Inside: From the CEO’s Desk | Evidence Matters | Ethics | Nursing Pulse | Careers
May 2019 Edition
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MARLÈNE AND HER MOM KNOW ABOUT
“ACTIVE OFFER” OF FRENCH LANGUAGE SERVICES
DO YOU?
For anyone taking care of an elderly parent, it’s top of mind: “Will my mother/father feel safe and be understood when I’m not there?” Everyone wants the best for their parents in their senior years. That’s what Marlène wanted for her mother when she needed home and community care services. Initially, Marlène was told that there was no one who spoke French. She was quite concerned that her mother would not be understood and might not respond well to the care provided. Though Marlène was able to interact with staff in English, the situation was stressful for both her and her mother since their primary language is French. Marlène insisted, knowing there were French-speaking employees in home and community care, since she herself had taught students in the field. Her case manager eventually located a staff person who spoke not only French but also Créole, her mother’s native language. And then the case manager simply reorganized workloads to allow the linguistically-qualified staff member to provide the care. “Quelle différence,” says Marlène. It made a world of difference since she could speak to the staff in their common language and more importantly, her mother could better grasp the care being provided and be reassured. Providing linguistically and culturally appropriate services leads to a better outcome. Find out more here: refletsalveo.ca/active-offer-training
Reflet Salvéo is a French-Language Health Services Planning Entity funded by the government of Ontario through the Toronto Central, Central West, and Mississauga Halton LHINs
A free online course
“DON’T LEAVE IT TO CHANCE” Imagine a health system where Marlène and her mother would have known they could be served in French (through a greeting at first point of contact), where they could have been given options (to be served in French at intake and when services were delivered) and where home and community care could connect them to French-speaking staff from the start (by identifying staff language skills and tracking them electronically). “Quelle différence!”
That’s Active Offer. It makes a difference. It improves patient experience, reduces risks and leads to better health outcomes.
Contents May 2019 Edition
IN THIS ISSUE:
World-first paediatric procedure
10 ▲ Nursing Heroes 2019
21
▲ Racial differences in end-of-life care
18 ▲ Enhanced Recovery Canada
COLUMNS Editorial ............................4
9
In brief .............................7 Ethics .............................14 Evidence matters ...........20 Long-term care news ........ 48 Doctors without Borders ..58 From the CEO’s desk .....59 Nursing pulse ................60
Cover photo by: Doug Nicholson, Sunnybrook Health Sciences Centre
▲ Workshop for dementia students
52
New equipment aims to make surgery safer
17
▲ 3-D virtual reality helps neurosurgeon
62
Opioids are killing Canadians in the thousands
By Senator Jane Cordy and Senator Raymonde Gagné wasn’t born to be a drug addict,” said a brave member of the audience at our recent Open Caucus meeting in the Senate on the Opioid Crisis in Canada. He told us of his struggle with drug addiction over two decades. His closing words hung in the air for us all to absorb: “We need to care more.” He’s right. And we’d better hurry up. More than 9,000 people lost their lives in Canada between January 2016 and June 2018 due to opioids, a class of highly addictive drugs that are commonly prescribed for pain relief and easy to buy illicitly. Most of the dead – almost 70 per cent – were young and middle-aged adults between the ages of 20 and 49, the majority male. It’s a national crisis and a public health emergency. Dr. Jeffrey Turnbull, Medical Director of Ottawa Inner City Health told the Caucus that less than one kilometre from Parliament Hill opioids are easily available on the street. “I now see 150 heroin addicts and five overdoses every day,” he said. What’s driving the addiction crisis? Dr. Turnbull told the panel, “They are treating their trauma with opioids.”
“I
In fact, as Dr. Sheri Fandrey, Clinical Assistant Professor in the College of Pharmacy at the University of Manitoba told the panel, “We don’t have an opioids crisis or a methamphetamine crisis. We have a trauma crisis; a housing crisis; a poverty crisis; a stigma crisis.” In other words, what’s fueling addictions are risk factors well-established by research, such as childhood trauma, low income, disability, unemployment and historic trauma, such as the residential schools experienced by Indigenous peoples. Dr. Esther Tailfeathers, the Medical Lead for the Population and Public, Indigenous Strategic Care Network told the panel that her community, the Blood Reserve in Southern Alberta, with a population of around 13,000, had two to three deaths per week from opioid use. One night they had 14 overdoses. So they embraced harm reduction. They set up a safe consumption site and a safe withdrawal site, created a mobile response unit and trained front line workers and community members. The first three months they used naloxone, a drug that reverses the effects of opioids in an overdosing situation, they had Zero opioid-related deaths. Continued on page 7
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Opioids are killing Canadians Continued from page 4 Dr. Caroline-Hosatte-Ducassy, a medical resident in Emergency Medicine at McGill told the Caucus that opioids still have an important use in medical practice to treat significant pain, but that doctors need more training, and integrated electronic records, to help prevent over-prescribing. Dr. John Weekes, Director of Research and Academics at Waypoint Research Institute noted the link between crime and the need to fund addiction. Yet, as he put it, “I’ve met thousands of people with substance addiction and I’ve never met any for whom this was their life plan.” So what can be done? In 2016, the federal government created the Canadian Drugs and Substances Strategy, earmarking more than $100 million over five years, along with other targeted resources and regulatory changes, to address the crisis. The recent federal budget sets aside an additional $30.5 million over five years to address gaps in harm reduction and treatment. Hearing from the experts it became clear we need to do more. “We can’t criminalize a solution,” as Dr. Turnbull put it. We need a public health solution that is integrated and multi-sectoral and focuses on primary prevention. We need an education campaign and we need to make non-prescription solutions for pain and mental health issues accessible. Abstinence-based treatment is ineffective, so we need to invest heavily in harm reduction strategies, including safe injection sites and opioid replacement therapy. Critically, we need long-term treatment facilities that treat root causes with trauma-informed care – without wait lists. As one member of the audience said, we need to “stop treating addiction like a moral failing,” and treat it like a serious medical condiH tion. It’s time to care more. ■ www.hospitalnews.com
Emergency department
outcomes vary among patients with cancer atients with cancer requiring emergency department care had better outcomes at their original hospital or a cancer centre hospital than at alternative general hospitals, found research published in CMAJ. “Patients who were seen in an emergency department that was not associated with where they received cancer treatment or one of the 14 major cancer centres in the province were less likely to be admitted to hospital but more likely to die within 30 days of the visit,” says Dr. Keerat Grewal, an emergency physician at Mount Sinai Hospital and the University of Toronto. “This may be because of a combination of factors, including a lack of cancer expertise at hospitals
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that do not routinely provide cancer care.” The study included data from ICES on 42 820 patients who were seen at an emergency department within 30 days of chemotherapy or radiation treatment between 2006 and 2011. Almost half of all patients who visited an emergency department for a cancer-related issue were admitted to hospital and, of these, about one-third visited hospitals other than the hospital where they were receiving cancer treatment. Patients who visited hospitals that were not where they received their treatment and were not a cancer centre had a lower rate of admission and a higher likelihood of death within 30 days.
The authors suggest the lower admission rates may be because of lack of cancer expertise and missed markers of worsening disease. “Emergency departments not affiliated with a cancer centre may not have the expertise to treat patients with cancer who often have complex medical histories,” says Dr. Grewal. “Emergency department physicians who infrequently encounter patients with cancer cannot be expected to know the intricacies of cancer care with little or no exposure to how to treat these patients.” “The association of continuity of care and cancer centre affiliation with outcomes among patients with cancer who require emergency department H care” was published April 23, 2019. ■
Maternal gestational Opioid-related overdose deaths diabetes linked to in Canada diabetes in children T
hildren and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ. Early detection of diabetes is important in children and youth, as many – about one-quarter – are diagnosed when seeking care for diabetic ketoacidosis, a potentially life-threatening complication of diabetes. “Although type 1 and type 2 diabetes in parents are well-established risk factors for diabetes, we show that gestational diabetes mellitus may be a risk indicator for diabetes in the mother’s children before age 22,” says Dr. Kaberi Dasgupta, a clinician-scientist from the Centre for Outcomes Research and Evaluation (CORE) at the Research Institute of the McGill University Health Centre. The study of 73 180 mothers compared data on randomly selected sin-
C
gle births from mothers with gestational diabetes to births from mothers without gestational diabetes. The incidence – the number of new cases – of diabetes per 10 000 person-years was 4.5 in children born to mothers with gestational diabetes and 2.4 in mothers without. A child or teen whose mother had gestational diabetes was nearly twice as likely to develop diabetes before the age of 22 years. The association was found in children from birth to age 22 years, from birth to 12 years, and from 12 to 22 years. “This link of diabetes in children and youth with gestational diabetes in the mother has the potential to stimulate clinicians, parents, and children and youth themselves to consider the possibility of diabetes if offspring of a mother with gestational diabetes mellitus develop signs and symptoms such as frequent urination, abnormal thirst, weight loss or fatigue,” says Dr. H Dasgupta. ■
he opioid crisis continues to have devastating effects on the health and lives of many Canadians, their families and their communities. During the first nine months of 2018, 3,286 Canadians lost their lives to apparent opioid-related overdoses. Tragically, this means that between January 2016 and September 2018, more than 10,300 Canadians died as a resulted of an apparent opioid-related overdose. In addition, the data show that fentanyl and other fentanyl-related substances continue to be a major driver of this crisis. From January 2018 to September 2018, 73% of accidental apparent opioid-related deaths involved fentanyl or fentanyl-related substances. The data confirm that this crisis continues to impact the entire country.
Continued on page 61 MAY 2019 HOSPITAL NEWS 7
NEWS
Supporting both patients and caregivers is key in
palliative care By Emily Dawson aggie Bruneau knows that delivering the best palliative care means offering flexibility and options, for both patients and caregivers. In the lead-up to redesigning Providence Healthcare’s palliative care program in 2016, interviews with dozens of patients and families were conducted to get a sense of how the community wanted to be supported at end of life. One of the key outcomes was a new process to help fulfill people’s wishes to spend their last days at home – while also giving them the assurance that there would be a seamless process for them to return to Providence if needed.
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ALMOST 75 PER CENT OF CANADIANS WANTED TO DIE AT HOME. Last fall, the Canadian Institute for Health Information released a report with an assessment of palliative care in Canada and found almost 75 per cent of Canadians wanted to die at home. “Some people think when they enter palliative care, they need to sell everything and this will be their last home,” says Bruneau, vice-president of Programs at Providence Healthcare. “But we have supports that allow patients to return home and come back to Providence should they need to. Even if we send someone home, and they get anxious or feel like something is changing at 2 a.m. we have
the process in place to re-admit them immediately.” Another key strategy was to build robust supports for caregivers who have family or friends in palliative care at Providence. “Our program includes a 33-bed unit – making it one of the province’s largest hospital programs – and we have a legacy of providing comfort, managing pain, and fostering dignity for the dying,” says Bruneau. “We also took great care in designing an environment and services to support their loved ones and caregivers.” We renovated and relocated the inpatient unit to give it a contemporary look and, at the same time, introduced a dedicated Family and Caregiver level, which includes two overnight suites for family members needing to stay close by, a children’s room, private dining area, business offices, and a multi-faith prayer room. These spaces help caregivers manage other responsibilities while balancing the need to stay close to their loved ones in palliative. Looking at evidence-based best practices and to the future, Providence’s leadership recognized that inpatient palliative care is not the preferred path for everyone. “We’ve been able to successfully implement a respite program, which gives in-home caregivers time for rest and renewal while their loved one receives care from us,” says Bruneau. Caregivers can use the time for selfcare, a vacation, or to manage professional obligations, knowing their loved one is safe with appropriate care and pain management. Caregivers may
We both felt at peace that Providence was her last stop,” says Michael Pasquale(pictured), who was his mother’s caregiver before she was admitted as an inpatient in Providence Healthcare’s palliative care program. also be experiencing their own health issues and respite gives them the confidence that they can concentrate on their own healing. For families caring for a loved one at home, respite services are a lifeline to maintaining their own well-being. Every situation is different and the team at Providence works individually with patients and families to help them achieve their plans and goals. Rosie Pasquale and her family chose Providence’s inpatient Palliative Care program. She always had warm memories of Providence, knowing that close family members had received exceptional care there. Her primary caregiver, her son Michael, eventually found she was requiring more intensive care that he could not provide and reached out to Providence.
“We spent lots of time together and I cherished that; I wanted to be able to care for her as she aged. But it was a difficult role for a son because it was very personal, like bathing and dressing her,” he says. “She had so many falls at home and I was nervous all the time. Ultimately, she had a terrible fall that changed everything. Her mind was sharp but her body was deteriorating quickly.” In a hospital after the last fall, Rosie’s doctor recognized that palliative care was the best option. “We both felt at peace that Providence was her last stop,” her son recalled. “Her doctor, nurses, and everyone on the unit were so good, and I always felt in the loop – they took good care of me too. She was safe and comfortable. That’s all we could have H wanted.” ■
Emily Dawson works in communication at Unity Health (Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital). 8 HOSPITAL NEWS MAY 2019
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NEWS
Enhanced Recovery Canada is helping patients get better faster By Carla Williams any people think that if they are having an operation tomorrow, they can’t eat or drink after midnight. While that may have been the practice for decades, the guidelines have changed and instead of fasting, patients are now allowed to drink up to two hours before their procedure. Enhanced Recovery Canada (ERC) is introducing new ways of managing care before, during and after surgery that have been shown to help patients heal and get back to normal everyday functions faster. Following ERC protocols also helps to standardize processes related to surgical care so that everyone is working from the same information, from surgeons, nurses and anesthesiologists to dietitians, physiotherapists, pharmacists, and patients themselves to improve health outcomes. ERC consists of evidence-based principles based on surgical best practices known to help patients receive optimal care. These core principles are patient-inclusive, standardized, evidence-based clinical pathways that encompass the most important enhanced recovery after surgery actions and are relevant for most surgeries. ERC has adopted a ‘care bundle’ approach. This means the key drivers or interventions, which have been clinically proven to have the greatest impact on outcomes before, during and after surgery, are grouped together to promote their delivery. The first clinical pathway ERC has addressed is colorectal surgery, with six core principles in the care bundle: patient and family engagement, nutrition, early mobilization, perioperative fluid management, multimodal pain management, and evidence-based surgical best practices. More than 40 healthcare professionals including surgeons, anesthesiologists, nurses, physiotherapists and dietitians from across Canada in various health disciplines are invested in ERC. Members develop pathways, identify evaluation metrics and develop knowl-
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ENHANCED RECOVERY CANADA CONSISTS OF EVIDENCE-BASED PRINCIPLES BASED ON SURGICAL BEST PRACTICES KNOWN TO HELP PATIENTS RECEIVE OPTIMAL CARE edge tools. Stakeholders, identified through their involvement with local enhanced recovery programs, serve as site-based champions and leaders for change, to implement the pathways. They are the early adopters, encouraging others to follow their lead. Enhanced Recovery Canada is a program of the Canadian Patient Safety Institute that is based on an international, comprehensive and multi-disciplinary approach to the care of the surgical patient. Enhanced Recovery After Surgery (ERAS) is a multi-modal approach to recovery pioneered in 1995 by Danish surgeon Dr. Henrik Kehlet. The International ERAS® Society, based in Stockholm, Sweden, was officially registered in 2010 and since then, the ERAS principles have expanded around the world; they are now applied to nine different specialties.
A number of healthcare organizations within Newfoundland and Labrador, Quebec, Ontario, Alberta and British Columbia have already embarked on the implementation of ERAS principles. These healthcare organizations have gained significant knowledge and experience to support the implementation of the ERC program across the country. After implementing ERAS for colorectal surgeries, Vancouver General Hospital reduced length of stay by two days and reduced most complications by 15.5 per cent. That’s about 57 patients in a 28-month period that avoided complications such as pneumonia, urinary tract infection or surgical site infection. Alberta Health Services (AHS) reported similar success from its ERAS strategy. Not only did patients report that they felt better sooner, but the av-
erage length of stay in hospital was also decreased by more than three days and the province calculated that for every dollar invested in ERAS implementation, approximately three dollars were saved. Patient education is the starting point in any enhanced recovery effort. St. Clare’s Mercy Hospital has been recognized by the Health Standards Organization (HSO) as having a leading practice in patient engagement for the role of patient advisors as members of the Interdisciplinary team responsible for implementation of ERAS at Eastern Health in Newfoundland and Labrador. This team participates in the review of evidence-based practices, develops standardized documents that guide clinical care at their institutions, and creates patient education materials. The patient advisors give direction on how, when and where surgery-specific education should be delivered to ensure patients are informed about the preparation for, and recovery from, major surgery. The McGill University Health Center Patient Education Office has developed a patient education resource, based on the ERAS principles. Patient integration is an important part of preoperative counseling and is the starting point for recovery. In April 2019, the Canadian Patient Safety Institute launched a Safety Improvement Project focused on these ERC surgical best practices to help healthcare teams make a significant impact on surgical outcomes. Seven teams from healthcare organizations across the country are participating in the 18-month knowledge translation/quality improvement learning collaborative. Resources provided to the ERC Safety Improvement Project teams will also be made available online to support any healthcare organizations interested in implementing a program to advance enhanced recovery. For more information, or to access these tools and strategies, visit www.patientsafetyinstitute.ca and search “ERC” or via e-mail: erc@ H cpsi-icsp.ca ■
This article was contributed by Carla Williams, Senior Project Manager at the Canadian Patient Safety Institute. www.hospitalnews.com
MAY 2019 HOSPITAL NEWS 9
NEWS
World-first paediatric procedure eliminates pain, treats rare condition for SickKids patient SickKids surgeons change blood flow in a vein from oneway to two-way in minimally invasive and life-changing procedure for teen
Linda recovers at SickKids after her procedure.
By Vanessa Blanchard hen Linda Fedele, 17, woke on May 14, 2017, to extreme back pain, she never thought it would be over a year until she was pain-free. She certainly didn’t think the solution would be a world-first surgical procedure. On June 4, 2018, Linda became the first paediatric patient in the world to successfully undergo an innovative procedure by a team of surgeons at The Hospital for Sick Children (SickKids) to treat her rare medical problem known as nutcracker syndrome. Nutcracker syndrome is a condition where the left renal vein, which drains blood from the kidney into the body’s main vein (called the vena cava), becomes compressed between the aorta and neighbouring superior mesenteric artery. This creates a partial blockage with pressure build-up in the left kidney, which can cause debilitating pain and hematuria (blood in the urine). This arrangement of arteries compressing the left renal vein has the appearance of a nutcracker, hence the name, nutcracker syndrome. When Linda’s pain first started, she and her mother, Cila, spent the next several months visiting doctors’ offices, emergency departments and specialists to try to find its cause. “When I came to SickKids to be seen by a urologist, I was nervous. I had already been told by other doctors that the pain was muscular, that it would go away with time and that it was all in my head,” says Linda.
