable chest x-rays as well as chest CTs for patients admitted to ICU. The proportion of all CTs that were chest CTs decreased by approximately 8% and the proportion of patients that required both a chest CT and a portable chest x-ray also decreased by approximately 7%.

Though these are early results and further analysis is required, the overall trend is very promising,” said Carla Girolametto, Director of Innovation, Research, and Clinical Trials at Grand River Hospital.

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22 HOSPITAL NEWS DECEMBER 2023

THE PURPOSE OF THE CAR’S NEW CT ACCREDITATION PROGRAM (CTAP) IS TO HELP ORGANIZATIONS AND FACILITIES ANALYZE DATA TO BETTER UNDERSTAND THEIR OWN PROCESSES, POLICIES, AND TECHNOLOGIES, WITH THE AIM OF ENSURING THE HIGHEST POSSIBLE STANDARD OF CT CARE. and bring them in line with the updated standards produced by the CAR.” “At Niagara Health, three sites are equipped with CT scanners,” said Stephanie Krajcovic, a registered MRT and CT Technologist at Niagara Health. “Through the CTAP experience, we’ve learned each site has its own unique operational differences based in part by the facility set-up and available resources. While the majority of our processes and policies are standard across all sites, it was discovered that there are a few processes that vary between sites.”

Additionally, the CTAP is revealing the value of a heightened focus on quality assurance for things that might not be obvious, like the need to test a room and its walls for radiation every five years instead of only performing an initial acceptance test or understanding the difference in monitor quality for technologists and radiologists and the potential consequences.

The CTAP has also enhanced staff knowledge about the CT modality and equipment usage, resulting in an increase in accredited education activities undertaken by team members.

Sharing knowledge within an organization and to the patient population elevates the work being done in your facility and creates a standard that brings people together.

“We are currently working on quality assurance processes necessary for the accreditation program,” said Krajcovic. “This next phase requires staff training and schedule evaluation for time allotment to execute. There are also policies requiring the managers and radiologists to work collaboratively for implementation.”

Accrediting your facility through the CTAP works to protect patients, staff, and the institution with best practices which are so specific to the CT modality that you can rest assured your department is safe and effective in delivering high-quality care. It is a voluntary program for facilities that want to increase CT standards for their patients through continuous quality improvement.

If you are interested in finding out more about the CAR’S CT Accreditation Program or other accreditation programs, please contact Marc Venturi, DiH rector of Accreditation and Quality. ■ www.hospitalnews.com

CANADIAN ASSOCIATION OF RADIOLOGISTS

Radiologists in Canada are using an AI-driven screening tool to improve population bone health steoporosis is sometimes called the “silent thief”.

Bones deteriorate over years, leading to low bone mineral density (BMD) and increased risk of fracture. Often, an osteoporotic fracture is the first sign of the disease.

These fractures lead to reduced quality of life for patients and significant costs for the healthcare system. For this reason, Canada has screening guidelines for patients 50 years of age and older, which aim to identify patients at risk of fractures before fractures occur. Despite these guidelines, screening rates are low.

Using a new, artificial intelligence-driven screening tool, RhoTM, radiologists now have the means and opportunity to help boost these screening rates. The vast majority of adults over 50 years of age undergo an x-ray for some reason, such as back pain, or to rule out pneumonia. When installed on an institution’s network, Rho takes the opportunity to automatically screen these x-rays for low BMD.

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OVER 70,000 PATIENTS HAVE BEEN SCREENED, AND 45 PER CENT OF THEM WERE AT RISK FOR LOW BMD. The software automatically detects, retrieves, and analyzes eligible x-rays as soon as they are acquired. Rho gen-

erates a score from 1-10, where the higher the score, the higher the likelihood that the patient has low BMD.

The radiologist can choose to include Rho’s finding in their report if the patient has a high likelihood of having low BMD. Inclusion of such a finding could prompt the referring physician to conduct a clinical fracture risk assessment, thereby improving low osteoporosis screening rates.