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10 HOSPITAL NEWS MAY 2019
Dr. Armando Lorenzo, Staff Physician in the Department of Urology at SickKids, immediately suspected that something more serious could be happening. By the time he saw Linda, the pain she was experiencing had significantly impacted her schoolwork and ability to participate in sports. He ordered a Doppler ultrasound, which evaluates blood flow through the renal veins, to assess her kidneys. Lorenzo’s suspicious were confirmed; Linda had Nutcracker syndrome. With a diagnosis, Lorenzo and Dr. Jessica Hannick, Fellow in the Department of Urology at SickKids at the time, set out to create a treatment plan, but complicating Linda’s case
was the fact that she was born with only one kidney. “Treatment for Nutcracker syndrome typically involves either large, open surgeries where the kidney is reconnected or by-passed to the vena cava elsewhere, or with placement of a foreign body to drain the kidney, such as a stent,” says Lorenzo. “Such invasive options held a lot of risk for Linda’s one kidney and we wanted to find a better way to alleviate the pressure in the kidney and therefore reduce her pain.” Lorenzo enlisted the help of his colleagues, Dr. Osami Honjo, Staff Cardiac Surgeon, and Dr. Joao Amaral, Division Chief of Interventional Ra-
diology in the Department of Diagnostic Imaging at SickKids. Together they developed a novel and minimally invasive technique that redirected blood flow from the kidney by converting a one-way vein into a two-way vein. Before the surgery, the team identified Linda’s gonadal vein as a suitable candidate for reducing the pressure build-up in her kidney. The gonadal vein has a series of valves that maintain blood flow in one direction but the surgeons thought if they could open the valves, they might be able to allow blood to flow in two directions. Through a small incision in Linda’s belly, Lorenzo identified the gonadal vein and Amaral inserted a small www.hospitalnews.com
NEWS
catheter to remove the gonadal vein’s valves guided by a real-time X-ray. Honjo then created a delicate connection to another vein using a technique commonly employed in cardiac surgery. Blood began to flow away from the kidney through this new pathway, decreasing the pressure and allowing the kidney to drain blood flow normally. “The unique circumstances of Linda’s case pushed us to collaborate and find a creative solution,” says Lorenzo. “The technique we developed expands our surgical toolbox and offers a minimally invasive intervention with significantly reduced risk to other vital systems in the body. This procedure was possible thanks to the culture of collaboration at our institution, as well as the hospital’s support for innovation” Since her procedure last June, Linda has been completely pain-free and able to resume her regular activities. She is
now a swim teacher for younger kids and is applying for university like other teens her age. “When Dr. Lorenzo came out of Linda’s surgery, he was smiling from ear to ear. He said it went perfectly and sure enough, to see her now, you would never know that she had been in so much pain before,” says Cila, Linda’s mother. SickKids typically sees one or two patients per year with Nutcracker syndrome. The clinical team believes this condition may be underdiagnosed because the primary symptom is back pain, which can have many causes. They hope to be able to offer this procedure to more patients like Linda in the future. Lorenzo is also Associate Professor in the Department of Surgery at the University of Toronto and Associate Scientist in Child Health Evaluative H Services at SickKids. ■
A drawing of Nutcracker syndrome illustrated by Dr. Armando Lorenzo.
Vanessa Blanchard is a Senior Communications Specialist at The Hospital for Sick Children (SickKids).
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MAY 2019 HOSPITAL NEWS 11
EVIDENCE MATTERS
Ending the waiting game for
cancer surgery By Nadia Daniell-Colarossi
Next, North York General revamped the operating room schedule to ensure maximum efficiency and with an aim to eliminate cancelled surgeries that usually result from emergencies. Today, it is extremely rare to have any type of surgery cancelled at NYGH. These changes have been supported by a dedicated wait times analyst, who through educating and monitoring, helps keep different areas of the hospital and surgeon’s office on track and working together.
or the past five consecutive years, North York General Hospital (NYGH) has received the Cancer Care Ontario (CCO) award for top performing hospital for wait times 2 (decision to treat to treatment) and for the second year in a row, the CCO award for meeting all targets for wait times 1 (time from referral to consult), a new CCO quality indicator. At NYGH, patients will receive, on average, their treatment within 19 days once their physician has decided with them the best plan of care. Patients will have their first appointment with a specialist, on average, within 10 days of their family physician making the referral.
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THE SOONER PATIENTS RECEIVE THEIR APPOINTMENTS, DIAGNOSTIC TESTS AND TREATMENT, THE LOWER THE RISK THEIR CONDITION WILL DETERIORATE. Last September, Lana Ostrovsky experienced the life altering news that comes with a cancer diagnosis, but felt reassured and well cared for when her surgery date, based on the level of urgency, was booked six days later at NYGH. “I received excellent care, with no waiting and I think that’s not only what patients hope for but how it should be,” says Lana. “For someone who has rarely even taken over the counter pain medication a cancer diagnosis is a lot to take in, but when your care falls into to place
INTEGRATED COLLABORATIVE CARE
Dr. Peter Stotland meets with patients, on average, within 10 days of receiving a referral from the patient’s family physician. quickly and seamlessly you are able to stay positive.” Shorter waits have significant benefits for patients – less time living with both the physical symptoms of their illness and the emotional stress of uncertainty. The sooner patients receive their appointments, diagnostic tests and treatment, the lower the risk their condition will deteriorate. “When patients learn that, in most cases, they will get their cancer surgery in just over two weeks at North York General it really helps give them a back a sense of control during a very difficult time,” says Dr. Peter Stotland, colorectal cancer surgeon. “Wait times can cause a lot of anxiety for health care professionals as well – we know how much is at stake for patients, which is why we are so committed to sustaining and improving upon the success we’ve achieved.” Wait times in the health care system are measured and monitored across the province to ensure patients get timely
access to the care they need. All hospitals continuously strive to shorten wait times for surgery and have various approaches to reducing ques.
NYGH’S MULTIPRONGED STRATEGY Reducing wait times at NYGH all started with gathering good, quality data to inform the best approach. “Our story starts with teamwork and collaboration, we needed to first look at the numbers and understand where the delays were happening in order to address the bottlenecks in the system,” says Linda Jussaume, Director of the NYGH Surgery Program. “The work going on behind the scenes in hospitals is usually the first place where processes can be improved, so one of the first things we did was to move paperwork to online bookings to reduce errors and delays due to lost paperwork, illegible writing or incomplete information.”
There are also many changes to reduce wait times that patients and families see and experience every day. The breast and colon cancer programs are based on the hospital’s award winning Integrated Collaborative Care (ICC) model, which brings together the entire care team to support each patient. Reducing wait times means patients see the care team in the cancer program quicker and get access to the cutting edge treatment and surgery from our internationally recognized surgeons. Patients in the breast and colorectal cancer program have their care followed by a dedicated nurse navigator, who supports them throughout their entire care journey at NYGH. From booking appointments to providing patient education, there is always someone to answer questions. “Being part of the cancer care team at NYGH, I have seen all of the checks and balances that the hospital has in place to ensure patients move seamlessly through the system,” says Paulina Ferreira, Nurse Navigator for the colorectal cancer program. “Maintaining low wait times is the result of a commitment from many different areas to ensure we keep up with the growing number of patients we see from all areas of the city and province.” ■ H
Nadia Daniell-Colarossi is a Senior Communications Specialist at North York General Hospital. 12 HOSPITAL NEWS MAY 2019
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NEWS
Stronger safeguards needed to protect patients and healthcare providers in hospital oncology
By Eva Baginska n Canadian hospital oncology settings, current procedures around chemotherapy medications can pose risks to both patients and healthcare workers. For patients, errors in preparation methods can be catastrophic, while the risk of exposure to medications presents serious risks to healthcare workers. While the dangers associated with drug exposure have been known for decades, chemotherapy compounding errors have gained more recent attention due to high profile incidents and subsequent awareness efforts. Rachel E. Gilbert and Dr. Chun-Yip Hon, and their respective collaborators, published research illustrating these risks in several recently published Canadian studies. Gilbert and Hon’s work demonstrates that Canadian hospitals have additional safeguards they can employ to protect both patients and healthcare workers from harms associated with hazardous oncology drugs. To protect the health and safety of Canadians, stronger control measures are needed to minimize risks associated with chemotherapy treatments throughout hospital medication systems. In “Intravenous Chemotherapy Compounding Errors in a Follow-Up Pan-Canadian Observational Study,” Gilbert and colleagues observed chemotherapy preparation practices at four cancer centre pharmacies, each in different Canadian provinces. In her paper, Gilbert differentiates between latent errors and actual errors: while a latent error represents an opportunity for an error to occur (e.g., similar treatments placed together), an actual error would represent an error actually taking place (e.g., the wrong treatment being selected). In the study, 11 latent errors were discovered. While no actual errors were observed, the high-risk practices noted could have led to catastrophic results for the patient. The latent errors observed included manual transcription into pharmacy systems; more than one mix being staged per bin; and reusing the same syringe to create a total dose; among others. Chemotherapy compounding is a high-risk activity; errors in preparation
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could result in death or permanent loss of function for patients. Gilbert notes that relevant Canadian guidelines do not address the 11 latent errors uncovered by the study: no current guidelines address all of the issues; some guidelines address certain issues; and some other issues were not addressed by any current guidelines. While Gilbert’s research addressed risks to patients in manual compounding processes, Hon investigated risk of exposure to antineoplastic treatments to Canadian healthcare workers. While awareness about this topic has increased in recent decades, Canadian-based research on antineoplastic drug contamination has remained limited. Occupational exposure to antineoplastic drugs can cause health risks including genetic damage, adverse reproductive effects, or increased risk of cancer. In “Antineoplastic Drug Contamination of Surfaces Throughout the Hospital Medication System in Canadian Hospitals,” Hon and team found detectable levels of drug residue on surfaces at all stages of the Canadian hospital medication system. While safe handling guidelines for these drugs do exist, the study showed drug contamination still occurs. Since dermal contact is understood to be the primary route of occupational exposure for healthcare workers, Hon also investigated dermal contamination levels on the hands of healthcare workers. Hon’s “Antineoplastic Drug Contamination on the Hands of Employees Working Throughout the Hospital Medication System,” observed healthcare workers in six Canadian hospitals. Workers from all job categories in the study had some level of contamination, suggesting the range of employees at risk of exposure is higher than previously believed. Following the investigations into external exposure, Hon noted that urine samples could account for other routes of exposure, including ingestions and inhalation. In “Antineoplastic drug contamination in the urine of Canadian healthcare workers,” Hon found that, despite control measures in hospitals, a range of Canadian healthcare workers
are at risk of antineoplastic drug exposure – not only nurses and pharmacy personnel. As the research shows, there is an urgent need for improvement to protect healthcare providers and patients from risks associated with hospital oncology. Gilbert’s research shows current practice standards do not address many opportunities for error, while Hon found dramatic rates of contamination on surfaces, hands and in the bodies of healthcare workers throughout Canadian hospital systems. Gilbert makes recommendations for how potential risks could be mitigated, including automating compounding processes; live quality control mechanisms; and interfaced pharmacy and information technology systems. Hon recommends a review of existing
control measures and recommends considering all at-risk healthcare workers when designing new measures. Both researchers also call for further investigations, so additional trends can be observed to inform interventions. These conclusions are aligned with a framework published by authors at the Institute for Safe Medication Practices Canada, which suggests that system-based prevention strategies that employ automation and computerization, as well as forcing functions and constraints, are the most likely to create lasting changes for safe medication use. In Canada, stronger system safeguards should be developed and widely adopted, in order to protect patients and healthcare workers from risks associated H with chemotherapy medications. ■
Eva Baginska is a health services researcher and is the vice president of Health Economics and Outcomes Research (HEOR) at BD - Canada.
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MAY 2019 HOSPITAL NEWS 13
ETHICS
Ethical issues in chronic pain management, treatment and research By Daniel Buchman ain is complex, multivalent, and dynamic. It is the main reason people seek healthcare and the relief of pain and suffering has long been considered a duty of the healing professions. Recent estimates indicate that approximately one-in-five people in Canada live with chronic pain. In Canada, chronic pain accounts for up to 60 billion dollars per year in healthcare costs, disability, and lost work productivity. These challenges exist alongside an overdose crisis, which began with high rates of opioid prescribing for chronic non-cancer pain. Definitions of and meanings attributed to pain have varied throughout history and across cultures. The invisibility and subjective nature of pain is a main reason why pain is highly stigmatized; chronic pain is not always associated with an identifiable injury or disease. The difficulties in conceptualizing, defining, and treating pain can produce feelings of frustration, dissatisfaction, and skepticism for healthcare providers and pain sufferers. These feelings may result in under or inappropriate treatment and people having their pain complaints dismissed. Pain sufferers are often expected to ‘pull themselves up by their bootstraps’ and not complain. There is no clinical test that can confirm objectively that someone is experiencing chronic pain. Neuroscientists are using functional brain imaging technologies to identify brainbased biomarkers to help predict, diagnose, and treat pain. This research raises ethics questions about whether and/or how this new knowledge should be used. For instance, should clinicians use these biomarkers as a ‘paino-meter’ to determine if someone is telling the ‘truth’ about their pain
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experiences? Since many pain sufferers report that they often have their credibility about their pain experiences undermined by others, an ‘objective’ picture of their brain might help to legitimize their experience. There might also be potential benefits of a pain-ometer for populations who are noncommunicative. There may be negative ethical consequences associated with the use of this technology as well. For instance, how should a healthcare provider manage a potential discrepancy between a brain scan and a person’s self-report? Privileging the scan over the person’s testimony could intensify stigma and distrust, let alone create tension in the clinical relationship. If brain-imaging technology is one day clinic-ready, using it will be expensive. This raises justice questions about access and resource allocation. Lawyers and insurance companies may be interested in a brain scan to help de-
termine whether someone is ‘truly’ in pain to settle disability-related claims. Some researchers and bioethicists caution the use of brain imaging as a type of lie detector, given the limitations of current technologies and the ethical significance its misapplication can have in diverse settings. While access to pain management is often described as a human right, there is consensus among pain experts that pain remains inequitably addressed at the population level. Social groups who bear the greatest burdens of chronic pain – namely those disadvantaged by factors such as race, class, and gender – are also the least likely to access pain care. For instance, lower income and less education is correlated with a higher incidence and severity of pain. Most pain clinics in Canada are in big cities, with waitlists up to years in length, resulting in inequities in access for people who live in rural areas. Provincial health insurance plans typi-
cally do not cover evidence-based pain interventions such as physiotherapy and various cognitive and behavioural health approaches, thereby limiting access to these treatments to people who are able to pay out-of-pocket. Children, youth, women, older adults, and Indigenous populations face their own unique challenges for pain care as well as accessing the most appropriate services for their needs. People who are members of racial minority groups, such as Black populations, are also less likely to access pain care and tend to receive lesser quality pain care when they do. These current inequalities related to race are informed, in part, by the racist historical view of biological differences in pain sensitivity between Blacks and whites. A recent U.S. study by Hoffman and colleagues explored the question of how pain among Black and white patients is perceived by both white laypeople and white medical students and residents. The authors found that of the participants who endorsed the false belief about the biological differences between Blacks and whites, half of the sample rated the pain of Black patients lower. Pain is not well understood by healthcare providers, patients, and the public. Pain research and treatment has been historically underfunded, much to the detriment of individuals and societies. Indeed, veterinarian students receive far more pain education than medical students do. There is a great need to address proactively the ethical issues in pain management, treatment, and research. This is not only because of rapid advances in science and technology, but also because of the increasing inequities that exist in the population-level distribution of H pain management resources. ■
Daniel Buchman is a Bioethicist at the University Health Network, a Clinician Investigator in the Krembil Brain Institute, an Assistant Professor in the Dalla Lana School of Public Health, and a Member of the University of Toronto Joint Centre for Bioethics. @DanielZBuchman 14 HOSPITAL NEWS MAY 2019
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NEWS
Medical devices can play a key role in
Canada’s chronic pain crisis By Peter Tomashewski he federal government’s recent decision to create a task force to find ways to better manage chronic pain in Canada is encouraging news for anyone who plays a role in trying to tackle this incredibly complex health crisis. The toll of chronic pain on individual Canadians, families and our country as a whole is staggering. One in five of us lives with chronic pain. For many, this constant pain is devastating to their quality of life. It can lead to lost productivity, an inability to work, damaged relationships with loved ones, depression, drug addiction, suicide, and avoidable overdose deaths. It also costs our healthcare and social systems billions of dollars per year. The headlines about the opioid epidemic that has killed thousands of Canadians over the past few years often focus on the issue of addiction and its often tragic outcome, but what about
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NO SINGLE ENTITY CAN SOLVE CANADA’S OPIOID AND PAIN CRISIS ALONE. WE NEED TO CONSIDER ALL OPTIONS, AND GET THE RIGHT TREATMENT, TO THE RIGHT PATIENT, AT THE RIGHT TIME – TOGETHER. exploring the root cause of the use of opioids? We often hear stories of people who began taking opioids after surgery and became addicted before they could wean themselves off. What we don’t hear about as often are the stories of people with chronic neuropathic pain – pain that results from permanent damage and must be managed for life. Chronic pain is so inextricably linked to the reliance and misuse of opioids, it’s in the public interest to devote a similar amount of attention to better understanding chronic pain and how to help Canadians treat it, more effectively.
The national task force recently announced by Health Minister Ginette Pepitas Taylor and its plan to consult with stakeholders across the country over the next three years is a welcome start. As a company with a 40-year history developing innovative pain management technologies, we urge Canada’s chronic pain task force to consider as part of its review how medical devices and therapies can be used as an alternative to opioids to alleviate chronic pain. We have seen firsthand countless times over the past four decades how these therapies and devices can help
patients overcome pain and regain quality of life, without reliance on opioids. Consider the experience of one patient, Sarah Graff, who had lived with debilitating pain in her back and legs for more than 10 years. The mother of two young children had turned to pain meds and regular spinal blocks to try to manage but continued to endure pain on a daily basis that made it difficult to enjoy a normal life. She was eventually referred to the Neuromodulation Program at Hamilton Health Sciences where she was implanted with a Medtronic spinal cord stimulator, which delivers mild electrical pulses to interrupt pain impulses before they reach her brain. The results were immediate. The pain that had dominated her days for more than a decade was gone. Now pain-free, Sarah credits the treatment with allowing her to regain her life and her happiness. Continued on page 17
Peter Tomashewski is Senior Director, Restorative Therapies Group at Medtronic Canada. 16 HOSPITAL NEWS MAY 2019
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NEWS
New equipment aims to make surgery safer By Ellie Stutsman dvancements in technology have greatly aided in making many procedures and surgeries safer for patients. This includes laparoscopic surgery, which has become a common approach over the past 40 years for a variety of surgical procedures. In laparoscopic surgery, a long, slim tool is inserted through small cuts into the abdomen. The tool is equipped with a very small camera and light on the end. Additional instruments are inserted through a similar technique. Images from the camera are fed to a screen, and the surgeon carries out the procedure by watching their movements on the screen. It’s used for many procedures including gall bladder removal, hernia surgery and colon resection. As a minimally invasive surgery, the incisions are much smaller. This reduces the patient’s risk of infection and significantly reduces the hospital length of stay, overall leading to a faster recovery. However, despite the benefits laparoscopic surgery offers, there is still room for improvement. Since surgeons are working within a much smaller space, it can sometimes be tricky to keep their multiple tools within a clearly defined safe zone. As a result, unin-
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A new device called LaparoGuard. It allows surgeons to identify and create a safe zone that the surgeon must stay within during laparoscopic procedures. tentional minor injury can occur to surrounding tissues. This injury is often recognized and treated when it occurs, however it can go unnoticed and eventually cause complications. To tackle this problem a local medical device company, Mariner Endosurgery, has developed a new device called LaparoGuard. It allows surgeons to identify and create a safe zone that the surgeon must stay within during laparoscopic procedures. If the instruments unintentionally move out of the safe zone, Laparoguard sends an audio and visual signal to the operating team.
After rigorous testing and approvals, the equipment is ready to pilot in a research trial at Hamilton Health Sciences (HHS). “We’ve come a long way in terms of the safety and precision of minimally-invasive surgery in recent years,” says Dr. Niv Sne, trauma surgeon at HHS and principal investigator for the LaparoGuard trial. “Still, no surgery is without its risks. This trial may present surgical teams with a more advanced option to conduct laparoscopic procedures with even fewer risks to the patient.”
LaparoGuard uses innovative image-enhancing technology, similar to what’s used in a fighter jet. It’s described by the makers as augmented reality without a headset. It’s installed in one operating room at Hamilton General Hospital for the pilot, which begins in the next few weeks. “We’re excited to be working alongside Dr Sne and the surgical teams at Hamilton Health Sciences,” says Mitch Wilson, president & chief operating officer of Mariner. “Their extensive experience conducting laparoscopic procedures and their interest in exploring new technology to improve patient safety and surgical precision is invaluable.” This collaboration between HHS and Mariner Endosurgery is one of the projects funded by Health Ecosphere, an innovation pipeline program that assists in commercializing health solutions. This, along with a grant from Hamilton Health Sciences Foundation, helped make this trial possible. The surgeons at HHS’ Hamilton General Hospital are excited to explore the new technology. “‘At this point we’re confident LaparoGuard can help make laparoscopic surgery safer for patients. Now we’ll use feedback from HHS surgeons to ensure it’s efficient for the team that’s using it,” says Mitch. “We’re looking forward H to the results.” ■
Ellie Stutsman is a Public Relations Specialist at Hamilton Health Sciences.
Chronic pain crisis Continued from page 16
It’s stories like Sarah’s that highlight the role technology can play in helping to address Canada’s chronic pain crisis and hopefully lessen the deadly impact of the opioid epidemic. We recognize that pain management therapies such as the ones we develop are not the complete answer to ending chronic pain or the opioid epidemic. Our device-delivered therapies don’t treat opioid addiction. But they can provide patients alternative ways to reduce pain and reduce exposure to high-dose opioids and long-term systemic opioid use that could lead to misuse and addiction. www.hospitalnews.com
Medtronic is committed to partnering with health system stakeholders to disrupt the opioid epidemic by providing solutions for improved pain management. We are working to increase awareness of the benefits of long-term, proven pain management solutions among patients, healthcare providers, payers, regulators, patient advocacy groups, and government decision-makers – solutions that can reduce or even eliminate the need for opioids. No single entity can solve Canada’s opioid and pain crisis alone. We need to consider all options, and get the right treatment, to the right patient, at H the right time – together. ■
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NEWS Racial minorities were significantly more likely to receive aggressive end-of-life care
Research finds racial differences in end-of-life care By Megan Mueller chulich School of Business Professor Sylvia Hsu led a six-person team of researchers from Yale University as they followed the healthcare pathways of over 100,000 cancer patients. Hsu’s team examined regional end-of-life expenditures (as a proxy for regional practice patterns) and found racial/ethnic differences in intensity of end-of-life care. They discovered that most white patients (70 per cent) used hospices, while racial minorities were significantly more likely to receive aggressive end-of-life care, such as being admitted into an intensive care unit or an ER visit, which is associated with high health care expenditures. This research, which looked at high- and low-expenditure regions, led Hsu’s team to conclude that regional practice patterns may influence racial/ethnic differences in end-of-life care. This work could inform future policy. “Programs to promote less aggressive care, such as hospices, could help to reduce racial/ethnic differences and improve the quality of end-of-life care,” Hsu says. Such programs, in other words, could be better for the patients and for expenditures.
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18 HOSPITAL NEWS MAY 2019
The results, published in the Wiley journal Health Services Research (2018), will be of interest to physicians; healthcare practitioners; administrators of hospitals, hospices and other healthcare facilities; and patients and their families.
RESEARCHERS LOOK AT EXPENDITURES TO EXPLAIN UNDERLYING DISPARITIES End-of-life care is increasingly important given the aging population, but it also pertains to those younger individuals with terminal, progressive or incurable diseases or conditions. Existing research has revealed that end-of-life care differs substantially by race/ethnicity. Black, Hispanic and Asian patients with advanced cancer are more likely to opt for more aggressive end-of-life care and less likely to use hospice services than white patients. Hsu’s original work adds to this literature because she takes a different approach: She considers racial/ethnic factors with a focus on regional endof-life expenditures (as a proxy for regional practice patterns) and end-oflife care.
Why? In low-expenditure regions where hospice care is common and aggressive care is not, Hsu suspected that doctors might be telling patients about the benefits of hospice care. Here, patients would be more likely to receive hospice care regardless of their racial/ ethnic background. Conversely, Hsu suspected that in high-expenditure areas, where aggressive care is more common than hospice use, diversity in patient preferences may result in greater variation in hospice use and aggressive care.
RESEARCHERS FOLLOWED 102,759 CANCER PATIENTS’ PATH THROUGH HEALTH CARE SYSTEM To conduct this research, Hsu turned to the SEER (Surveillance, Epidemiology, and End Results)-Medicare database through which it was possible to follow a large sample of 102,759 patients and their path through the healthcare system at the end of their lives. The sample consisted of patients with breast, prostate, lung, colorectal, pancreas, liver, kidney, melanoma or hematological cancer, diagnosed from
2004 to 2011. All patients were between 66 and 94 years of age, had died within three years of diagnosis, and were continuously enrolled in Medicare during the last 18 months of life. The researchers turned to Medicare claims to see how end-of-life health care services were used. They looked at corresponding end-of-life expenditures for the complete picture.
RESULTS SPEAK VOLUMES ABOUT DISPARITY This research showed that racial minority patients entered end-of-life care in dire straits, when compared to white patients: • Compared to white patients, Hispanic and black patients were younger. • Compared to white patients, racial minority patients were significantly more likely to have multiple comorbidities – that is, two or more chronic diseases or conditions. What kinds of health care services did they receive – hospice versus aggressive end-of-life care? • Hospice use was highest among white patients (70 per cent), next most common in Hispanic (65 per cent) and black patients (62 per www.hospitalnews.com
NEWS
YORK-LED RESEARCH, CONDUCTED IN COLLABORATION WITH YALE UNIVERSITY, DISCOVERS RACIAL/ETHNIC DIFFERENCES IN END-OF-LIFE CARE, WHICH SUGGESTS THAT LOCAL PRACTICE PATTERNS MAY BE INFLUENCING DECISIONS AROUND THIS CARE. THE RESEARCHERS HAVE POLICY-BASED SUGGESTIONS FOR IMPROVEMENT THAT WILL BE OF INTEREST TO THOSE IN THE HEALTHCARE SECTOR IN BOTH CANADA AND THE UNITED STATES. cent), and lowest in Asian patients (53 per cent). • Racial minorities were significantly more likely to receive aggressive end-of-life care, compared to white patients.
WHAT CAN HIGH- AND LOWEXPENDITURES REGIONS TELL US?
Hsu sums up: “Hispanic and Asian patients had end-of-life care patterns that were similar to white patients in low-expenditure areas, but received more aggressive end-of-life care than whites in high-expenditure areas. Black patients were more likely than white patients to receive aggressive end-of-life care in all expenditure regions.”
POLICY IMPLICATIONS
Overall end-of-life expenditures per cancer decedent in the last six months of life by race/ethnicity ranged from $10,800 to $15,400. Isolating this analysis by low- and high-expenditure regions (again, as proxy for regional practice patterns), reinforces the racial differences.
This research tests and confirms Hsu’s hypothesis that regional practice patterns may be influencing people’s choices around end-of-life care. She believes that this has two key policy implications. 1. Since high heath care expenditures are associated with aggressive endof-life care, and regional practice
patterns (as determined via expenses) may play a role in this, then reducing regional expenditures might decrease racial differences in health care utilization. 2. Earlier research has told us that an integrated palliative care model and reduced fragmentation of care may decrease aggressive end-of-life care. (Fragmentation refers to the systemic misalignment of incentives, or lack of coordination, that spawns inefficient allocation of resources or harm to patients. It adversely impacts quality, cost, and outcomes.) Given this, health care administrators in high-expenditure areas could adopt the approaches used in the low-expenditure areas to cultivate regional practice norms promoting
hospice services over aggressive endof-life care. Physicians could be trained to talk about treatment plans to patients of diverse racial/ethnic groups Elaborating on the second policy implication, Hsu suggests that physicians and hospital administrators could modify their approach and practice patterns to reduce the expenditure of end-of-life care and address the cultural/ethnic differences. “Physicians could get communication skills training to efficiently deliver information about treatment plans to patients of diverse racial/ethnic groups. These systemic changes could help minority patients accept hospice care and avoid aggressive end-of-life care,” Hsu H explains. ■
Megan Mueller is the senior manager, Research Communications, Office of the Vice-President Research & Innovation, York University.
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EVIDENCE MATTERS
Minimally invasive glaucoma surgery: Better than current treatments? By Dr. Brit Cooper-Jones laucoma – a progressive optic neuropathy (a disease that damages the nerve that enables sight) – is a leading cause of blindness, affecting more than 400,000 Canadians. While early-stage glaucoma has no noticeable signs or symptoms, many patients who have been diagnosed with glaucoma are fearful about the possibility of one day losing their sight – something so critical to our ability to perceive and interact with the world around us, to say nothing of our independence and ability to continue doing the activities we love. So what happens in glaucoma? Elevated pressure inside the eye (called intraocular pressure) is thought to contribute to gradual and progressive damage to the optic nerve (the nerve that enables sight). The condition starts asymptomatically, but this does not mean that damage is not occurring. As the damage to the optic nerve becomes more advanced, it eventually starts to impact sight and can ultimately lead to blindness. Fortunately, however, we can significantly slow the progression of the disease – and thus preserve patients’ sight for as long as possible – by giving treatments that help to lower the pressure inside the eye. The current treatments for glaucoma may vary based upon the severity of a patient’s disease. In early-stage glaucoma, patients are typically prescribed eye drops that help to lower the pressure inside the eye (in turn slowing the rate of damage to the optic nerve). Patients with early-stage glaucoma may also receive laser surgery. However, while these treatments effectively slow the progression of glaucoma, none of them can stop it completely. As a result, additional forms of treatment become necessary as time goes on. This often starts with the addition of different types of eye drops. And, as patients’ glaucoma becomes more severe, many go on to require more invasive eye surgeries (for example, implantation of a device to divert
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fluid outside the eye to help manage the intraocular pressure). These more invasive eye surgeries may be done independently or at the same time as cataract surgery (for patients who have both glaucoma and cataracts). The good news is that the currently available treatments do work well. But there is always the question of how we can do better – it is at the root of medical innovation – and, in the field of glaucoma treatment, it has led to the latest surgical development: minimally invasive glaucoma surgery (also known as “MIGS” for short). What is MIGS? Or should we say what are MIGS? Because “MIGS” actually represents a class of many different newer minimally invasive surgical options. In fact, there are currently 11 MIGS devices and procedures approved for use in Canada, although
one – the CyPass Micro-Stent – was voluntarily withdrawn from the global market in August 2018. “Minimally invasive” refers to devices and procedures that are less invasive (meaning those that require no dissection of the sclera and minimal or no manipulation of the conjunctiva), leading to the hypothesis that MIGS devices and procedures may be safer and/or have a faster recovery time than the traditional more invasive surgeries. However, is this truly the case? Have MIGS been shown to be a better option than alternative treatments, or is it still too soon to tell? If they are better, is one MIGS device or procedure superior to others? And is public health care funding warranted? To help answer these questions, and to guide decisions about MIGS and where they fit in the glaucoma clini-
cal care pathway, decision-makers and the health care community turned to CADTH – an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures – to find out what the evidence says. CADTH conducted a Health Technology Assessment (HTA) that looked at the comparative clinical effectiveness and safety, as well as the comparative cost-effectiveness, of various MIGS devices and procedures versus each other and versus alternative current glaucoma treatments. In the HTA, the perspective and experiences of patients were also considered, alongside ethical issues and implementation issues involved in using MIGS for the treatment of adults with glaucoma. Treatment options were considered both independently as well as in combination with cataract surgery (for patients with both glaucoma and cataracts). The Health Technology Expert Review Panel (HTERP) then developed recommendations based on the findings from CADTH’s report. Overall, it was concluded that, at the present time, there is simply not enough evidence to know whether MIGS offers a benefit beyond what is already offered with current treatment options. From a clinical effectiveness standpoint, a safety standpoint, and a cost-effectiveness standpoint, the results were inconclusive. HTERP acknowledged that there is a potential role for MIGS for the treatment of adults with glaucoma; however, more research is still needed to determine the optimal use of MIGS and what its role should be in the glaucoma clinical care pathway. To view CADTH’s full report, see: https://cadth.ca/optimal-use-minimally-invasive-glaucoma-surgery-health-technology-assessment And if you would like to learn more about CADTH, visit cadth.ca, follow us on Twitter @CADTH_ACMTS, or speak to a Liaison Officer in your reH gion: cadth.ca/Liaison-Officers. ■
Dr. Brit Cooper-Jones, MD is a Knowledge Mobilization Officer at CADTH. 20 HOSPITAL NEWS MAY 2019
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s e o r e H g n i s r Nu
o t e t u l a S A
S E S R U N S ’ A D A AN C G N I T A R B E L CE ou by: t to y Brough
NATIONAL NURSING WEEK 2019
List of Nominees
Nermin Ibrahim, Trillium Health Partners
Natalie Lauder, Markham Stouffville Hospital
Marjorie Imperial, University Health Network
Krystal Lawley, University Health Network
Michael Freeborn, Hamilton Health Sciences Centre
Ukpong James, Centre for Addiction and Mental Health
Nadine Lawson, University Health Network
Lisa Fronzi, Hamilton Health Sciences
Parminder Jawanda, Westpark Healthcare Centre
Carolyn Lawton, Sunnybrook Health Sciences Centre
2019 Nursing Hero Awards Bridget Akioyamen, Centre for Addiction and Mental Health Joy Allanic, University Health Network Teressa Allwood, Interior Health Christine Apilado, Runnymede Healthcare Centre Katrina Arellano, University Health Network Laura Bainbridge, McMaster Children’s Hospital Jennifer Barbeau, Southlake Regional Health Centre Megan Beirnes, Hamilton Health Sciences Centre Edgar Belanger, Children’s Hospital of Eastern Ontario Julie Bernier, Cornwall Community Hospital Alice Boland, Children’s Hospital of Eastern Ontario Janine Bowen, Centre for Addiction and Mental Health Lindsay Bowers, Peterborough Regional Health Centre Joanne Boyce, Niagara Health System Sarah Branton, Centre for Addiction and Mental Health Shelley Brock, Peterborough Regional Health Centre
Sam Bunjevic, Southlake Regional Health Centre Deborah Butt, Southlake Regional Health Centre Shay Cannon, Peterborough Regional Health Centre
Susan Davidson, The Hospital for Sick Children, St. Joseph’s Health Centre Toronto Angel Dinglasan, University Health Network Eleanor Diokno, Sunnybrook Health Sciences Centre
Cara Carney, Runnymede Healthcare Centre
Tsering Dolma, Centre for Addiction and Mental Health
Val Carroll, McMaster Children’s Hospital
Amelie Dupont, Children’s Hospital of Eastern Ontario
Cathy Case, Niagara Health System
Janine Duquette, Hamilton Health Sciences Centre
Sonimol Chacko, Runnymede Healthcare Centre Charles Chen, University Health Network Tashi Chozom, Runnymede Healthcare Centre
Lisa Egan-Bates, Southlake Regional Health Centre Halimo Elmi, Sunnybrook Health Sciences Centre, Mackenzie Health
Elli Clarke, Sunnybrook Health Sciences Centre
Debra Everts, Thunder Bay Regional Health Sciences Centre
Kelly-Jo Clarke, Peterborough Regional Health Centre
Darlene Fitzpatrick, Headwaters Health
Krista Cole, Hamilton Health Sciences Angie Coluccio, Trillium Health Partners Stacey Currier, Cornwall Community Hospital Euneka D’Aguiar, Sunnybrook Health Sciences Centre
22 HOSPITAL NEWS MAY 2019
Corrine Gable, Interior Health Bella Gago, Hamilton Health Sciences Centre Cheryl Gayder-Ruzgys, Niagara Health System Patricia Gilbert, Trilium Health Partners Natasha Goldsbury, Interior Health Andres Gomez, Trillium Health Partners Rebecca Gonser, Sunnybrook Health Sciences Centre Joan Greer, Southlake Regional Health Centre Natalie Halasa, Hamilton Health Sciences Centre Emily Harrilal, University Health Network
Michelle Flegal, Hamilton Health Sciences
Lance Hermanstyne, Centre for Addiction and Mental Health
Jayda Fox, Southlake Regional Health Centre
Emily Horak, Southlake Regional Health Centre
Cunanan Francis, University Health Network
Hristina Hristovska, Providence Health Care Toronto
Bonnie Fraser, Children’s Hospital of Eastern Ontario
Juliet Hutchinson, Sunnybrook Health Sciences Centre
Sivi Joachim, Unity Health Toronto (St. Michael’s Hospital) Salome Johnson, Peterborough Regional Health Centre Kamini Kalia, Centre for Addiction and Mental Health Navjot Kaur, Centre for Addiction and Mental Health Kezia Kiruri, Hamilton Health Sciences Centre Ann Klein, Southlake Regional Health Centre Cheryl Knott, Providence Manor, Kingston Christy Konietzny, St. Joseph’s Health Centre Toronto Morgan Krauter, Southlake Regional Health Centre Helen Kroeker, Peterborough Regional Health Centre Kim Krog, Holland Bloorview Kids Rehabilitation Hospital Lucena Lacambra, Centre for Addiction and Mental Health Susan Laliberte, Southlake Regional Health Centre