Rho has been installed at multiple imaging facilities across Ontario and Alberta. Over 70,000 patients have been screened, and 45 per cent of them were at risk for low BMD. By triggering a fracture risk assessment, Rho gives these patients and their healthcare providers a chance to discuss the best ways to slow the rate of bone loss and minimize fracture risk.

Rho was developed by 16 Bit Inc., a Toronto-based medical device company, co-founded by Canadian radiologists Drs. Mark Cicero and Alexander Bilbily. 16 Bit’s mission is to create trusted AI-based medical software to improve the quality, efficiency, and H accessibility of healthcare for all. ■

DECEMBER 2023 HOSPITAL NEWS 23

CANADIAN ASSOCIATION OF RADIOLOGISTS

Creating meaningful impact with equity, diversity, and inclusion: An interview with Dr. Faisal Khosa Authored by Doctors of BC r. Faisal Khosa, a well know CAR member, graduated from medical school in Pakistan and completed postgraduate training and board certifications in Ireland, America, and Canada. He has an MBA in leadership and equity, diversity, and inclusion.

A passion of his, Dr. Khosa leads equity, diversity, and inclusion (EDI) research projects with high school and undergraduate students from underrepresented and minority groups.

Their work has resulted in over 270 peer-reviewed articles and multiple invitations to host workshops on leadership and EDI for Doctors of BC, the Canadian Conference for Physician Leadership, Vancouver Coastal Health, Fraser Health, Canadian

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Medical Protective Association, and more.

For this work, he and his team have received provincial, national, and international awards including the recent Michael Smith Foundation – Health Professional Investigator Competition grant (2023-2028).

In a recent article, Doctors of BC spoke to Dr. Khosa about this important work: Q: What is your definition of EDI and why is it important to you?

Equity, diversity, and inclusion is a set of principles and practices that promote fairness, respect, and equal opportunities for all regardless of their backgrounds, identities, or characteristics.

It is meaningful to me because it aligns with the universal values of

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24 HOSPITAL NEWS DECEMBER 2023

equality, justice, and inclusivity. It recognizes the inherent worth and dignity of every person and seeks to create an environment where everyone can thrive and contribute their unique perspectives and talents.

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” – Martin Luther King Through thoughtful EDI practices, we can actively remove barriers, address systemic inequities, and promote a sense of belonging for all individuals.

Q: Can you talk about your process for incorporating EDI in practice?

EDI is a continuous journey. Opposition to EDI research, advocacy, and activism can be insidious and costly, resulting in work environments that create barriers for minority groups.

Incorporating EDI in your practice is a vital step toward fostering an inclusive and equitable environment.

There are many components to promoting EDI within the workplace.

These include: • Allocating funds, ensure protected time, and provide recognition to those carrying out EDI work.

• Evaluate your institution’s current practices, policies, and procedures to identify potential areas of improvement. This includes critiquing the hiring processes, promotion benchmarks, client interactions, and more.

• Create a clear vision and strategy that states your commitment to EDI and how your institution plans to incorporate it into practice.

• Encourage open and respectful communication and establish zero-tolerance policies for discrimination.

• Provide EDI training to staff to raise awareness, promote understanding, and develop skills to navigate diversity-related challenges. Training should cover topics such as unconscious bias, cultural sensitivity, inclusive communication, and allyship.

• Involve employees, clients, and other stakeholders in the EDI process.

Adapt strategies and approaches to ensure your practice remains inclusive and equitable.

Q: What is the impact of EDI on the workforce and patients?

Impact on your team: The tangible benefits of EDI include a team who are more likely to be intrinsically motivated, engaged, and efficient at their work. This results in improved creativity and innovation, as people from unique backgrounds have unique insights and problem-solving approaches. When the workforce feels valued and supported, they’re much more likely to stay with the organization, thus decreasing turnover and reducing burnout. A diverse workforce also creates more opportunities to have diverse mentors and role models for employees to draw from.