Joy Lee, University Health Network Cheryl Lockhart, Collingwood General & Marine Hospital Lorna Loney, University Health Network Janet Love, Sunnybrook Health Sciences Centre Meghan McBride, Hamilton Health Sciences Centre Sandra McDowell, Sunnybrook Health Sciences Centre Karen McLean, Sunnybrook Health Sciences Centre Peggy McLean, Trillium Health Partners Courtney Meadows, Hamilton Health Sciences Centre Carla Millar, Children’s Hospital of Eastern Ontario Dallas Miller, St. Joseph’s Health Care London Erin Mitchell, Hamilton Health Sciences Centre Selina Mitchell, St. Joseph’s Health Centre Toronto Khadija Mohamoud, University Health Network www.hospitalnews.com
NATIONAL NURSING WEEK 2019 Audrey Montcliffe, Trillium Health Partners
Kelly Pensom, Peterborough Regional Health Centre
Christine Murphy, The Ottawa Hospital
Samten Phuntsok, West Park Healthcare Centre
Edsel Mutia, North York General Hospital Shanti Nadesamoorthy, Southlake Regional Health Centre Phuntsok Namgyal, Runnymede Healthcare Centre Jane Nash, McMaster Children’s Hospital Massey Nematollahi, William Osler Health System Clint Neubauer, Thunder Bay Regional Health Sciences Centre Alice Nzarora, Hamilton Health Sciences Alan O’Connor, Runnymede Healthcare Centre Nicole O’Donnell, University Health Network Siobhan O’Malley, Thunder Bay Regional Health Sciences Centre Eric Pallarca, University Health Network Paolo Pascual, St. Joseph’s Health Centre, Toronto Genevieve Parent, Children’s Hospital of Eastern Ontario Amita Patel, University Health Network Lucy Paul, Hamilton Health Sciences Centre www.hospitalnews.com
Woodrow Pinsent, Centre for Addiction and Mental Health Melanie Punch, Interior Health Christine Rae, Markham Stouffville Hospital Irene Razon, University Health Network Miranda Retzler, Alberta Health Services Eda Reyes, University Health Network Heidi Rice-Gulseth, Interior Health Alyssa Richard, Sunnybrook Health Sciences Centre Julia Rintoul, Hamilton Health Sciences
Joseph Schultz, Southlake Regional Health Centre
Ali-Akber Shermohammed, Centre for Addiction and Mental Health
Jacqueline Torrance, Peterborough Regional Health Centre
Betty Anne Whelan, Southlake Regional Health Centre
Sarah Scully, Sunnybrook Health Sciences Centre
Linda Slodan, Centre for Addiction and Mental Health
Lee Triplett, Westpark Healthcare Centre
Margaret White, University Health Network
Carmela Sorbara, St. Joseph’s Health Centre Toronto
Michael Uhryniuk, Thunder Bay Regional Health Sciences Centre
Carol Williams, Southlake Regional Health Centre
Erin Stephen, University Health Network
Maria Urban, Scarborough Health Network
Kristy Stollery, Alberta Health Services
Mark Urdaneta, Sunnybrook Health Sciences Centre
Karen Sutherland, St. Joseph’s Health Care London
Analyn Villaluz, University Health Network
Dee Lu Sebastian, Hamilton Health Sciences Centre Anna Seto, University Health Network Sue Seymour, Sunnybrook Health Sciences Centre Bency Shajan, William Osler Health System Andrea Sharp, Trillium Health Partners Galyna Sharson, University Health Network Kathy Shaule, Trillium Health Partners
Jasmine Tai, Vancouver Coastal Health Authority Niall Tamayo, Centre for Addiction and Mental Health
Gavin Wells, Hamilton Health Sciences Centre Paul Welsby, Trillium Health Partners
Sarah Wilson, Peterborough Regional Health Centre Linda Woodhouse, Scarborough Health Network Christina Wray, St. Joseph’s Health Care London Grace Yu, Sunnybrook Veteran’s Centre Jun Zhao, University Health Network
Patricia Shaw, Trillium Health Partners
Eva Rodney, University Health Network Cindy Ruelens, Holland Bloorview Kids Rehabilitation Hospital Kanika Russel, University Health Network Arvie Salonga, University Health Network Shelagh Scanga, St. Joseph’s Health Centre, Toronto Beth Schaffer, Peterborough Regional Health Centre (7) Jen Schmidt, Alberta Health Services MAY 2019 HOSPITAL NEWS 23
NATIONAL NURSING WEEK 2019
C O N G R AT U L AT I O N S TO T H E W I N N E R S O F O U R
A Salute to
Nursing NURSING HERO Heroes 2019 AWARDS
st prize
Rebecca Gonser
Sunnybrook Health Sciences Centre
$1500
Cash Prize
nd prize
Laura Bainbridge
McMaster Children’s Hospital, Hamilton Health Sciences
$1000
Cash Prize
rd prize
Christine Murphy The Ottawa Hospital
$500
ourteen years ago when we started this contest, we received approximately 40 nominations. The feedback was extremely positive and we knew that it was something we could grow. We were determined to honor the amazing work nurses do and give people (patients/families/colleagues) an opportunity to say thank-you. Since that first year with 40 nominations, we have come a long way. This year we are thrilled to have received a record 214 nominations. Heroism is alive and well in our health system – in spite of the many challenges that have come to light over the last year. Mainstream media inundates us with stories of health system failures and yes, there is definitely room for improvement and we have a long way to go in achieving health system efficiency. It is much less often we hear of a nurse who has made a difference in the lives of many, or even one. These stories don’t grab headlines. And that is why we started this contest – to share these stories of every-day heroes who have devoted their lives to helping others. Every single nominee is a nursing hero. We have selected a few standout nominations to share throughout the following pages. No nominee is more a hero than another and selecting the finalists/winners is no easy task. This year’s winner, Rebecca Gonser works in the trauma department at Sunnybrook Health Sciences Centre. She has made a huge impact on her colleagues and a patient population that can be extremely difficult to care for. Her care is consistent and compassionate. Rebecca regularly volunteers
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to care for the most difficult patients all the while inspiring and uplifting her colleagues. She received nominations from numerous colleagues, only some of which we could share here. Laura Bainbridge from McMaster Children’s Hospital has provided exceptional care to countless families facing the daunting task of caring for a sick child. When a child is ill it’s not just the young patient that a nurse cares for…there are also parents who need to be helped through the illness. Laura provided such exceptional care to this patient and her family they wanted to share it and thank her. Laura also received numerous nominations from colleagues that had a hard time putting into words just how special Laura is. Oftentimes nurses are a patient’s life-raft during the most difficult time in the patient’s life. Every nurse in these pages has gone above and beyond the call of duty. The nomination letters speak for themselves. I hope every nurse who reads them can take a minute to think of a time when they were a patient’s life-raft and remember that in spite of all the challenges and pressures in our new normal of hallway healthcare that YOU ARE MAKING A DIFFERENCE. I will be publishing more nominations online than we have space for in these pages, so please keep an eye out. If you are on the nominees list, we would be thrilled to share your nomination with you. Please email me at editor@hospitalnews.com As we celebrate Nursing Week across Canada, Hospital News would like to extend a huge thank-you to all H nurses. We salute you! ■
Cash Prize
Kristie Jones Editor, Hospital News 24 HOSPITAL NEWS MAY 2019
www.hospitalnews.com
NATIONAL NURSING WEEK 2019
st Photo by: Doug Nicholson, Sunnybrook Health Sciences Centre
Rebecca Gonser
prize
Sunnybrook Health Sciences Centre – Trauma Unit 1ST NOMINATION Rebecca and I have worked together on C5, for the past 4 years. Initially, I met Rebecca when she was a student on C5. It did not take long for our manager and others to recognize her vigor, and she was quickly hired onto our unit and seamlessly became an active and respected member of our C5 family. If you’re reading this, you can begin to understand why in my books she is already a nursing hero, let alone a superhuman. Her achievements are most definitely applaudable, however, this is not the reason why I have nominated my colleague for this award. I am nominating her because of the type of nurse she is and what she represents, in order for others to have a role model and a clear definition of what the gold-standard of nursing care looks like. www.hospitalnews.com
I AM NOMINATING HER BECAUSE OF THE TYPE OF NURSE SHE IS AND WHAT SHE REPRESENTS, IN ORDER FOR OTHERS TO HAVE A ROLE MODEL AND A CLEAR DEFINITION OF WHAT THE GOLD-STANDARD OF NURSING CARE LOOKS LIKE. With her patients, there is no one like Rebecca. Her empathy and understanding of her patient’s and the human condition, matched with her ability to manufacture creative solutions/ interventions to improve their care, is truly remarkable. Rebecca is the type of nurse who is able to level and communicate with that closed off or “difficult” or “non-compliant” patient; appreciate their voices; recognize their needs; and proceed to
bring in her personal collection of nail polish, word searches, music, homemade gifts/ assistive devices, you name it – all in the effort of improving her (or her colleagues for that matter) patients’ experience at Sunnybrook (sorry for the world’s largest run-on sentence). On C5, we routinely work with patients with Spinal Cord Injuries. Rebecca took an early interest in bettering her knowledge and care for this
patient population (I have LOADS of stories to defend this). I will never forget Rebecca’s relationship with one patient, who was a female quadriplegic with limited family in Toronto. This patient, in particular, had little trust in Sunnybrook, partly to do with some unfortunate and unpredictable incidents, but largely to do with the nature of her helplessness in her situation. Her lack of trust in the staff, made nurses fearful and unreceptive to working with this patient, however, Rebecca took on the opposite outlook, and made “Ms. Y”, a problem and patient to be solved and aided, respectively. Communication was a huge concern for “Ms. Y” – with her tracheostomy, English as her second language, and physical limitation, communication was HARD. Continued on page 26 MAY 2019 HOSPITAL NEWS 25
NATIONAL NURSING WEEK 2019
Rebecca Gonser Continued from page 25 Rebecca, quickly recognized this as a barrier for the patient, and would create communication boards, specially tailored call-bells and communication strategies to remedy this. Boredom was another factor for this patient. When Rebecca found out that her favourite artist was Adele, I’m guessing you can imagine which songs could be heard from the nursing station originating from Ms Y room, all thank to Rebecca. Adele must have been a REALLY nice change from the numbing sound of the humidified O2 blowing in Ms. Y’s ear. Ultimately, after many months of being in the ICU and on C5, it came time for rehab for this patient. Rebecca came in on her day off (uncompensated) to escort this patient of ours who had developed a certain trust and relationship with Rebecca to tour the rehab facility she was pended for. To this day, I am sure, Ms Y would never have trusted this new facility, and would never have consented to leaving Sunnybrook, with-
out the reassurance, support and care of Rebecca Gonser. Rebecca is four years younger than me, and I swear, I have learned more about life and nursing from this individual than I would ever be able to teach her. Sincerely,Emma Beairsto, RN, C5 Trauma Unit, Team Leader
2ND NOMINATION Rebecca Gonser is the kind of nurse you would want to have if you ever needed to be in hospital. She starts her shift with a smile and she gets to know each of her patients for the person they are, not their diagnosis and treatment. She brings an energy to the unit that is unmatched by any other staff member. You can see from her interactions with every person on the unit, she loves what she does. She is a leader amongst our nurses, despite only working for four years. She mentors young nurses, tirelessly promotes quality improvement initiatives
SHE MENTORS YOUNG NURSES, TIRELESSLY PROMOTES QUALITY IMPROVEMENT INITIATIVES AND TAKES SPECIAL INTEREST IN TRAUMA PATIENTS AND THEIR CARE, ESPECIALLY THOSE WHO HAVE SUSTAINED A SPINAL CORD INJURY. and takes special interest in trauma patients and their care, especially those who have sustained a spinal cord injury. Rebecca is a remarkable nurse, blending her nursing knowledge and expertise with her knowledge of people, and what will make a difference in their day. For example, she was caring for a man who sustained a spinal cord injury resulting in quadriplegia. Rebecca began her day as she always does, ensuring her patients’ needs were met, and that she was caring for them according to best practice. She began this gentleman’s morning care and then as she was getting to know him, she asked what type of music he likes listening to. He said he likes country music and she responded, “well you have found the right girl”. She turned on her phone and played one of her favourite
country music playlists while she got him ready for the day, something that had never been done for him before. This small act made such a difference for that man that day – she gave him the power to control something in his environment which is challenging in a hospital setting. She continued his care and noted that he was starting to develop a pressure injury. It was in the early stages, but this could be detrimental to his recovery. Rebecca made it her mission to ensure this was cared for properly and did not progress any further. She applied a dressing, made signs to place in his room for proper positioning, she searched for extra pillows (which are always impossible to find!) and she added important information to the nursing handover sheet for the next nurses caring for him. Continued on page 30
NATIONAL NURSING WEEK 2019
Photo by: Doug Nicholson, Sunnybrook Health Sciences Centre
Laura Bainbridge McMaster Children’s Hospital, Hamilton Health Sciences
was emotionally broken the first time I met Laura. My daughter, Avery, who was age three at the time, was stuck in a pattern of thousands of daily intractable seizures and had been recently diagnosed with Myoclonic-Astatic Epilepsy. We were in the Emergency Room at McMaster Children’s Hospital, and were being told the news we were longing to hear – that Avery would be accepted into the care of the Neurology Clinic and admitted on an urgent basis for Classic Ketogenic Diet therapy. This news was a relief after our relentless search to
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find help within Canada and the tears of joy were streaming down my face. And, also down Laura’s. This empathy that Laura displayed from the first minutes we met her became the common thread between the many times we worked with Laura. She invested in our family in a way far beyond our expectations from that very first day – sharing in the emotional baggage, as well as the big decision-making, and really connecting with our confident and creative daughter. She was Avery’s champion over every hurdle. I remember very clearly the day that Avery had her first MRI booked.
This diagnostic procedure was an unknown for us and Laura knew that Avery was anxious about the procedure. We were speechless as Laura came in on her day off to make sure that Avery was okay. During clinic visits, Laura would bring Avery on special adventures to keep her occupied, safe, and calm. She visited us in the ward during illnesses that landed Avery for inpatient care or during EEGs, coached us, advocated for us on and off the clock, and fundraised for the service most near and dear to her heart – the hospital. Laura’s passion for caring for the health and
nd prize well-being of children is so evident. She invests in her profession and sets a high standard of excellence. We have been the most lucky recipients of Nurse Laura’s expertise, empathy, and passion for nursing. Her dedication to working with our family and her medical team contributed significantly to Avery’s neurological and emotional health, helping her to achieve remission. We are forever grateful that Laura was the nurse who took us under her wing when we needed a hero in our lives the most. Nominated by Kari Lockett, Mom to Avery Continued on page 28 MAY 2019 HOSPITAL NEWS 27
NATIONAL NURSING WEEK 2019
Laura Bainbridge Continued from page 27
FROM HER PATIENT:
2ND NOMINATION
I’m Avery and I had seizures when I was three years old. I had to go to the hospital and they put a tube in my belly to give me medicine and food. Nurse Laura gave me special things because she cares about me. She gave me toys and stuffies because she knows I love them. We went to Nurse Laura’s house to buy cookies and lemonade to help her raise money for the hospital. From, Avery Lockett. Age 8- In remission from Myoclonic-Astatic Epilepsy.
I would LOVE to nominate Laura Bainbridge who works in Pediatric Infectious Diseases at McMaster Children’s Hospital. I have had the pleasure of working with her for three years and I can genuinely say she is the most selfless and caring person I have ever met. She goes above and beyond to look after everyone else without a thought to herself. She is always leaving me motivational messages and cheering me
Nurse Laura is my:
H-appy. E-xcellent. R O-utrageous Nurse! -idiculously Funny.
on in all aspects of my life. She has supported me through many ups and downs through losses of family members or celebrating my successes. She is the biggest cheerleader in my life. I honestly cannot put into words how much she inspires me, lifts me up, makes me feel special, believes in me, supports me and goes so far above and beyond being a colleague. Nominated by Stacey Clark
3RD NOMINATION This award describes exactly who she is – Laura is in every sense of the word a hero to her patients, her colleagues, and to her friends and family. I have had the privilege to call Laura my colleague for the past five-and-ahalf years. As soon as I met Laura, I knew that she was a special person. She has the ability to make everyone feel important and listened to. She will help anyone with pretty much anything if she can. Laura goes above and beyond in so many different aspects of her life. I was given the daunting task of taking over Laura’s position in the pediatric Neurology clinic at Mc-
Thank you to nurses Nurses are thanked daily by the people of Ontario for supporting them in health and tending to their needs in times of illness. During Nursing Week, May 6 to 12, RNAO – the professional body that represents RNs, NPs and nursing students in Ontario – extends its collective, deep gratitude to nurses for their expertise and unwavering dedication. Nurses are beacons for those in pursuit of health, equity and work that is grounded in evidence and compassion. It was Florence Nightingale, the Lady of the Lamp and founder or modern nursing, whose care for soldiers led countries around the world to adopt sanitary reforms and improvements. For this, May 12 – the birthdate of Nightingale – is recognized the world around as the day of the nurse. The noble and brilliant work of nurses is all the more necessary in an Ontario where patients are cared for on hallway gurneys, too many citizens are plagued by poverty, and improvements are urgently needed in the care of children, adults and the elderly. We salute all nurses for intervening to save lives, strengthen communities and shape decisions in the hallways of Queen’s Park.
Master Children’s Hospital, working with Dr. Ronen. She worked with Dr. Ronen for a number of years, and in that time she became immensely important to the patients and families that she worked with. I know this as I was the one who had to attempt to fill her nursing shoes in this role. Patients would come to clinic or call on the phone and say “where’s nurse Laura?” as soon as they saw me or heard my voice. I would say that she had changed roles, and every single patient and parent expressed how much they would miss her! Time and time again I was told what a difference Laura made in the lives of these patients and their families. There were stories of Laura helping families to understand a recent diagnosis that they had been given, to helping parents “survive” through a tough transition in their child’s medications. There were stories of how kind Laura is and how she always made the children feel a little more at ease at the doctor’s office. A few even said that their child WANTED to come to the hospital as they knew they were going to get to see Nurse Laura. Continued on page 43
Angela Cooper Brathwaite RN, MN, PhD President, RNAO
Doris Grinspun RN, MSN, PhD, LLD(hon), Dr(hc), FAAN, O.ONT. CEO, RNAO
Your expertise, dedication and resilience shine.
28 HOSPITAL NEWS MAY 2019
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NATIONAL NURSING WEEK 2019
Christine Murphy
The Ottawa Hospital hristine Murphy is a Nurse Specialized in Wound, Ostomy and Continence. (NSWOC), at the Ottawa, Hospital, Civic Campus, Ottawa, Ontario. Christine was a registered nurse working in the trauma unit and decided to take the wound ostomy continence nursing education program and continued her educational pathway completing a Masters of Clinical Science in Wound Healing (MScClin-WH) and PhD concentrating on vascular wounds which is rare in the nursing field. When she started her role as a Nurse Specialized in Wound, Ostomy and Continence ( NSWOC), it was a hospital wide position and not just focused in vascular wounds. She decided that there was a need to provide a focused program on vascular wound management and through a meeting with the Chief of Vascular Surgery, she explored aligning her efforts to support a complex vascular wound service. Christine was referred to another Vascular Surgeon who had become very interested in wound management – Dr. Tim Brandys. Together with Dr Bandys, they identified a need to create stronger communication among the healthcare team to better support those experiencing vascular wounds from hospital to community. They also developed methods to provide better outcomes for patients experiencing vascular wounds once they moved from the
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hospital to the community where they could have access to out-patient care. Christine was committed to change practice in how patients with vascular wounds were being managed. She started reaching out to all stakeholders and actively looked at ways to engage them in coordinated care setting up a model where everyone feels they are adding something positive to improving wound care , breaking down silos. Christine also contacted nurses in senior home care positions to discuss ideas as to how to improve serving patients with vascular wounds from hospital to community. She started to educate other healthcare professionals by explaining rationale, and informing staff physicians and residents on the need to share their patient cases at vascular grand rounds. She worked relentlessly to build trust between the interprofessional healthcare team members in order to be more effective. As a result of many hours of work, twelve years ago, the first Limb Preservation Wound Clinic with a half day clinic in Parkdale was initiated at the Ottawa Hospital, Civic Campus. Christine and the team knew that they could make a positive change to reduce both inpatient and home care costs, the number of hospital readmissions and cut down on antibiotic use. After graduating with her PhD from Western which was focused on vascular wounds, it was time for Christine to move into a change-agent role
rd
prize
PATIENTS AND THEIR FAMILIES ARE GRATEFUL FOR CHRISTINE’S KNOWLEDGE AND ADVOCACY AS SHE ENSURES THEY RECEIVE THE HIGHEST STANDARD OF PATIENT CARE. where she could put her expanded knowledge and skills to use. The department of vascular surgery supported this role where a Limb Preservation Program could be further developed. This program involved inpatients and outpatients of the vascular surgery department where research could be initiated and data collection and outcomes could be tracked. When asked about what makes Christine a Nursing Hero, it is clear that Christine is a triple threat. In addition to her clinical role, Christine serves as the President of the Wound ,Ostomy and Continence Nurses Canada ( NSWOCC) supporting wound, ostomy and continence education and programs to over 600 nurses nationally. She presents locally, regionally ,na-
tionally and internationally on vascular wounds, infection control and limb preservation and is actively involved in research to support practice change. Christine has supported the launch of an innovative and sustainable Limb Preservation Clinic at the Ottawa Hospital ( Civic Campus) which acts as a “Hub” to the many “Spokes” of smaller communities in and around the Ottawa area. At the Ottawa Hospital ( Civic Campus) Limb Preservation Clinic, family-centered care is a priority. Christine embodies that in all she does, and by providing continuity of care to patients and families. Patients and their families are grateful for Christine’s knowledge and advocacy as she ensures they receive the highest standard of patient care. Continued on page 43 MAY 2019 HOSPITAL NEWS 29
NATIONAL NURSING WEEK 2019
Rebecca Gonser Continued from page 26 Within one week, the pressure injury resolved. Rebecca’s devotion to patients and nurses is astounding. She is a fantastic nurse, and a positive force to work with. Sincerely, Caitlin Cornish , RN
3RD NOMINATION Rebecca consistently goes over and above every day! She generously offered to be a regular primary nurse for a patient, Buddy (not his real name), who was a high school student who was involved in a very bad car crash, resulting in a severe head injury. As a result of his head injury he was disinhibited, and verbally and physically abusive towards staff and his family. Because of his size, his propensity to hit out and kick out, and his ongoing slew of verbal abuse it was challenging to find nurses who wanted to care for him. However, because of his behaviour he also derived benefit from consistent nurses. Rebecca stepped up to the plate to act as a primary nurse
and to care for him, redirect him and to encourage him to take part in his care, to become more independent, to demonstrate that he could go to a rehabilitation hospital. She played a pivotal role through her skilled nursing, and positive attitude, with a ready smile, that Buddy was able to achieve his goal and go to a Rehabilitation Centre, where he eventually recovered well enough to return home and to school. Rebecca also stands out as she is always willing to take on new learning and challenges. She has sought out training to become one of our few skilled nurses to provide very specialized education and care to patients, their families and staff about spinal cord injuries. She is on the Hospital Emergency Response Team for Sunnybrook. She participates as an educator in the PARTY program (Prevent Alcohol Related Trauma in Youth) a program developed at SHSC. She is an instructor in the Stop the Bleed
SEIU Healthcare Nursing Division Champions Unity: One Goal, One Team, One Vision SEIU Healthcare, Canada’s Healthcare Union, is proud to celebrate our professional, hard-working nurses.
Our coverage meets and can exceed the requirements of the College of Nurses of Ontario.
SEIU Healthcare is the only service union in Ontario that has a dedicated space for nurses with its own constitution and bylaws. Our Nursing Division promotes leadership, diversity, and unity through educational training and political activism. We advocate with our nurses regarding their professional scope of practice.
During Nursing Week 2019, our nurses will be hosting in-unit events across the province that will be fun opportunities to connect with each other and celebrate their profession. The events will also be a chance for nurses to plan actions that can bring positive changes to nursing. The Nursing Division will also be hosting regional social events and a political lobby day at Queen’s Park. Our Nursing Division is committed to educating decision makers on the importance of addressing the recruitment and retention crisis in nursing and achieving zero tolerance for violence and harassment toward nurses in their workplaces.
Our nurses are leaders who identify issues and find solutions to improve their workplace and the healthcare system. We have heard from nurses that they have excessive and unsafe workloads, so we are promoting the use of Workload Review Forms to better track working conditions. SEIU Healthcare’s Nursing Division also offers numerous quality assurance learning modules and free Professional Liability Protection (PLP) insurance for all our nurses. The PLP insurance covers all nursing practice from facilityto-facility, even in a workplace that is not unionized with SEIU Healthcare.
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We invest in our nurses because we know that nurses play a critical role in quality patient, resident, and client care in every sector of healthcare. Thank you #SEIUNurses! To learn more about SEIU Healthcare’s Nursing Division please visit www.seiunurses.ca.
Course at SHSC, and facilitated training to new educators. She participates in Quality Improvement Projects and Practice Based Research. She is also a member of the Practice Council. She participates in the BIST run (Brain Injury Support Toronto) on a regular basis, encouraging others to join in. Nominated by Janna Di Pinto MSW, RSW Social Worker, Trauma
4TH NOMINATION This story about an extraordinary nurse is so valuable considering today’s focus on violence and health care workers. Right from the start, I knew she would have a positive impact on patient care and on interprofessional relationships. It is rare to see a young nurse with such confidence and comfort in working on a diverse interprofessional team. The following story is a perfect example of how Rebecca has become a nursing hero... for all staff. We recently had an incident on the floor where a code white was called and the team was confronted with a violent and high risk scenario involving a patient and multiple family members in the hallway of the unit. Both hospital security and the Toronto Police were called to diffuse this situation. The staff working at the time and the patients on the floor witnessed some shocking verbal and physical violence, and for a period of time before police arrived, the hospital security team was struggling to control the situation. By all accounts, staff felt out of control and vulnerable. As a team, we debriefed the next day in what we call a ‘code lavender’, where a colleague from spiritual care leads a group discussion to diffuse tension and discuss our feelings. Rebecca, along with many other nurses and allied health professionals attended this session, where feelings of fear of workplace violence were shared openly and honestly by almost all of the staff in the room. Because of the severity of the incident, a second debrief was held later in the day with many of the same unit-level nurses and allied health, but this time management, senior leadership and members of the security team, including the head of security were present. The climate in the room
completely changed with the presence of leadership. In the previous meeting, where members of the team were clearly comfortable and outspoken about their feelings, almost no one was willing to speak up in this ‘high stakes’ scenario. Members of the leadership team empathized with the team, and discussed ways in which policies and procedures would be improved in light of the incident. The focus was on overall unit and patient safety. It was Rebecca who took this opportunity to highlight the fear staff were feeling during this incident. With passion and emotion, she relayed the details of our earlier debriefing and articulated how unsafe, vulnerable and fearful nursing and allied health felt during the incident in question, and about the general increase in violent incidents on the unit as a whole. She bravely put her heart on the table, becoming tearful in the process, and spoke for all those who felt too intimidated to do so. She emphasized how feeling unsafe at work is not acceptable, and that before we can keep patients and families safe and secure, we need to feel that way ourselves. There was a palpable diffusion of tension in the room when Rebecca started talking. She was relaying exactly what everyone else wanted to express, and she did so from a place of profound love and respect for the C5 staff. It was incredibly impactful. As a result, the conversation started to unfold in a more open and honest way. Because of Rebecca’s bravery, the leadership team left the meeting with a clear sense of how violence in the workplace is a major factor in job satisfaction and that it must be addressed right away. Since that meeting, multiple safety measures have been improved or implemented, including a standard hourly security walk around, locked patient care unit doors, and mock ‘code silver/ active shooter’ scenarios for staff members. Rebecca’s one voice tipped the scales toward meaningful improvements in staff safety. Her speaking up for what was right was a true moment of heroism. Erin MacGregor, RD Clinical Dietitian, Trauma, Neurosurgery, Orthopedics, H Sunnybrook Health Science Centre. ■ www.hospitalnews.com
NATIONAL NURSING WEEK 2019
Ali-Akber Shermohammed The Centre for Addiction and Mental Health am writing to nominate my colleague Ali-Akber Shermohammed. He is a full-time RNs and a great team lead at the CAMH schizophrenia acute care unit. Every day Ali works very hard, combining team lead role with primary nursing. He excels in both roles, making sure his team functions smoothly and also always has time for any of the 25 clients on the unit. Even though it is not part of his role as a charge nurse, he still spends time talking to clients when they want to talk, helps them deal with their anxieties and symptoms. Clients ask him for help and not the assigned primary nurses because Ali is the best in relating to clients and the most helpful from the client’s perspective. He is great at de-escalat-
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ing agitated clients and many times he was able to prevent Code Whites from happening while supporting clients through difficult times without the need for restraints. I learn every day from Ali about how to make clients feel heard and understood and how to build such strong therapeutic relationships that even during worst periods of psychosis they still trust him and are willing to talk to him. In addition, for clients who are more stable he goes out of his way to support their needs, sometimes sacrificing his own needs. For example he takes clients to the gym to play basketball almost every day (not part of his
THANK YOU, NURSES! As we celebrate Nursing Week, |_; !;]bv|;u;7 u-1া1-Ń´ †uv;v vvo1b-াom o= m|-ubo would like to recognize and thank nurses - Registered u-1া1-Ń´ †uv;v -m7 -Ń´Ń´ m†uv;v -Ń´bh; ĹŠ =ou |_; ;Š1;rাom-Ń´ 1-u; ‹o† 7;Ń´bˆ;u ;ˆ;u‹ 7-‹ĺ
32 HOSPITAL NEWS MAY 2019
role and not required) and on some days he does not take a break or takes a very short break to accommodate this. Clients appreciate this greatly because our unit is highly acute and very busy, therefore other nurses are too busy attending to more acute clients to be able to accompany those who feel better to go play basketball or to work out in the gym. Ali makes time to play cards with clients or to play videogames or simply chatting and making them feel supported. He is my personal nursing hero and I believe he deserves this title more than anyone I know. Nominated by: Julia Knap, RN, CPMHN.
HM mention
2ND NOMINATION I would like to nominate Ali-Akber Shermohammed as my nursing hero. I know this is long but I really hope it does him justice as he truly deserves recognition for his hard work and dedication. If a person was trying to choose a career and performed a Google search on what a Registered Nurse is they would find an official definition describing the technicalities and specifics regarding the profession. Anyone can read these definitions and websites, and decide to work hard and go to school and obtain the degree necessary to become an RN. What the Internet will not prepare you for is the hardships in nursing; the dynamics, the sacrifice, and the empathy that is involved. Nursing can be a satisfying career but it also has the potential to be detrimental to one’s health. Think about it, a nurse is constantly putting others needs before their own, listening to their client as well as their family members predicaments, not taking a break which leads to not being able to eat or go to the
bathroom, and long shifts that are exhausting. All of these things combined can become overwhelming, they can persuade many individuals to skip that career in nursing and choose a different profession, but some people, some people were just born to be nurses. Ali is one of those individuals. Ali works relentlessly to ensure that the clients on our acute schizophrenia unit are taken care of. He began as a front line nurse and quickly became amazing at it. He is usually one of the only people on the team (which consists of and is not limited to nurses, psychiatrists, security, occupational therapists, recreational therapists, behavioural therapists, social workers, and pharmacists) to de-escalate a client while avoiding a code white situation. He is known at the Centre for Addiction and Mental Health and is even called to other floors to assist with clients in order to avoid a conflict that can potentially lead to an aggressive situation. Ali respects our clients, who are often marginalized and left out in society. He advocates for them both on the unit and on the street, never leaving his nursing career at the door when he leaves the unit for the day. He rarely will take a break, and if he does it is generally on the unit so he is never too far away if a problem were to arise. Ali understands fully how to be empathetic, he gives the clients someone to speak to, he does not define them by their diagnosis and does not let the diagnosis impede them. Instead, he treats our clients with dignity, pays attention to their hobbies and likes and dislikes and builds a rapport with them that many other staff members are not able to achieve. Ali is able to get a severely paranoid client to believe and trust in him despite the client’s strong delusions while in psychosis. He allows for the clients to have a safe space with him, he will play games with them, take them to the gym, and take them out on walks instead of taking a break or going home to his family on time. www.hospitalnews.com
NATIONAL NURSING WEEK 2019
Ali got promoted (rightfully so) to team lead of the unit. This job consists of being the charge nurse of the unit, basically managing the other staff, doing administrative tasks as well as dealing with bed flow. Most team leaders do not take care of clients as their job becomes more on the managerial side of things, however not Ali. He completes the team lead role tasks exceptionally and is still somehow able to take care of the most acute clients on the unit. He even has time to speak with clients that are not assigned to him, but who often turn to him because they know that they can rely on him. He resonates with the clients regardless of their race, gender, illness, or age and this is what makes him so impactful. There are many stories that can be told to demonstrate his impeccable nursing but there is a specific one that stands out to me. A young client of ours had been aggressive to others and was at risk of self-harm and therefore required locked seclusion.
Ali-Akber Shermohammed
Continued on page 45
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“MEGHAN IS AN INSPIRATION EACH DAY. HER CREATIVE THINKING AND CARE PLANNING FOR OUR DEMENTIA PATIENTS IS INCOMPARABLE. SHE GOES ABOVE AND BEYOND EACH AND EVERY DAY AND WE ARE TRULY LUCKY TO HAVE SUCH AN AMAZING EDUCATOR GUIDING OUR TEAM.” – NGAIRE I. (CLINICAL LEADER) ACUTE MEDICINE
Meghan McBride
Hamilton General Hospital, Hamilton Health Sciences Network hen you say you are looking for a “nursing hero”, one name immediately comes to mind within the Acute Medicine program at the Hamilton General Hospital: Meghan McBride. Meghan is a Registered Nurse who is the Clinical Educator for 8 South and 8 West, two of the Acute Medicine units at the Hamilton General Hospital. She is both a formal and informal leader whom all health professionals, not only nurses, respect and admire. On a day-to-day basis, Meghan goes above and beyond expectation. She prides herself in performing “meaningful work grounded in the principles of openness, creativity, curiosity and reflection”.
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Meghan acts as formal educator through the corporation’s Critical Practice Orientation training, by presenting the interpretation of normal and abnormal cardiac rhythms and teaching what the nurse’s action should be in response to them. She instructs at the hospital’s Annual Review and has encouraged front-line staff participation in this important education initiative. She helps facilitate the orientation of new staff and is a necessary resource to seasoned staff. She provides education through in-services and is creative in doing so, such as coordinating an education session on wound care and including the participation of a patient telling us
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“MEGHAN IS ENERGETIC, SUPPORTIVE, AND AN EXCELLENT GUIDE AND LEADER. SHE IS A CONSTANT POSITIVE ENERGY ON THE UNIT. A GENERAL GREAT COWORKER ALL THE WAY AROUND.” – KARMEN D. (RN), ACUTE MEDICINE. their own personal experience, or creating an “Escape Room” of learning. More recently, she has a vested interest in patients with delirium and dementia who can present with behaviours that are difficult to manage in the daily busyness of an acute inpatient unit. Meghan has truly been a leader in creating behavioural strategies to help minimize these behaviours. She led the team in partnering with Behavioural Supports Ontario to have simulation-based learning that addressed
unit-specific struggles. These strategies included Gentle Persuasive Approach that is crucial to this population. She has spearheaded the introduction of the Interdisciplinary Team Meetings that assists in bringing all members of the team together to discuss strategies and create an action plan for the safety of both the patient and for staff. She has partnered with a Geriatrician and developed documentation standards that need to occur for these meetings and patients. Continued on page 45
34 HOSPITAL NEWS MAY 2019
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Trillium Health Partners
CELEBRATES NATIONAL
NURSING WEEK May 6 â&#x20AC;&#x201C; 12, 2019 | #VoiceToLead
Nurses are vital members of our interprofessional health care team, helping us deliver on our mission by providing compassionate and high quality care to our patients and their families. National Nursing Week is a time to acknowledge the compassion, excellence and courage that nurses bring to their practice.
Thank you to the more than 4,200 nurses at Trillium Health Partners for providing exceptional patient care each and every day.
NATIONAL NURSING WEEK 2019
Elli Clarke Sunnybrook Health Sciences Centre y name is Jay Davis. On November 6, 2014, I had lifesaving and life altering triple bypass surgery at Sunnybrook Hospital. Following my recovery I decided that I wanted to give back to the hospital as a thank you to all of those who helped save my life. In May of 2015 I officially became a HeartPal, a volunteer position that allows me to come in to the hospital on a weekly basis and meet with patients who are about to undergo major heart surgery and share my experience with them. This program is the first of its kind in the Greater Toronto Area. It was through this program that I met Elli Clarke, who is the current Cardiac Coordinator of this program and also a CV/ICU nurse. Working alongside Elli on a weekly basis has allowed me to see firsthand her incredible integrity, commitment, compassion and patience. Elli goes out of her way to make sure that all of her patients have a full understanding of their impending surgery and is always sensitive to their fears and their many questions. She follows up with all her patients to make sure they are recovering properly and checks in with families to ensure they are looked after as well. Elli has also been instrumental in researching and championing the Sunnybrook Cardiac Surgery Support Group which much like the HeartPal program, is the first of its kind in the Greater Toronto Area. The group meets from 6-8 pm the third Thursday of every month and allows recovering heart surgery patients and family members the opportunity to share their experiences, concerns, fears and strategies for recovering in a save inclusive and respectful environment. It should be noted that Elli also heads up this group after hours and on her own free time. For all her hard work and dedication and especially for her ability to stand out and make a difference, I would like to nominate Elli Clarke as my nursing hero. Nominated by Jay Davis, a volunteer at Sunnybrook
Photo by: Doug Nicholson, Sunnybrook Health Sciences Centre
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2ND NOMINATION I am respectfully submitting my nomination for the 2019 Nursing Hero Award. Ms. Elli Clarke has been a nurse working full time for the past 12 years. She began her career as a Cardiovascular Intensive Care Unit nurse at Sunnybrook Health Sciences, working in one of the most stressful and demanding environments for an early career nurse. I had the pleasure of first meeting Elli during my tenure as staff Cardiac Surgeon at Sunnybrook. I recall vividly Elliâ&#x20AC;&#x2122;s unsurpassed work ethic, her skill, and her unmatched bedside manner in dealing with critically ill patients. But one aspect in particular which made Elli stand out from the others was her caring and compassion. On one particular occasion, I remember the manner in which she cared for a dying patient. The patient had suffered an acute aortic dissection, and had undergone emergent cardiac surgery. Soon after the surgery, however, it became apparent that the patient was not going to survive, and had only hours to live. The patientâ&#x20AC;&#x2122;s wife was called in to spend the last hours with her dying husband. It quickly became apparent that the wife had no immediate family to support her during her time of grief. Elli put aside her paperwork, and spent the entire shift sitting beside the wife, holding her, and consoling her. Elli even went on to forgo her break so that she could stay with the wife. At the end of her shift, Elli stayed on until the patient passed. In fact, she stayed hours past her shift to enable her to complete her paperwork. This is not just the kind of person Elli is, but the kind of nurse she is. She epitomizes everything that nursing stands for: skill, excellence, caring, compassion. Elli has since transitioned into a nursing leadership role. She is currently the Head Triage Coordinator for the Division of Cardiac Surgery at Sunnybrook Health Sciences Centre where she manages triage, scheduling, and booking of all inpatients requiring urgent cardiac surgery. Even in this role, www.hospitalnews.com
NATIONAL NURSING WEEK 2019 Elli has gone beyond the call, working tirelessly and independently in her free time to establish the first ever Sunnybrook Cardiac Surgery Patient Support Group. This initiative was Elli’s brainchild, established to enable patients and families of patients undergoing cardiac surgery to share their experiences, concerns, fears, and strategies for recovery, in a safe and inclusive environment. As is evident from the above, Elli is one of a kind, and I truly believe that she is worthy of the title “Nursing Hero”. Nominated by: Dr. Gideon Cohen MD,PhD,FRCS(C). Chief, Division of Cardiac Surgery, Sunnybrook Health Sciences Centre.