Impact on patients: Patients from different backgrounds have different approaches to navigating health care. Overall, EDI and inclusive workplaces enhance teamwork, improve health care access, foster cultural sensitivity, and ensure the provision of culturally competent care.

Q: What does culturally competent care entail?

Culturally competent care refers to health care providers’ and an organization’s ability to successfully meet the health care needs of clients from diverse cultural backgrounds. This involves understanding and respecting the beliefs, values, practices, and behaviours of all patients and folding that into how a patient navigates the system.

It seeks to understand and respect the patients’ decision-making process so providers can deliver care that is sensitive to cultural values and circumvents assumptions or stereotypes.

A key component of culturally competent care means adapting health care services to meet the cultural needs and preferences of patients, including dietary accommodations, traditional healing practices, or specific cultural beliefs. Involving clients and their families in decision-making and incorporating their input ensures that the provision of care aligns with the H client’s cultural values and goals. n www.hospitalnews.com

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NEWS

Elevating the standard of care through accredited continuous education in nursing

By Misty Fortier he pace of change in Canadian healthcare is fierce, and nursing continuing education and training must keep pace to keep standards of care high. As highly-skilled professionals, nurses are trained to perform in varied workplace settings. Their multifaceted roles make them incredibly versatile, able to adapt to different health-care settings and evolving patient needs.

Their expertise in coordinating care, managing complex situations, and applying critical thinking skills ensures that patients receive comprehensive, culturally competent care. Continuing education supports nurses in their professional growth and career advancement while fostering a culture of lifelong learning within the profession.

To help maintain the significant value that good continuing education programs offer to the profession, accreditation of continuing education

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programs for nurses is crucial to ensure Canada’s nurses have access to the relevant, high-quality development opportunities they need to advance their professional practice.

Continuing education accreditation from the Canadian Nurses Association (CNA) provides nurses with a clear pathway to identify high-quality courses, ensuring their time and resources are well-invested in advancing their knowledge and skills. The process of accreditation provides an impartial evaluation that external organizations conduct to assess educational programs and affirm the currency, relevancy, and high-quality design. With the mark of accreditation, continuing education providers can signal their commitment to excellence, providing nurses an assurance of the value of their professional development.

Accreditation bodies like the Canadian Nurses Association assess

Continued from page 18

Improving lives As one of four standalone specialized mental health and addiction hospitals in Ontario, Waypoint Centre for Mental Health Care serves some of the province’s most complex and disadvantaged populations. We know from our experience the power of research to drive change and improve patient and community health outcomes and experiences. We are excited and energized as we turn our minds to the next ten years of further strengthening and growing WRI, transforming Waypoint into a learning health system and our partnerships into learning networks – dynamic entities that continually integrate research evidence and real world data to improve care delivery together.

WRI researchers are achieving significant success through competitive

grant funding, and Waypoint is also grateful to donors who support our vision for transformational research.

Funds raised at this year’s annual Waypoint gala, to be held on Dec. 8, 2023, will be directed to the WRI. The newly established Breakthrough Fund offers meaningful opportunities for donors to contribute to life-changing advancements in research and care.

In celebrating this 10-year milestone, I extend my deepest appreciation to the dedicated team of researchers, scientists, clinicians and support staff who have made this progress possible. Together, we are enhancing the lives of individuals affected by mental illness and addictions; and we look forward to continuing to lead in research that creates a brighter, healthier future H for all. ■

Dr. Nadiya Sunderji is the President and CEO of Waypoint Centre for Mental Health Care 26 HOSPITAL NEWS DECEMBER 2023

nursing education programs to ensure the program meets national nursing standards. As the mark of quality, CNA Accreditation ensures nurses can readily find continuing education that meets national competencies and standards, which translates into safe, effective, and high-quality care for patients.