Coordinator for Cardiac Surgery. I have been a staff cardiac surgeon for close to 30 years, former Divisional Head and Professor of Surgery at University of Toronto. I have worked alongside Elli for the past 15 years, i.e. during both roles. I can attest that Elli is a very skilled ICU nurse, and her bedside care and input into the overall patient management was invaluable. In addition, she wanted to grow in her position – she was a George Brown clinical instructor for the ICU program, and also served as one of the charge nurses in CVICU. The triage role began for Elli about five years ago, initially as a part time position, and later full time. The position is challenging – it requires someone with excellent clinical knowledge as well as superb communicative skills as the individual needs to relate to health care teams both inside and outside the institution as well as the patients in a very timely manner. There are also pressures from the in-
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3RD NOMINATION I am nominating Elli Clarke in the strongest possible terms for the Nursing Hero Award. Elli has been at Sunnybrook for approximately 15 years – initially as a CVICU nurse, and then later as a Triage
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stitution as cardiac surgery is volume funded. The stress level is high. There are frequently conflicts that need to be resolved; the operative schedule changes regularly, as patients’ conditions change, and new emergencies arise. Hence, the need for effective triage. Elli however manages to work through these situations with equanimity. As well, during this time she has worked diligently toward standardizing the triage process through the development of an orientation process, communication documents, and restructuring of the pre-operative education through a revamping of the class and teaching material. Most recently, she has identified a gap in post-operative treatment focused on depression and anxiety. This will be addressed in the form of a cardiac surgery support group. The Sunnybrook HSC cardiac surgical support group is likely the first of its kind in the GTA. The group will meet every third Wednesday of the month which will allow recovering surgical patient and family members the opportunity to share experiences, concern, fears and strategies to improve the recov-
ery process. The idea of this program is supported by evidence to reduce infection rates, readmission rates, overall patient satisfaction and most of all improve outcomes. I would be remiss if I didn’t also mention her baking. Elli routinely brings home baked goods from home for the team on H4, which are invariably extremely tasty, if not heart friendly. This is something that she clearly has done on her own volition. We are very grateful for this little something extra from Elli – we are very appreciative of her efforts, and this little something extra helps reduce the anxiety we routinely face treating patients with severe heart disease. What is the Nursing Hero Story? It is of course everything I mentioned in this letter, but maybe in addition to all of her qualifications it’s the little something extra is what makes Elli so special. Please do not hesitate to contact me if there are any questions related to this letter of recommendation. Again, I strongly support Elli Clarke as the Nursing Hero. Nominated by Dr. Stephen E. H Fremes ■
Our nurses make Extraordinary Caring & Innovation their daily mission Join Niagara Health – a proud Best Practice Spotlight Organization since 2002 – in celebrating nursing professionals everywhere, and the compassion, ingenuity and leadership of our nursing team. Caring and innovative, our Nurse Practitioners, Registered Nurses and Registered Practical Nurses go above and beyond to make extraordinary patient outcomes a reality for the communities we serve across Niagara Region. Visit our website to find out more and apply online.
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MAY 2019 HOSPITAL NEWS 37
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Susan Davidson The Hospital for Sick Children, St. Joseph’s Health Centre, Toronto usan Davidson manages the practice of a dozen or so consultant paediatricians, both at the Hospital for Sick Children and at St Joseph’s Health Centre in Toronto. For three days per week, over the past 20 years, I have had the privilege of working with this absolutely incredible, inspiring health care provider for children. As is customary for the practice of a paediatrician, my patients eventually graduate. It is typical that they they thank me for my years of service with a warm handshake. Susan gets the warm embraces. It is because she becomes an integral part of the lives of so many families. She is the voice on the other end
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SUSAN IS THE HERO TO THE SICK AND TO THE HEALED. SHE IS THE HERO TO THE ENGAGED AND TO THE DISENFRANCHISED. of the phone when they need help. She successfully navigates under-resourced services for families. She advocates for families by attending team meetings, by writing impassionate letters, by calling and emailing and calling again. She is the voice on the other end of the phone when I need help with a difficult medical decision. She is my most trusted colleague. She is my wisest advisor. She is the heart and soul of my practice. My medical trainees discuss cases with her (to make sure they get it right)
Nursing Week Is Something To Celebrate! On behalf of all of us at the Health Care Providers Group Insurance plan, we’d like to take a moment to celebrate all of the hard-working nurses across Canada! The impact you have on our healthcare system is immense and invaluable, and we’re forever grateful for the positive differences that you make each and every day. Thank you for your continuous compassion, care and dedication!
38 HOSPITAL NEWS MAY 2019
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before discussing with me. Susan triages consults to me, helps figure out disposition, helps solve dilemmas and develop treatment plans and asks me nothing more than, “…if you agree, sign here”. We work with many kids and teens with mental health challenges. Susan has performed neurodevelopment testing for kids, provided counselling for families, navigated options, championed their advocacy and educated them. She has cried with families in times of both sadness and success. She has enriched the lives of so many families dealing with mental and medical health issues. However, when a child’s health is not improving, understandably, parents become frustrated with their health care providers. Parents who have ‘fired’ all of their doctors and nurses, continue to remain engaged with healthcare through Susan. She is not just the hero for kids who are doing great, she is the hero for families continuing to suffer. There are so many examples but here are a couple of very recent ones that come to mind: [1] We treated a girl with significant impairment from ADHD and anxiety for many years. Mom was very motivated and bright and bonded with Susan. Through testing that Susan performed, advocacy for this girl’s Individual Education Plan, ensuring medication was titrated, re-ordered, adjusted and optimized and through letters of support, subspecialty referrals, coordination of care and tons of emotional support, guidance and education that Susan provided to this family for over a decade, this was a success story. Her daughter who was also very bright and motivated, matured and grew in confidence and graduated from our clinic (at
18 years of age) and was accepted to University. In her 2nd year, while thriving, she was diagnosed with lymphoma. At the age of 20, who did they call for emotional support and to help them navigate the healthcare system? They called who they needed and trusted; their paediatric nurse, Susan. We all cried; and then Susan got to work ensuring that this girl was getting the best care and providing ongoing emotional support to this family. [2] We treated a child with complex mental health challenges and although gifted, was doing poorly. Not surprisingly mom was frustrated with the care they were getting from the sub-specialists we had referred them to. Mom severed relationships with these health care providers and lodged complaints. This child was doing poorly at school as well and, not surprisingly, mom was frustrated with the school and severed relationships and lodged complaints. Despite this mom being perceived as ‘difficult’ by many, Susan saw her suffering and the good in her. Susan facilitated psychiatric care that was a better fit for the child and despite mom’s disenchantment with our health care system and with our educational system, recently, while heading into the examining room for another child, I noticed this mom dropping off a wrapped gift for Susan. Susan is the hero to the sick and to the healed. She is the hero to the engaged and to the disenfranchised. She is my hero too. Susan’s efficient and thorough care of our patients has allowed me ‘protected time’ to be successful in academia. I have won awards because of her hard work and it’s not fair. It’s time she wins one. Nominated by, Dr. Mark Feldman MD FRCPC, Associate Professor, University of Toronto, Director, Community Paediatrics & Continuing Education, The Hospital for Sick Children and Saint H Joseph’s Health Centre. ■ www.hospitalnews.com
NATIONAL NURSING WEEK 2019
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MAY 2019 HOSPITAL NEWS 39
NATIONAL NURSING WEEK 2019
Paul Welsby Trillium Health Partners t is with great pleasure that I nominate Paul Welsby, Renal Navigator, for consideration for the 2019 Nursing Hero Award. Throughout his career, Paul has repeatedly demonstrated his passion and commitment to improving the quality of patient care, service delivery, and team morale. This award provides an opportunity for the Regional Renal Program to recognize and show appreciation for Paul’s compassionate nature, outstanding leadership and unwavering commitment to both the program and Trillium Health Partners (THP) as a whole. With over 20 years’ experience at THP, Paul has served many roles within the Regional Renal Program. Starting as a young and eager Registered Nurse (RN), Paul quickly excelled, gaining experience at all renal sites. Some of his most notable positions
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include Education Facilitator, Clinical Leader and most recently, Patient Navigator. Paul is exceptionally gifted in viewing complex situations from a variety of perspectives. Driven by his intrigue and passion for health care, he is always looking for new possibilities, and innovations; and approaches each new challenge with initiative and enthusiasm. For example, over the last year, the program experienced significant growth across all Chronic Kidney Disease modalities; including our inpatient need, where there is limited capacity but increasing demand. To address this issue, the program planned to pilot an inpatient Navigator role to help coor-
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SE Health recognizes and thanks all Nurses across Canada during Nursing Week As we celebrate Nursing Week, SE Health would like to recognize and give a tremendous thank you to all nurses across Canada for their leadership and commitment to spreading Hope and Happiness into the lives of patients and their families. SE Health is deeply rooted in nursing. Our story began in 1908 when four nurses came together in Toronto, to establish Saint Elizabeth Visiting Nurses Association to provide care to the poor, new moms and babies, and others in need. We celebrate over 110 years of nurses paving the way to becoming the largest segment of health care workers that are uniquely qualified to be innovation activators, influencers, designers and collaborators. #SENurses are committed to their patients, families and communities, utilizing their wide range of expertise and skills to provide excellence in care. They are patient advocates in our health care system, bringing kindness, a drive to learn and quality practice to the care they provide. Through May 6-12 give a big ‘Thank You’ to a nurse you know, and tag them using #SENurses, for all of their hard work and dedication in taking care of Canadians.
40 HOSPITAL NEWS MAY 2019
dinate dialysis needs and access. Seizing a new opportunity, Paul volunteered for the role and rose to the challenge. He partnered with Nephrologists and clinical partners across Patient Care Services to improve access, coordination and support individual discharge planning. Since the launch of the pilot in November 2018, Paul has been able to support a 76 per cent reduction in delayed treatments, thereby improving patient safety due to fewer delayed dialysis treatments through better coordination of care. In addition, patient flow improved by reducing shuttling patients to receive their dialysis. These efforts have contributed to improved sustainability and will save THP an estimated $58,000 per year in avoidable costs (i.e. shuttling, back-fill, overtime etc.). Clinical partners have noted the impact to patient safety and experience, and have supported the program in pursuing a permanent inpatient Navigator role to continue Paul’s effective management of patient flow and resources. Christine Johnson, Manager Cardiac Health, commented: “It has been my experience that Paul has been professional, communicated well, followed-up with the Cardiac teams and worked very collaboratively with our group.” This pilot was successful in large part to Paul’s enthusiasm, commitment, and resilience. Furthermore, Paul is known to the program and teams across the hospital for his creativity and team mentality.
Always humble and ready to help, Paul never declines an opportunity to assist staff and patients. Paul’s approachable nature makes staff and patients comfortable in seeking his guidance, wisdom, and coaching. Armed with a wealth of knowledge, Paul is always able to adapt and communicate in a way that supports the needs of the learner. For example, Paul led the creation of an educational video to support patient education. He also collaborates with the other Renal Navigators to coordinate and run Patient Education Nights for Hemodialysis, Peritoneal Dialysis and Transplant. In valuing the contributions of team work, Paul is quick to recognize the efforts of his team and calls out individuals for their exceptional work. Paul is also known for his thoughtfulness. Staff recall Paul purchasing gift cards from his own money as a “thank you” to clinical leaders and staff. He also “anonymously” donated a tea set and beautiful pottery as staff prizes for World Kidney Day; further demonstrating his kindness and generosity. Staff also recall Paul’s playfulness. He has a keen ability to use humour to uplift patients and staff, defuse stressful situations, and manage patient care situations. As an example, Paul once wrote and coordinated a play for the Patient Christmas Party and injected humour to uplift everyone’s spirit. Nominated by Kimberly Moore, Program Director, Out-patient Medicine and Regional Chronic Kidney Disease ProH gram, Trillium Health Partners. ■ www.hospitalnews.com
Celebrating Nursing Week
Thank you! Nurses combine valuable clinical expertise and caring to provide quality care to people across a wide range of settings. From Hospitals to Home Care - Nurses are a strong and integral part of our health care system. At SE Health, we are proud of our highly skilled nurses and the amazing care they provide in peopleâ&#x20AC;&#x2122;s homes every day.
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Carolyn Lawton Sunnybrook Health Sciences Centre arolyn has spent her career in nursing sounding the alarm that action must be taken to stop the diabetes epidemic. The human toll of diabetes is great as it makes its presence known everywhere. Diabetes contributes to 30 per cent of strokes, 40 per cent of heart attacks and 50 per cent of kidney failure requiring dialysis, 70 per cent of non-traumatic limb amputations and is the leading cause of blindness. So how does one nurse make a difference to stem the tide of this health care tsunami? She graduates from the University of Western Ontario and with BScN in hand finds work on a medical unit at Toronto General Hospital. This staff nurse position exposed her to a number of chronic conditions that lit her passion for enabling patients to self-manage their own care. The light bulb came on that patients with diabetes need to actively participate in their own healthcare, but often lack the resources to do so. Addressing the nursing challenge of supporting behaviour change led her to a University of Toronto Master’s thesis based on Dorothea Orem’s Theory of Self-Care. In 1988 the timing proved right for Carolyn, as Sunnybrook was willing to invest in diabetes care and education, which aligned with Carolyn’s ambition to become a Clinical Nurse Specialist in Diabetes. She provided advanced consultation and support for diabetes practice and education for patients, their families and staff. Diabetes Education Centres were a new concept and just beginning to evolve. Treatment options and technology were very limited, compared
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42 HOSPITAL NEWS MAY 2019
Photo by: Doug Nicholson, Sunnybrook Health Sciences Centre
NATIONAL NURSING WEEK 2019
to what we have today. The one constant that remains is that people still have the same fears about their future health. Carolyn was up to the task with her colleagues to create and lead from the ground up a program that would provide the essential knowledge and skills but also appreciate that the patient was the ultimate decision-maker. The Sunnybrook Diabetes Education Centre (SUNDEC) was born! Under her guidance and stewardship SUNDEC had to be more than an education program. It has continued to evolve and for more than 30 years has been there for people to assist them to live well with diabetes through innovative programming and support. Carolyn then received her Acute Care Nurse Practitioner EC certification in 1996 and transitioned into the role of Nurse Practitioner for Diabetes from 1997 to the present. She provides advanced diabetes care for medically complex patients in both inpatient and outpatient settings. She participates in the Rapid Referral and Assessment Clinic, (RADAR), dealing with patients in urgent need of enhanced diabetes management. Carolyn is the Chair for the inter-professional Nephrology/SUNDEC journal club, and is a member of the Pharmacy & Therapeutics Committee as the Nurse Practitioner representative. As a member of the Inpatient Diabetes Committee she has contributed to many quality improvement initiatives such as: Hypoglycemic protocol
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and Subcutaneous Insulin Order sets, Insulin self-management pen policy, Insulin Pump Policy and was a lead in the hospital wide Insulin pen conversion project. Carolyn has a strong commitment to the mentoring and preceptorship of nursing students. As an adjunct clinical appointee to the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto (U of T), she has been the preceptor for numerous U of T NP students. She was the primary NP Mentor through an RNAO Clinical fellowship, to assist a renal Nurse Practitioner to expand her scope of practice to improve diabetes care for patients with both chronic kidney disease and diabetes. Her research interests include reducing the occurrence of hypoglycemia for the inpatient population and exploring remedial factors associated with hospital readmissions for patients with diabetes. Carolyn has received many honours and accolades which are too numerous
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to mention, but some notable highlights include the Banting and Best Diabetes Educator of the Year (2009), team recipient of the Best Research for Developing Country award from the Journal of Wound Care through her work with the Canadian-Guyanese Collaboration to Improve Diabetes Foot Care (2013). Carolyn has also amassed an impressive collection of research, oral and poster presentations as well as publications. Carolyn is a highly accomplished and extremely knowledgeable NP, possessing many positive attributes, including a strong work ethic and approachable demeanor. Carolyn’s passion and mission to raise the profile of diabetes care and education to prevent the burden of diabetes complications continues on with her commitment to empower patients, families and staff. Colleagues and patients all agree that there is nobody more deserving of this recognition than Carolyn Lawton! Nominated by Fiona Stone and Julie H Paterson ■ www.hospitalnews.com
NATIONAL NURSING WEEK 2019
Laura Bainbridge Continued from page 28
Laura always puts the needs of her patients first. She is a fierce advocate for her patients and can often be found walking with them to their next appointment, or working to have them seen by another service “since they’re already here”. If she knows a number of tests are needed, then she will do everything in her power to coordinate them all for the same day so as not to inconvenience families more often than needed, but also to get the patients and their families the results as soon as possible as she does not want them to have to worry for any longer than absolutely necessary. There have been times when Laura has stumbled upon someone sick in the elevator requiring help. I remember one day she told me that she came across a pregnant woman and her daughter, and the woman was clearly in distress. Even though Laura had work to do, she didn’t think twice about it, she immediately helped the woman to get to labour and delivery, and she stayed
with the daughter while the mom was taken in, reassuring the daughter that she was not alone and that she would stay with her until other family members arrived. I have no doubt that that little girl will remember Nurse Laura’s kindness, and how she made that very scary situation a little brighter. There was a particular family that to this day states that they would not have been able to get through what they did with their daughter without Laura. The only reason that they were able to get their daughter to come to the hospital at all was the promise of seeing Laura when she got here. When Laura moved to another team, I tried my best, but I was no substitute for Laura in this patient’s eyes. I can only hope to be the reason my patients like to come to the hospital! I know that if asked, there would be countless families that would write letters in support of Laura the Super Nurse. She is one of the kindest, most selfless people that you will ever meet. She will
Nurses: A Voice to Lead Health for All Ontario Shores Centre for Mental Health Sciences (Ontario Shores) is proud to be Celebrating a Century of Care to mark our 100th anniversary of providing specialized mental health services to the communities we serve.
shadows. Along with caring for their patients, nurses have assisted in removing the stigma associated with mental illness by becoming advocates for a segment of the population which has been marginalized for decades.
Throughout our history of providing exemplary care, nurses have played an integral role in the lives of people living with mental illness and have been central in our history and evolution as an organization.
While we look back at our history as well forward to the future of mental health care, it’s important to pause and recognize the wonderful efforts of today.
As we prepare to officially turn 100 on October 23, 2019, we celebrate the contributions of nurses and value their leadership in helping mental health come out of the
literally do almost anything she can to help someone. In our neighbourhood she is a go-to for medical advice and has been known to accompany friends with sick children to the hospital if needed. Laura is an amazing nurse, mother, friend, and colleague. I really can’t
think of anyone more deserving of this award. She truly is a hero to so many. Nominated by Beth Hawke, Registered Nurse, Pediatric Neurology – 2G Clinics McMaster Children’s Hospital Hamilton H Health Sciences. ■
Christine Murphy Continued from page 29 She has made a major contribution to wound care education through being an adjunct professor in the masters of clinical science in wound healing master’s degree program at Western University and has been committed to healthcare provider teaching with both bedside nurses, residents and physicians, and collaborates with inter-professional team members on a daily basis. With complex vascular wounds, there are many things that need to be considered such as blood flow to the limb, proper assessment and diagnostics and pain control. With a highly committed
team, these complexities are handled more effectively. Christine’s calm manner and thorough approach to problem solving augment her ability to lead teams and, educate, advocate and do research to improve the outcomes for patients suffering from vascular wounds. She exemplifies “Nursing Leadership” through innovation of hospital to community vascular wound care delivery. Vascular Health is now a priority area of research at the Ottawa Hospital. Nominated by: Catherine Harley Executive Director, NSWOCC Nurses Specialized in Wound, Ostomy & ConH tinence Canada ■
Thank you to our nurses at Ontario Shores for supporting and empowering our patients through their recovery journey. Nurses: A Voice to Lead Health for All
As an organization we are both proud and excited to celebrate Nursing Week with our Nurse Practitioners, RPNs, and RNs!
#VoicetoLead!
ontarioshores.ca/100 www.hospitalnews.com
MAY 2019 HOSPITAL NEWS 43
NATIONAL NURSING WEEK 2019
Teressa Allwood Interior Health
W
e wish to nominate our Patient Care Coordinator (PCC), Teressa Allwood for the 2019 Nursing Hero
Award. Teressa has been an exemplary leader from day one. She is one of the most talented, ethical and valued members of our nursing team. Her leadership qualities and excellence for patient care are insurmountable. To say she goes “above and beyond”, is an understatement to describe her commitment and dedication to patients, colleagues, and the greater organization. Teressa is an expert emergency registered nurse (RN); a skilled operating room (OR) nurse; a knowledgeable maternity nurse; a certified chemotherapy nurse; and she is one of Cariboo’s few certified peripherally inserted central catheter (PICC) nurse
TERESSA HAS BEEN AN EXEMPLARY LEADER FROM DAY ONE. SHE IS ONE OF THE MOST TALENTED, ETHICAL AND VALUED MEMBERS OF OUR NURSING TEAM. clinicians. Her diverse skill set and knowledge base are the foundation to her excellence in clinical practice in the rural setting of 100 Mile House Hospital (OMH); and support her innate ability to mentor and develop others. Teressa has graciously stepped forward several times to act as interim Manager at 100 Mile District General Hospital (OMH). During her tenure she was instrumental for many patient care improvements – including (but not limited to) Mobility Project, ex-
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44 HOSPITAL NEWS MAY 2019
panded scope of nursing practice, and the LPN Over Hire project. Through her diligence and hard work she supported staff professionally, functioning as a knowledge broker; which has transformed OMH into an acute care hospital. In 2017, while Teressa was temporarily filling the site manager’s position, a fast moving, aggressive wildfire broke out on the outskirts of our community. Within hours, our health care facility was evacuated, and shortly thereafter, the entire community of 100 Mile House was also evacuated. In the following hours, days and weeks, Teressa worked literally non-stop to ensure residents and staff were safe and well-cared for. She rarely took a break of more than a few hours; communicated with staff regularly to keep us updated on the grim situation threatening our town; and she was available by phone around the clock. Teressa’s leadership during this time was strong and reliable and we all felt we could turn to her for answers and support during this incredibly difficult situation. To this day, Teressa continues to receive calls and texts from staff on her “off hours” and she graciously provides support and direction. Under Teressa’s leadership, the length of patient stays in the acute care ward fell by 21 per cent, occupancy rates dropped from 127 per cent to an average of 107 per cent of the bed census and emergency inpatient days were reduced from 4.8 to 2 per cent. The number of 100 Mile House patients sent to tertiary care sites plummeted by an astounding 64 per
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cent, the percentage of patients waiting for alternative levels of care decreased by 69 per cent and residential and assisted living admissions fell by 58 per cent. These results are nothing short of jaw-dropping, and at a time when health care dollars are in short supply; rightfully garnered the attention from the most senior levels of Interior Health’s management team. As a result, in November 2018, Teressa and her team of hard-working nurses were recognized with a Quality Award from Interior Health. Teressa embraces and supports others through change and challenges. Her values are aligned with Interior Health’s values of quality, integrity, respect and trust – all of which she demonstrates each and every day. Her humility is impeccable; her selfless attitude goes above and beyond; her quest for improved working conditions and positive patient experiences are goals she strives for. She advocates for improved staffing levels, increased security measures, succession planning; and can be counted upon to promote the latest “best practice” innovations to those who work with her. We cannot think of anyone more deserving of the title of “Nursing Hero” than our leader, co-worker and H friend, Teressa Allwood. ■
mention
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NATIONAL NURSING WEEK 2019
Meghan McBride Continued from page 34 She has personally invested her own time by fundraising to raise money for door wraps to assist in camouflaging exits for our exit-seeking dementia patients. She has also used her own time to create ‘fidget aprons’ by sewing zippers, buttons, laces, and fabrics onto aprons for patients who are bored and often ‘fidget’ with their own clothing. Through this, she has demonstrated compassionate care and her ability to be creative in strategies that better patient care. Meghan has also demonstrated her attention to patient safety with the introduction of the discharge pause. Working together on a team, the creation and implementation of this discharge pause has successfully shown to decrease errors on discharge, including medication prescription errors. The success of this discharge intervention was published in the Canadian journal Nursing 2017! She continues to have a vested interest in safe patient discharge and currently is a member of the medicine discharge process interdisciplinary committee.
Meghan’s academic endeavors have also led her to co-author in a second publication in the Journal of Interprofessional Education and Practice. This time, this was an opportunity to advance the learning and understanding
of residents among interdisciplinary team members and in turn improve patient care in Medicine. Meghan interacts positively with staff on a daily basis through unit safety huddles and CQI board. She summarizes recent changes and educates staff accordingly. She always ends our huddle with “It’s going to be a great day!” Meghan’s positivity
is infectious and we are so lucky to have her on our team! She continuously seeks opportunities for Quality Improvement Projects in all areas of care. Meghan’s passion and leadership for advancing patient care is evident in everything she touches! She truly is our nursing hero. Sincerely, The H Acute Medicine Team ■
Ali-Akber Shermohammed Continued from page 33 The client had a medical issue and thus had to be sent to a hospital in the GTA. This transfer necessitated police, paramedics, two nurses and four point restraints to hold the client to the stretcher to ensure both staff safety as well as the clients. I was one of the nurses accompanying the client as well as a different nurse. The client was agitated, irritable and wanted to seek treatment immediately. The staff did the best that they could to avoid any unsafe situations. I was at the general hospital for about four hours by
the time the other nurse was relieved as his shift was over and Ali showed up. The affect of the client instantaneously became bright upon seeing him. Although the wait for care was still about another three hours, Ali made those three hours enjoyable. He got Tim Horton’s for the client as he did not eat and did not like the hospital food that was available and he obtained a deck of cards and began playing with him. But it wasn’t these tangible things that he did for the client that stood out, it was the psychological things, like speaking to
the client regarding his delusions, his illness, allowing the client to use Ali’s personal phone to make long distance calls to the client’s brother in order to set him at ease. The client was medically stable and was taken back to the unit by Ali and I, free of police, and free of mechanical restraints. I saw a different side of the client that day, I saw a person that has issues like the rest of us, that was scared and vulnerable but was able to be put at ease by someone who truly cared. Nominated by Jessica Cristiano RN, H CAMH ■
PR OT ECT IN G T H OS E WH O P U T TH E C AR E I N H E A LT HCA RE : I N R ECOG N IT ION O F NU R S E S ’ WE E K Cavalluzzo would like to recognize the skill, compassion, and professionalism of nurses everywhere.
Remaining true to the values of innovation and dedication that our firm was founded upon, we continue to provide superior advocacy for health professionals. Health law experts for all of your labour and employment needs:
Since 1983, our firm has grown to more than thirty lawyers who share a commitment to excellence and justice in workplaces. We represent trade unions, organizations and individuals in both the public and private sector.
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Kate Hughes Jan Borowy Phil Abbink Danielle Bisnar Michael Mandarino Niiti Simmonds Tyler Boggs
416.964.5525 416.964.5518 416.964.5547 416.964.5535 416.964.5528 416.964.5514 416.964.5522
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MAY 2019 HOSPITAL NEWS 45
NATIONAL NURSING WEEK 2019
Andres Gomez
Trillium Health Partners uthor Mandy Hale once wrote “To make a difference in someone’s life you don’t have to be brilliant, rich, beautiful or perfect. You just have to care”. Andres Gomez exemplifies this quote as a nurse, mentor, and an individual. It is his supportive nature and exceptional teaching ability that has made working even in the Emergency Department a welcoming space for nurses like myself. My nursing journey began in high school when I started volunteering at a long-term care home. It dawned on me that nurses can really make a difference in the lives of people by being a comfort to them during a difficult time. This made me realize that above all, I wanted to be a good nurse. When
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I first transferred to the Emergency Department, I was very anxious. Andres was assigned as my preceptor. My nursing background is in general medicine and the Emergency Department brings with it a sense of pride as well as intimidation. I worried about the new environment, apprehensive of my own skills, and conscious of those I lacked. The first sign of Andres being an exceptional individual came before I even joined the unit. He went above and beyond in welcoming me to the ER. He reached out to me via an email in which he voiced his enthusiasm in aiding me to develop the skills I would need to become a successful ER nurse. Unbeknownst to him, this gesture alleviated much of the stress and anxiety that I previously had. For the first time
since accepting my job offer, my anxiety did not outweigh my excitement to begin this new role. I knew that I would be okay. The last few months of working with Andres has really cemented my first impression of him. I have watched myself learn and flourish under his guidance. Andres has an absolute wealth of knowledge from his many years working in the ER, his active participation in projects, and from taking on leadership roles around the unit. I can persistently go to him with questions knowing he will always be willing to answer and will often use his own time to do research regarding my queries to really help me understand concepts. Furthermore, he is always ready to share his personal notes gained
from his professional experience to ensure that I feel comfortable with the new and existing cases that I will encounter during my years of practice. Apart from being a wonderful leader, he is just as wonderful a team player. At times he will even skip his breaks just to help his colleagues with their tasks to ensure that they are not falling behind, although he will always ensure that I had mine. Even with the pace of the day, he is never lacking in patience. No matter how horrible his day is, he is always generous with his smiles and his prevailing optimism. When it gets too busy or chaotic in the ER, or when things are just not going the way that they should, his positive attitude helps get everyone through the day. I am most grateful for his habit of endwww.hospitalnews.com
NATIONAL NURSING WEEK 2019 ing our days with a “good job” no matter how tumultuous our shift was, how many questions I had, or how many tasks I needed his help with, he would always find something to ensure I never felt discouraged at the end of day. I go home every shift ready to take on the next one knowing I have the help of such a wonderful preceptor to guide me, this support and encouragement mean the world to me. His confidence in my abilities, even when I personally did not have any, allowed me to feel comfortable in the ER and I learned to trust in my own capabilities; beginning to see that I knew more than I gave myself credit for. Andres was also always looking for learning opportunities for me. He would consistently allow me to take part in emergency situations. He understood that I was not yet comfortable with participating in critical cases, so he was always there to explain to me everything that was occurring in a situation. In order for me to gain experience and confidence with handling precarious patient conditions, he would assign small tasks to me to allow me to gradually become more
accustomed to the responsibilities and duties as a member of the team and not just a bystander. No matter the severity of the situation, Andres would always be calm and collected and his demeanour continues to be a grounding force which allows myself and the staff in the room to think clearly, accurately and act quickly. I clearly remember a shift when I was having trouble with administering an emergency medication and began to panic, Andres proceeded to walk me through how to administer it correctly. He never got frustrated with my shortcomings and never took over the job but rather spent the time to teach me how to perform the task allowing me to become more competent and gain confidence in my abilities even amidst the stress of the situation. Andres’ positivity and caring nature does not only impact the staff, but also resonates deeply with his patients. Furthermore, he goes above and beyond to ensure that all of our patients are
comfortable. He would advocate for pain medication and the acceleration of diagnostic tests if he thought that it was required. In one instance, he even went to multiple units seeking baby powder to fulfill a patient’s request to allow her to be more comfortable. Whether they were grand errands or little tasks, Andres always took time to address patients’ concerns and strived to make them feel as comfortable as possible. I truly believe that some people are destined to become nurses and positively influence others’ lives, and Andres is one of those people. He shines in so many ways and deserves every bit of recognition and more. Andres does not go above and beyond for praise or for the sake of acclamation, he does it out of the kindness of his heart and his desire to advocate for those who don’t have the ability to do it. His boundless amount of patience, extensive body of knowledge, con-
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tinual support of fellow colleagues, and frequent advocation for patients, has made him one of the most extraordinary people that I have had the chance to work with. It has been my privilege and honor to have him as a preceptor and I will be forever grateful for his time, support, and encouragement throughout the challenging beginning of my ER career. His unyielding belief in me has gotten me through some of the most trying times when I thought that I was not good enough to become an emergency nurse. I have realized that no words can ever describe my appreciation towards Andres, but like American researcher Steve Maraboli once said, “[he] changed my life without even trying, and I don’t think I could ever tell [him] how much [he] means to me. I can’t imagine what things would be like if I hadn’t met [him]”. Over the short months that I have known Andres, he has become so much more than just my mentor. He is my friend, my colleague, my counsellor, my teacher, but most of all, my hero. H Nominated by Christine Lai ■
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NATIONAL NURSING WEEK 2019
Juliet Hutchinson Sunnybrook Health Sciences Centre ear award selection committee, It is my pleasure to write this letter nominating Juliet Hutchinson for the 2019 Nursing Hero Award. I am writing on behalf of myself and many of the staff here on D3 E&G and P&L Odette Family Cardiac Inpatient Unit at Sunnybrook Health Sciences Centre. I have had the pleasure of working with Juliet since the beginning of January 2019 when I joined the D3 team as a new cardiac surgery nurse practitioner. Although I have spent a very short time in her company, I could tell from the very start that her hard work deserved recognition. Juliet takes pride in her role and executes it seamlessly. More often than not she carries out additional nursing tasks and stays over time to support the unit, all with a smile on her face. It seems as though for Juliet that her day is done not when the clock indicates “quitting time”, rather, her day is complete when she feels personally fulfilled and satisfied with the work she has put in. I believe it is important to highlight the impact that she has had on the team. As such, I have included short excerpts of what some of her colleagues have to say about her. “I have known Juliet for over 10 years as the D3 charge nurse. I remember interviewing Juliet for a 1 year temporary charge nurse position – back then I felt that Juliet had something special and would make a difference. It has now been over 10 years and she has definitely made a huge impact as well as a great footprint. Juliet is definitely D3’s Nursing Hero! Juliet continues to give so much of herself and can often be seen working after her hours alongside her colleagues to en-
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48 HOSPITAL NEWS MAY 2019
sure that the remainder of their day shift is manageable. She arrives daily at 07:00 for a 07:30 start and consistently leaves around 18:00 rather than her scheduled time of 15:00. She consistently comes to work with sense of duty and compassion. She is the epitome of a true leader. A charge nurse’s role is an important part of the patient care experience. Her strong work ethic, persistence and intellectual integrity make her an excellent charge nurse. Juliet demonstrates exceptional knowledge and skills within our unit – she is the go-to-person. Juliet is an excellent communicator. She is enthusiastic, energetic, competent and well-organized. I particularly appreciate her expertise in providing exceptional person-centered care. I have truly enjoyed working with Juliet. She is a true champion for person-centered care when it matters most.” Garshia Ferdinand- Flament, PCM “It is hard to put into words what Juliet means to the unit. Juliet’s role is as a charge nurse on D3 who oversees the unit operations. But she is much more than just her role. She is the go-to person for clarifications, problem-solving, support, and a good laugh. She goes above and beyond the expectations/ role of charge nurse. She often stays beyond her regular hours to support the staff, resolve issues, and help out when staff are overwhelmed. She will never leave a problem unsolved and will go out of her way to make sure everything is smooth for patients, patient family and staff. She works tireless-
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ly and you will see her always running around helping everyone any way she can. She is truly our nursing hero.” Todd Wang, RN & Luwam Thomas, RN I am in a temporary role on D3, having joined the team in Sept 2018. The first person I met on the unit was Juliet. She welcomed me warmly and considered me a member of the team from the onset. She has exceptional skills that allow her to manage a high paced environment with competing demands. She is knowledgeable, organized and keeps the flow of the unit running smoothly. Juliet gives so much of herself to provide comfort to patients. Her caring nature has touched so many lives. She has witnessed so much pain, anger and heartache from the patients and families she works
with, and continues to make space to support staff. Juliet deserves to be honored not only today but always. Rinat Mayer, MSW The knowledge, approachability and confidence that Juliet exhibits in her practice makes her an exemplary mentor not just for the nursing staff on D3, but also for myself as a practitioner. It is evident that Juliet takes pride in being a nursing leader. I am convinced that Juliet’s work ethic and leadership qualities are exemplar and deserves to be recognized as such. I strongly believe that Juliet Hutchinson should be awarded the 2019 Nursing Hero award. I would like to thank you for considering Juliet as a recipient for this award. Stephanie Fernandes, MN-NP (PHCGH), BScN, HBSc, Nurse Practitioner, Division of Cardiac Surgery, Schulich H Heart Centre. ■ www.hospitalnews.com
Humber River Hospital celebrates National Nursing Week May 6-12
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Patient Care Reinvented.