CNA is Canada’s only national accrediting body dedicated to the assessment of continuing education for nurses. These accredited courses, programs and exams offer a wide range of educational opportunities, from one hour self-paced courses to over 500 hours of instructor-led graduate certificates and micro-credential programs.

Through the two-year cyclical CNA Accreditation process, continuing education providers must keep pace with current evidence-based practices and the latest knowledge. By providing a diverse range of accredited courses, programs, and examinations, CNA supports nurses in their career journey across different practice settings and specialties.

In a survey conducted in the summer of 2023 by the Canadian Nurses Association, 75% of nurses responding to the survey and aware of accreditation said that they preferred CNA-accredited programs whenever possible.

Accredited continuing education providers agree that nurses have confidence their CNA-accredited courses and programs because they have been rigorously reviewed to meet the highest standards of quality and relevance.

“CNA Accreditation acknowledges the unwavering dedication of nurses.

By ensuring nurses are equipped with the latest evidence and best practices in accredited continuing education programs, CNA recognizes the pivotal role of Canada’s nurses in fostering a culture of excellence within the profession and the best quality care and safety for patients,” explains CNA President Sylvain Brousseau RN, PhD, FFNMRCSI, FAAN.

From oncology, Indigenous health and medical aesthetic nursing courses to clinical specialty programs, CNA recognizes a broad range of comprehensive and focused continuing education for nurses to broaden their knowledge, stay current and specialize in a practice area. Here area few examples of the speciality programs: • Indigenous health, one-hour accredited course, Inuusinni Aqqusaaqtara – My Journey from the Pauktuutit Inuit Women of Canada • Leadership, one-hour accredited course, Clinical Nursing Leadership The Ontario Centres for Learning, Research and Innovation in LongTerm Care and Bruyère Research Institute • Mental health, three-hour course, Suicide: Facing the Difficult Topic Together – Empowering Nurses, Instilling Hope in Patients from the Mental Health Commission of Canada (MHCC) • Emergency nursing, 525-hour program, Regional Emergency Department Education Program (REDEP) from Interior Health • Perioperative nursing, 535-hour program, Advanced Certificate in Perioperative Nursing Specialty from the British Columbia Institute of Technology (BCIT) Keeping Canada’s nursing workforce at the forefront of health-care change and innovation makes accreditation more critical than ever. Nurse employers must ensure their nurses are competent, up-to-date, and capable of providing safe and effective patient care. Our nurses must have an assured way to acquire this expertise and demonstrate new competence in diverse practice areas to benefit all Canadians. Accredited continuing education is essential for nurses and their employers in supporting the skilled professionals we need in healthcare today.

Take a closer look at CNA-accredH ited continuing learning. ■

Misty Fortier is Director of Credentialing Centre and Nursing Policy, Canadian Nursing Association. www.hospitalnews.com

ETHICS

Patient safety and the dignity of risk

By Andria Bianchi ealthcare organizations, and providers who work within them, put significant effort in striving to achieve a culture of patient safety. The concept of “safety” is somewhat of an umbrella term insofar as different types of safety exist: physical safety, psychological safety, and cultural safety are just three examples. When thinking about physical safety in particular, there are countless ways in which this is prioritized and practiced. For instance, many, if not most, healthcare organizations strive to achieve “zero falls” within their spaces. To this end, healthcare providers adhere to calculated protocols to decrease medication errors and evidence-based strategies are followed so that pressure injuries are prevented.

The prioritization of patient safety goes part and parcel with the bioethical principle of non-maleficence, which is the idea that we (healthcare providers) ought to prevent patients from experiencing harm. In other words, if we ought to prevent people from experiencing harm, then it seems essential to promote patient safety.

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hip fracture. Subsequently, Mr. D was admitted to an acute care hospital and surgery was offered. After receiving surgery, Mr. D was given an opportunity to be transferred to a post-acute care rehabilitation centre. While in rehab, Mr. D participated in all therapeutic interventions and expressed an eagerness to return to his previous home.

The rehab team (comprising of occupational therapy and physiotherapy) recommended that in order to facilitate a safe discharge home and prevent future falls, Mr. D should: (a) install grab bars in his washroom and (b) use a rollator walker in both indoor and outdoor environments.

In response to these recommendations, Mr. D stated that he would not be making alterations to his home, nor did he intend on using a walker upon leaving the hospital. Although Mr. D was using a walker and grab bars while in-hospital, he stated that he would not live “this way” when he leaves.

The clinical team stressed that he is at an extremely high risk of experiencing another fall without implementing these strategies, but he could not be swayed.

PATIENT SAFETY IS IMPORTANT, PREVENTING HARM IS IMPORTANT, AND DIGNITY IS IMPORTANT, AND IT MAY BE THE CASE THAT WE DEFINE AND/OR PRIORITIZE THESE CONCEPTS DIFFERENTLY THAN OUR PATIENTS. Healthcare providers’ and organizations’ dedication to patient safety is necessary so that we can provide patients with the best care possible. With that being said, an ethical dilemma sometimes occurs in circumstances wherein patients may not want their safety to be prioritized. In order to describe this kind of scenario, let’s consider the following: Mr. D, a 78-year-old male, lives by himself in a 3-storey home. A few weeks ago, as Mr. D was walking to the washroom in the middle of the night, he fell down the stairs, resulting in a

The importance of patient safety, coupled with healthcare providers’ obligation to prevent harm, makes Mr. D’s response is difficult to accept. In fact, Mr. D’s response may influence providers to experience quite a bit of distress.

Providers may reasonably ask why a person would want to be discharged to an environment that is not safe?

Ethicists are sometimes consulted in these complex circumstances to facilitate decision-making processes and support all parties in determining next steps, particularly if there is uncertainty on the “right” way to proceed. In the

case of Mr. D, we may explore whether Mr. D is providing a fully capable, informed refusal of recommendations.

We may unpack his decision-making rationale. We may ensure he is aware of what to do if he changes his mind about installing grab bars and/or using a walker. We may also explore alternative options in terms of patient recommendations. In short, we may take various actions and explore multiple options as an interdisciplinary team to ensure that next steps are ethically defensible.

I understand why clinicians may experience distress when patients make autonomous, informed, and capable risky decisions. With that being said, when it comes to cases like Mr. D’s, it can sometimes help to reflect upon and grapple with the concept of the dignity of risk.

The dignity of risk is a concept that was introduced in 1972 by Robert Perske. Although the concept was initially used in relation to people with mental illness and cognitive impairment, it is frequently applied to other populations in which “risk-taking” may be prevented. In his work, Perske describes the importance of offering and allowing people “to assume a fair and prudent share of risk” in relation to their capabilities, and he notes that

some risk-taking may be an important part of human dignity. In other words, the concept suggests that living a dignified life may, in fact, require some degree of risk-taking.

The dignity of risk can, at times, be a useful concept for us to consider as healthcare providers. If, for instance, Mr. D’s idea of what it means to lead a dignified life involves risk-taking, then his decision to take some risks and not to prioritize safety makes sense. Now, it is still important to ensure that we – as healthcare teams – promote safety. However, it may also be important to promote dignity and consider the possibility that this concept may mean different things to different people; a dignified life may look different depending on the person.

Balancing the many competing priorities and responsibilities that healthcare providers owe to patients can be complex. Patient safety is important, preventing harm is important, and dignity is important, and it may be the case that we define and/or prioritize these concepts differently than our patients. The concept of the dignity of risk can sometimes help us work through circumstances where patients make capable and informed decisions to take risks and not prioritize our H conception of safety. ■

Andria Bianchi, PhD, is a Clinical Ethicist at Unity Health Toronto – Centre for Clinical Ethics, where she offers ethics support to post-acute care settings. She is also an Assistant Professor (status-only) at the Dalla Lana School of Public Health – University of Toronto.

28 HOSPITAL NEWS DECEMBER 2023

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SAFE MEDICATION

Oral dosage form modifications: Important considerations to safeguard patient safety

By Karnie Garabedian, Pamela Molina, Sanaz M. Chenani, and Certina Ho ily, an 18-year-old patient, has recently been prescribed Venlafaxine Extended-Release Capsules to address her symptoms of anxiety. Lily is facing challenges when it comes to swallowing these capsules due to their size and finds herself at a loss on how to proceed. Despite her attempts to find a solution, she is unsuccessful. Lily ultimately decides to visit the pharmacy, hoping to gain clarity and guidance.

In the ever-evolving realm of pharmaceuticals, continuous strides are being made to enhance drug delivery, patient adherence, and overall treatment efficacy. Refinements to oral dosage forms, such as tablets and capsules, present tailored solutions to address diverse patient needs. However, when these modifications are not executed properly, they can lead to dire consequences that may compromise patient safety and treatment effectiveness.

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THE DELICATE BALANCE OF PHARMACEUTICAL FORMULATION Oral medication administration is an intricately designed process to precisely deliver therapeutic agents to the body.

The ability to modify an oral dosage form depends on various factors including the medication’s chemical properties, the tablet or capsule’s formulation, and patient requirements. Modifying dosage forms can be advantageous for patients struggling with swallowing whole tablets or capsules, those who require precise dosage adjustments, or patients with unique medical needs/ conditions. However, it is imperative to note that improper alterations may lead to unintended consequences.

TABLETS: CRUSH OR SPLIT? The practice of crushing tablets is often employed to facilitate administration, particularly for patients who have difficulty swallowing. However, not all tablets can be crushed. Tablets

IMPORTANCE OF HEALTHCARE PROFESSIONAL INVOLVEMENT

IN THE EVER-EVOLVING REALM OF PHARMACEUTICALS, CONTINUOUS STRIDES ARE BEING MADE TO ENHANCE DRUG DELIVERY, PATIENT ADHERENCE, AND OVERALL TREATMENT EFFICACY. formulated for immediate release (IR) are generally more suitable for crushing as they are designed to be disintegrated and released quickly upon ingestion. Conversely, drugs with special formulations such as extended-release (ER, XR, XL), sustained-release (SR), controlled-release (CR), enteric-coated (EC) tablets, and dissolvable tablets should not be crushed.

Such actions could alter the intended drug release profile, potentially inducing dose dumping (i.e., a large amount of drug was quickly released into our body’s circulation) and adverse effects. Additionally, medications that are considered hazardous (https:// hospitalnews.com/hazardous-and-cytotoxic-drugs-safety-considerations/) or have a narrow therapeutic window (i.e., the dosage range of a medication between its minimum effective therapeutic concentration and its minimum toxic concentration is very narrow) should also be spared from crushing, as doing so may lead to unpredictable and potentially dangerous fluctuations in drug absorption (A), distribution (D), metabolism (M), excretion (E), and overall drug safety and efficacy.

Tablet splitting allows for dosage adjustments, particularly when a lower dose is required. Tablets with a score line, indicating their suitability for splitting, are generally safer for such purposes. Ensuring even splits is essential for precise dosing. Similar to crushing, ER, SR, CR or EC tablets should not be split, given the potential compromise to therapeutic efficacy and safety of the medication. Neverthe-

less, exceptions do exist; and there are oral dosage forms that are scored and amenable to splitting, but not crushing. Patients are advised to check with your pharmacist before doing so.

Other factors to consider (prior to crushing or splitting) are film-coating and taste. Splitting or crushing film-coated tablets could compromise drug integrity due to exposure to light, moisture, and air. Furthermore, this may expose patients to the medication’s full taste, which might be unpleasant or bitter.

CAPSULES: OPEN OR NOT? Hard gelatin capsules often encapsulate powders or small granules of medication. In some cases, these capsules can be opened, and their contents can be sprinkled onto soft foods or directly consumed for easier ingestion. However, this should be approached cautiously, as consuming the entire contents of the capsule is vital to obtaining the full therapeutic dose.

Soft gelatin capsules that contain liquid or semi-solid formulations are typically not designed to be opened, as doing so may expose the contents to air and moisture, potentially compromising drug safety and efficacy.

How can we help Lily?

Venlafaxine Extended-Release Capsule is supplied as a hard gelatin capsule filled with pellets. Therefore, these capsules may be carefully opened, and the entire contents can be sprinkled onto soft food, such as applesauce, and swallowed completely.

Inappropriate modifications of oral dosage forms may result in several complications, ranging from altered drug release, drug degradation, inconsistent dosing, and altered the A-D-M-E of a medication and overall drug safety and efficacy. Healthcare professionals are pivotal in mitigating these risks by assessing each patient’s medical history, conditions, and preferences before recommending any modification. Their guidance extends to recommending appropriate modification methods, ensuring patients follow safe practices that would preserve drug efficacy and safety. There are several resources that can be consulted to determine which modifications, if any, would be appropriate. For example: • Drug product monographs (available at the Health Canada Drug Product Database: https://health-products. canada.ca/dpd-bdpp/) • Compendium of Pharmaceuticals and Specialties (CPS: Drug Information) (available at https://www. pharmacists.ca/products-services/ cps-print/) • Hospital drug formularies Modifying oral dosage forms to meet patient needs is a delicate and complex process that requires a deep understanding of pharmaceutical science, drug properties, and patient considerations. While some tablets may be crushed or split, and certain capsules may be opened, these actions should always be taken under the guidance of healthcare professionals. Safety, efficacy, and patient well-being remain paramount when exploring modifications of oral dosage forms. Consulting healthcare providers and referring to reliable sources is essential to making informed decisions that support patient safety and optimal treatment H outcomes. ■

Karnie Garabedian, Pamela Molina, and Sanaz M. Chenani are PharmD Students at the Leslie Dan Faculty of Pharmacy, University of Toronto; and Certina Ho is an Assistant Professor at the Department of Psychiatry and Leslie Dan Faculty of Pharmacy, University of Toronto. www.hospitalnews.com

DECEMBER 2023 HOSPITAL NEWS 29

LONG-TERM CARE NEWS

New healthcare program keeps residents safe at home thel McGuire has lived in the same East Toronto apartment building for 30 years. For the last 25, she has been the building manager. For Ethel, looking out for the seniors in the building is a natural part of her role.

“Just over eight years ago, when I hadn’t seen Mr. Carter in a few days, I followed up and found him on his bedroom floor unable to get up,” Ethel says of one of the building residents.

“When he went into hospital, I asked if there was anyone he wanted me to call and he said there was no one. We kind of adopted one another at that point.”

Mr. Carter was recently enrolled in MGH2Home, an enhanced care program from East Toronto Health Partners (ETHP), the Ontario Health Team (OHT) serving East Toronto,

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that helps patients transition home safely when they leave Michael Garron Hospital (MGH) in Toronto’s east end.

Patients in this program are assigned a dedicated team of healthcare professionals from VHA Home HealthCare (VHA), Spectrum Health Care and WoodGreen Community Services, who work collaboratively as an interprofessional team. All of these organizations, including MGH, are members of ETHP. Each patient’s team includes a nurse who can connect with the patient’s primary care doctor. The team may also include occupational therapists (OT), pharmacists, social workers, personal support workers (PSW) and more.

Together they assess the patient’s needs and collaboratively develop and deliver a customized care plan

of services for up to 90 days based on the individual needs of the patient.

DIVERSE TEAM PROVIDES COMPREHENSIVE CARE “The OT, PSW and nurse that were assigned to Mr. Carter seemed to be the perfect fit,” Ethel says.

“It took a lot for Mr. Carter to admit he required the extra help, but he came to welcome it and I believe he thrived because of this care.”

“One of the benefits of MGH2Home is the functional exercise program we are able to offer with the support of OT assistants (OTA) and physiotherapy assistants (PTA),” notes Jeanie Lee, supervisor for the program from VHA. “In home care, we often see patients who have reduced mobility following a

hospital stay due to the time spent in bed. OTAs and PTAs support MGH2Home patients with an exercise mobility program to help them get stronger, which supports their transition home.”

A main goal of MGH2Home is to help patients and their care providers safely manage care needs at home, in turn reducing unnecessary emergency room visits and re-admissions to hospital. The program has made a difference for over 105 patients since its launch April 17, 2023.

“When patients are discharged from the hospital, we want to help ensure they can remain safe and healthy out of hospital,” says Dorothy Quon, Director of Emergency Health Services at MGH. “This helps improve their health outcomes and ensures hospital emer-

$! $. // - / #*( Bayshore’s home care services are extensive, ǀĂƌŝĞĚ͕ ĂŶĚ ƉĞƌƐŽŶĂůŝnjĞĚ ĨŽƌ ĞĂĐŚ ŝŶĚŝǀŝĚƵĂů͘ tŚĞƚŚĞƌ ŝƚ͛Ɛ ũƵƐƚ Ă ůŝƚƚůĞ ĂƐƐŝƐƚĂŶĐĞ ǁŝƚŚ ĚĂŝůLJ tasks or round-the-clock ŚŽŵĞ care, Bayshore’s caregivers can help your loved ones to live ƚŚĞŝƌ ďĞƐƚ ůŝĨĞ ǁŚŝůĞ ƌĞŵĂŝŶŝŶŐ Ăƚ ŚŽŵĞ͘

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LONG-TERM CARE NEWS

A MAIN GOAL OF MGH2HOME IS TO HELP PATIENTS AND THEIR CARE PROVIDERS SAFELY MANAGE CARE NEEDS AT HOME, IN TURN REDUCING UNNECESSARY EMERGENCY ROOM VISITS AND RE-ADMISSIONS TO HOSPITAL. gency departments have capacity to continue providing care for urgent, life-threatening health issues, especially as we approach respiratory illness season.”

COLLABORATION KEY TO SUCCESS Naushin Chauhan, one of the MGH2Home primary nurses from Spectrum Health Care, believes one of success factors of the program is the collaboration of the care team.

Jhenelle Grey, a social worker from WoodGreen Community Services who helps connect MGH2Home patients with community resources, agrees. “Our ‘one team’ approach means we problem solve together so we can respond quickly to any changes in a patient’s situation and provide more timely access to services,”

Jhenelle says. “I’ve heard from many patients and their caregivers that they appreciate how coordinated the care is. And it also improves my experience as a healthcare professional, as I can learn from colleagues with different specialties.”

“I would agree that a great benefit to this program is the collaborative team approach,” Jeanie adds. “Patients tell us they feel supported and working as “one team” helps the providers feel supported as well.

“I totally appreciate the MGH2Home service,” Ethel adds. “Communication with the team is definitely key.”

MGH2Home is an important step in ETHP’s efforts to integrate care in East Toronto and to support more patients at home, where they most want H to be. ■

Jhenelle Grey is a social worker from WoodGreen Community Services.

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DECEMBER 2023 HOSPITAL NEWS 31

Enhancing Patient Care Through Caregiver Inclusion

Different from visitors, family caregivers or essential care partners play an active role in providing physical, psychological and emotional support to a family member, partner or friend. Evidence shows that including essential care partners as part of the care team leads to improved quality of care and patient outcomes, improved working conditions for health professionals and less pressure and reduced cost on the health system.

Contact the Essential Care Partner Support Hub at ontariocaregiver.ca/essentialcarepartner for free expert guidance and evidence-informed resources to build or enhance an Essential Care Partner program.