LONG-TERM CARE NEWS
The Speak Up Challenge By Mary Ann Murray and Chad Hammond dvance Care Planning is a process of thinking about and sharing wishes for future health and personal care. It allows a person to tell others what would be important if they were unable to communicate due to illness or an unexpected crisis. The need to develop and share Advance Care Plans is becoming more urgent. By 2026 the number of Canadians dying each year will increase by 40 per cent (330,000 per year). By 2036, Canada will see more than 425,000 deaths a year (Statistics Canada, 2010). Current research indicates that advance care planning benefits patients and families while reducing costs and conflict during end-of life-care. Recognizing the important impact of advance care planning, critical care specialists in the Choosing Wisely Canada project recommend not starting or con-
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tinuing life supporting interventions that are inconsistent with the patient’s values and realistic goals of care. In the March edition of Hospital News, Hebert and Heckman (2019) challenged us to overcome inertia and fear. In a profound call to action they dared us to engage in advance care planning, share our wishes and values with each other, and respect preferences communicated in Advance Care Plans. A recent national poll confirmed that while more than 90 per cent of Canadians consider it important to talk about advance care planning fewer than 20 per cent have completed an Advance Care Plan (CHPCA, 2019). The same poll indicates that having tools and resources to support advance care planning would make it easier to make a plan. The Canadian Hospice Palliative Care Association (CHPCA), in col-
AS CLINICIANS, WE DO OUR PATIENTS AND LTC RESIDENTS A DISSERVICE BY NOT HAVING AN UPSTREAM APPROACH TO ENGAGING IN ADVANCE CARE PLANNING CONVERSATIONS. laboration with partners from across Canada, has developed a suite of tools to help patients, families and health care providers to have conversations about wishes and values. CHPCA’s ‘Speak Up’ initiative has workbooks, conversation starters and tips for developing a solid Advance Care Plan. These tools and resources are freely available for download and printing on Speak Up’s website (www.advancecareplanning.ca) or for hard-copy purchase on the CHPCA Marketplace (market-marche.chpca.net/advance-care-planning).
The Canadian Frailty Network has identified elders living in long term care (LTC) as one of the most frail and marginalized populations in our society. Chart audits from four LTC sites revealed that of the 26 per cent of residents who had died in the past year, 65.3 per cent had visited Emergency Departments (ED) during the last year of life; 45.8 per cent had ED visits in the last month of life; with 27.1 per cent of those visits occurring in their last week of life. Following the rollout of a multi-center intervention (Strengthening a Palliative Approach
Personalized home care services At Bayshore Home Health we understand that leaving home can be a challenge and that staying at home is the best ŽƉƟŽŶ ĨŽƌ Ă ůŽƚ ŽĨ ŽůĚĞƌ ĂĚƵůƚƐ͘ Ɛ LJŽƵƌ neighbourhood care provider, we are ŚĞƌĞ ƚŽ ƐƵƉƉŽƌƚ LJŽƵ ĂŶĚ LJŽƵƌ ĨĂŵŝůLJ ƚŚƌŽƵŐŚ ĞǀĞƌLJ ƐƚĞƉ ŽĨ ƚŚĞ ĐĂƌĞ ƉƌŽĐĞƐƐ͘ FREE IN-HOME CONSULTATIONS NO LONG TERM CONTRACTS BONDED & INSURED CAREGIVERS
Support is just a phone call away. 1.877.289.3997 50 HOSPITAL NEWS MAY 2019
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LONG-TERM CARE NEWS in Long-Term Care (SPA-LTC)), there was a decrease in transfers to hospital at the end-of-life and an increase in satisfaction with care. Building on this success, the Canadian Hospice Palliative Care Association is now embarking on a multi-year project that includes strengthening capacity, processes and skills related to Advance Care Planning in LTC. As health care providers, we so often see families in distress and chaos as they struggle to make tough decisions about treatment interventions during a time of uncertainty and emotional upset. As clinicians, we do our patients and LTC residents a disservice by not having an upstream approach to engaging in advance care planning conversations. As leaders, we do a disservice by failing to develop processes to enable those discussions and to create ways to embed patients’ personal Advance Care Plans into patient health records that can be accessed across care settings and sectors. The
downstream outcomes of this gap are increases in: suffering for patients; complicated grieving; and resource utilization of interventions that patients do not want (Lum, Sudore & Bekelman, 2015). In contrast, a recent meta-analysis of 80 systematic reviews identified several benefits when Ad-
vance Care Plans were in place, such as: 1) improved end-of-life communication; 2) documentation of care preferences; 3) dying in preferred place; and; 4) health care savings (Jimenez et al, 2018). Let’s heed Hebert and Heckman’s call to action. Commit to talking
with your patients and LTC residents about advance care planning, champion interventions to embed advance care planning processes into the mainstream delivery of care and, most of all, speak to your loved ones about your wishes, values and H preferences. ■
Dr. Mary Ann Murray, RN PhD CHPCN(C) is the Program Director for Advanced Care Planning in Canada with the Canadian Hospice Palliative Care Association and Dr. Chad Hammond, PhD is the Program Manager for Advanced Care Planning in Canada with the Canadian Hospice Palliative Care Association.
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MAY 2019 HOSPITAL NEWS 51
LONG-TERM CARE NEWS
Photographic memories:
Using technology to connect to patients with dementia By Monica Fleck or many people, a loved one’s dementia diagnosis not only means a loss of shared memories, but also a decline in the experience of personal, meaningful conversation. At its most fundamental level, conversation brings people together and helps establish and develop relationships. A research study conducted by Western University and McCormick Dementia Research looked at how to preserve those relationships by connecting in a shared experience, and more specifically, enhancing the quality of conversation by accessing and sharing family photos using iPad technology. “We were looking at ways we could bring that meaningful conversation back into the picture,” says Kelsey Dynes, researcher and graduate of
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Western’s Health and Rehabilitation Sciences Program. “We wanted something that gave us more of a person-centred approach,” she adds. “People living with dementia and their caregivers, family, friends and health care professionals have struggled mightily to maintain personal connectedness despite the language and communication problems inherent in a dementia diagnosis,” says Dr. Joseph Orange, Professor at Western’s School of Communication Sciences and Disorders. To achieve this connectedness, iPad technology was selected as the study tool for its innovation and ease of use. Participating family members were asked to collect 40 photos of their loved one to look at together. The photos were scanned to an iPad, which includes a software program to
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52 HOSPITAL NEWS MAY 2019
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Using tablet technology to share old family photos with someone who has dementia is a simple and effective way to enhance conversation and to help preserve communication skills. add a grammatically simple sentence beneath each picture. “The goal of person-centred communication includes recognizing and validating one’s individuality. We wanted to identify the individual in a unique way and use those personal references in the context of conversation,” says Dynes. The use of personal photos offered many beneficial outcomes. “We saw more positive conversations emerge and an increase in the frequency of utterances, which commonly decrease in people with dementia. Not only did they give more specific comments that were less vague and more detailed, their recall ability was enhanced,” she says. “All of the participants in the study rated the iPad system as easy-to-use and helpful in maintaining close and more intimate communication and connections on a personal level,” says Orange. In addition, family members found that the experience of sharing the photos was beneficial for them as well. “They really appreciated taking the time to sit down with their loved one,” says Dynes. “They enjoyed how meaningful the experience was.”
“The findings from this study will assist the tremendously rapid advances in communication software and hardware applications for persons living with dementia. Maintaining person-centred communication is key to their optimal social inclusion, physical and mental health status, and overall health-related quality of life,” says Orange. According to Steven Crawford, CEO of McCormick Care Group, the study resonates with the basic need to enhance and maintain human connectedness. “We recognize that it’s important to find ways for people with dementia to exercise their basic communication skills and capacities in order to prolong their use. We were pleased to be involved in a study of something so fundamentally important to a person’s sense of self.” The main takeaway, according to Dynes, is that whether or not you use an iPad to do so, just the experience of sharing old photos with someone who has dementia is a good way to stimulate conversation, prolong verbal abilities, exercise memory recall and enjoy H enhanced togetherness. ■
Monica Fleck is the Communication Director at McCormick Care Group. www.hospitalnews.com
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INNOVATIONS IN AGING AND BRAIN HEALTH
Workshop for nursing students tackles ‘reality shock’ in dementia care By Rebecca Ihilchik en Hartung is no stranger to dementia care. With a mother who’s a nurse and grandparents who lived with dementia, he was inspired by his own life experience to become a geriatric nurse. As he transitioned from nursing school to the professional world, Hartung noticed many of his peers going through a difficult adjustment period. “You learn a lot of textbook knowledge in school,” says Hartung, now an advanced practice nurse at Baycrest. “But as a new nurse, you’re faced with another reality of a patient with dementia who could be pacing the halls, yelling, looking for their loved ones. Handling that can be emotionally burdensome.” What Hartung was picking up on is a phenomenon called ‘reality shock’. The term was coined by theorist Marlene Kramer in 1974 to describe the reaction of new graduate nurses who discover the theoretical work situation they prepared for in school doesn’t match up with the realities of the practical field. Psychologically adapting to the reality of dementia care can be so difficult for new nurses that they choose to leave geriatrics, or even nursing altogether. This increased turnover can result in worse continuity of care for patients and more money spent by institutions and the healthcare system at large.
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Ben Hartung is an advanced practice nurses at Baycrest who has developed a new dementia communication workshop for nursing students. at Baycrest. I’ve been really fortunate The workshop ran in September powered by Baycrest, Hartung’s workto work with CABHI, which helped 2018 at Baycrest, where Hartung shop aims to introduce students to make my project possible.” presented to 43 first-year nursing stuthe realities of dementia care as earOn top of the funding, CABHI dents. He collected survey evaluations ly as possible in their education. The supported the project by partnering from the students before, directly folworkshop covers common behaviours Hartung with Baycrest’s Kunin-Lunlowing, and nine weeks after the workof dementia patients, frameworks of enfeld Centre for Applied Research shop. The results are being used to responding to those behaviours, and and Evaluation (KL-CARE), which measure the workshop’s efficacy. simulated case scenarios to implement is assisting with analysis and reporting Hartung’s project was funded new knowledge – taking theory and results. through CABHI’s Spark Program, “CABHI’s added a tremendous which supports the development and THE WORKSHOP AIMS TO INTRODUCE amount of value,” Hartung says. testing of promising early-stage innoSTUDENTS TO THE REALITIES OF DEMENTIA “They’ve been really supportive.” vations in seniors’ care by point of care CARE AS EARLY AS POSSIBLE IN THEIR In the future Hartung would like to staff. He worked on the CABHI appliEDUCATION. make the workshop accessible not only cation with his supervisor, Baycrest’s to more students and staff at Baycrest, Professional Practice Chief of Nursing but to students across the province Calen Freeman. or even the country, as an e-learning “Point of care staff are some of the connecting it to practice in a more coHartung is on a mission to help module. best innovators. We are involved hesive way. make that transition for new nurses “The more we can do to advance with patient care throughout the “This way, students can have a cousmoother. That’s why he developed a care for dementia patients, the better,” spectrum,” Hartung says. “At times ple of tools and techniques in their new dementia communication worksays Hartung. “And that all goes back it seems daunting and difficult to oppocket instead of experiencing a whirlshop for nursing students. to the nurses.” erationalize any of our great ideas, wind of not knowing what to do,” HarFunded by the Centre for Aging + H Learn more at www.cabhi.com. ■ but a good idea can go very far here tung says. Brain Health Innovation (CABHI), Rebecca Ihilchik is the Marketing & Communications Specialist at the Centre for Aging + Brain Health Innovation (CABHI). 54 HOSPITAL NEWS MAY 2019
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LONG-TERM CARE NEWS
Best practices for nutrition, food service and dining in long-term care homes By Dale Mayerson and Karen Thompson egistered Dietitians and Nutrition Managers responsible for food and nutrition services in longterm care (LTC) homes are faced with numerous challenges. Ultimately, their goal is to determine and implement practices and procedures that make the food and nutrition team achieve a high level of performance. While Ontario’s LTC homes comply with comprehensive legislation, opportunities still exist to optimize care and services. A best practices document helps to offer supportive guidance on many topics.
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PEER-REVIEWED AND RESEARCH BASED GUIDELINES A newly revised document entitled ‘Best Practices for Nutrition, Food Service and Dining in Long Term
56 HOSPITAL NEWS MAY 2019
Care Homes’ is available to provide staff, managers, dietitians and administrators with peer-reviewed dietary/ nutrition guidelines to assist them to develop a clear vision for their food service department. This document was first launched by Dietitians of Canada in 2007 and was revised in 2013. Most recently, the Dietitians of Canada’s Ontario LTC Action Group conducted a review of international research and practices and has developed an expanded document that addresses new and emerging issues. The 2019 revision has just been released by the Dietitians of Canada. This document, in its revised format, can be found at: www.dietitians.ca. This Best Practices document is intended to assist food service professionals and other staff to support resident care. The document is organized
to include the following topics: • Organization and Administration • Menus • Standardized Food Production • Nutrition and Hydration Care • Meal Service and Pleasurable Dining • Continuous Quality Improvement
ORGANIZATION/ ADMINISTRATION Best Practices ensure that the nutrition, food service and dining program is organized and administered to effectively and safely provide resident-focused nutrition care and services. The program is designed to reflect the mission and philosophy of the LTC home, meet current residents’ needs and expectations that are in keeping with professional practice, standards of care, applicable governing acts, regulations and directives.
MENU PLANNING The Best Practices document covers information on menu cycles, meal day patterns, portion sizes for foods and fluids, variety and choice, as well as the use of fresh, seasonal and local foods. Specific input from resident surveys, opinion polls and involvement from Residents’ Councils, Family Councils and staff are all needed for a menu to be customized for individual homes. New topics include individualized versus standard menus and diet liberalization. The recently introduced International Dysphagia Diet Standardisation Initiative (IDDSI) is also part of the discussion on texture modified food and fluids. Tools associated with menu planning include portion charts, order guides and more.
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LONG-TERM CARE NEWS
STANDARDIZED FOOD PRODUCTION Food Production is a detailed and complex activity. A well-managed food production operation paves the way for consistent nutrition and hydration care including an organized and accurate meal service and pleasurable dining. The Best Practices document includes information on standardized production practices including purchasing/receiving and storing guidelines, forecasting, production planning and recipes. Food safety discussions include internationally recognized Hazard Analysis Critical Control Points (HACCP), principles of time and temperature management, and sanitation.
NUTRITION AND HYDRATION CARE Nutrition and Hydration Care involves the interdisciplinary team and includes all members of the Food and Nutrition Department. Ongoing nu-
trition assessment, monitoring and care planning are essential to the role of the Registered Dietitians and Nutrition Managers in the LTC setting so that individualized nutrition care can be provided for optimal benefit of each resident. The Best Practices document addresses these topics along with: consent to treatment, liberalized diets, unplanned weight change, hydration, skin and wound care, dysphagia, diabetes, constipation, nutrition supplements and a food first approach, dementia/responsive behaviours, enteral feeding, and end of life care.
MEAL SERVICE AND PLEASURABLE DINING Meal Service and Pleasurable Dining are enhanced when there is a relaxed, supportive environment and the meal service is organized and monitored by the registered staff in the dining room. The integration of proper seating, socializing, positioning, and use of assistive devices are essential to
achieve the best outcomes possible in the dining room. Best Practices covers dining tools and quality dining practices such as serving one table at a time, offering choices with “show plates,” serving meals by table and resident, and confirming that residents are receiving the correct food items. Care plans provide information around the specifics of diet; they communicate to all staff regarding proper seating arrangements, positioning and use of assistive devices and strategies to ensure optimal nutrition care. Providing an organized and accurate meal and dining service is critical, but equally important to residents is the social aspect of meal service. This is supported by attention to resident placement within the dining room and the demeanor of staff providing the service.
CONTINUOUS QUALITY IMPROVEMENT The Best Practices document emphasizes the need for a strong continu-
ous quality improvement program that addresses quality improvement, risk management and utilization review. Ongoing staff training is critical to an effective education program.
CONCLUSION Best Practices help to clearly guide and support nutrition and food service practice and assist everyone involved in developing that clear vision that will move the food service departments closer to achieving full potential. A supportive environment that takes advantage of these best practices will help to meet the high standards needed for seniors in Ontario. LTC homes need to ensure that the information is shared with members of the interdisciplinary team so everyone learns from one another and practical applications can be determined in each work setting. With this approach we can work towards offering the best possible care to the residents in LTC H across the province. ■
Dale Mayerson, BSc, RD, CDE, and Karen Thompson, BA Sc, RD are Registered Dietitians with extensive experience in Long-term care. They are co-authors of “Menu Planning in Long Term Care and Retirement Homes: A Comprehensive Guide” and have participated for many years on the Ontario Long Term Care Action Group, an advocacy group of Dietitians in Canada.
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DOCTORS WITHOUT BORDERS
Doctors Without Borders:
Upstream in the Congo By Dr. Thomas Piggott he bridge has broken” a colleague said to me over the loud Congolese music playing at a Saturday evening party. “What do you mean the bridge has broken, which bridge broke?” I asked. “The bridge, the big one, it collapsed.” My mouth hung open in shock. This was not good news at all. I was deep in the jungle in the Democratic Republic of the Congo, Africa’s largest country by land mass and with a population triple the size of Canada’s. I was on my first assignment with Doctors Without Borders, working in a project in a violence ridden region with poor access to healthcare and horrific burdens of malaria and other preventable diseases. We were working alongside Congolese colleagues to build capacity for primary care and the local health system. The biggest challenge here in the Congo, beyond the armed groups that rule the region, is access. To get to the project, I had to take three flights from my home in Canada, then drive five hours over winding roads to enter the country from neighbouring Ruanda. From there to our remote project it was two more days of travel, first by car and then, when the road conditions were too poor, by motorbike. The 120 kilometre trip, a distance that would have taken just over an hour on the highways back home, took 13 hours. Access was even more difficult for the local population who did the same journey by foot. There was insecurity on this road as well, which meant that the population we were serving in our project was very isolated. Access is so difficult that vaccines and essential medicines had rarely made their way there until Doctors Without Borders had arrived to try to ensure a more reliable supply.
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Dr. Piggott at the site of the broken bridge. The news I’d just received was devastating as it would make our access to a number of community health centres we were serving impossible. My mind drifted back to the bridge. It had been built 50 years earlier by the Belgians, one of the few positive things their otherwise devastating colonial rule had left behind. But now it too was gone. The bridge traversed a river filled with white water rapids that we wouldn’t otherwise be able to cross.
I remembered standing on the bridge when I first arrived, looking out upstream. In my field of public health, we often use the metaphor of working ‘upstream’. The story goes that there are people on a river’s edge who see a child coming down the river, struggling, drowning. They jump in and pull the child out, saving her. Only to find another child coming down again, struggling, drowning. They jump in again, and this repeats over and over again.
Until one person finally starts asking: Why are these children drowning in the river, why are they falling in and why can’t they swim? And so that person travels upstream to find the causes, to try to prevent them. In healthcare, we often find ourselves pulling children out of the river over and over again, unable to act upstream and prevent the causes of the diseases we see on repeat. That upstream work is the realm of public health, my specialty in medicine and my passion. Here with Doctors Without Borders we were doing a lot of downstream work, treating infections like malaria that should have been prevented, treating injuries from violence that never should have happened. But it wasn’t all downstream. We were doing health education, worked on preventing diseases by distributing vaccines. This was the work that gave me the energy to continue when I felt down from ‘pulling children out of the river’ over and over again. But now all this work would be impossible. With the bridge collapsed we wouldn’t be able to reach the population. Humanitarian work, particularly in the most difficult regions of the world where Doctors Without Borders works, is like that. You have to adapt to changes and do the best you can. But a few weeks later we were back visiting patients in remote communities, this time crossing the river over a suspension bridge built from bamboo and vine. As I made my first crossing of the rickety bridge, the terrifying experience looking down at the white water some ten metres below me made my gripping knuckles turn white and my breath hasten. I continued, but then, part way across, I looked out to my right, upstream, and I remembered why we were here and my breathing H calmed. ■
Dr. Thomas Piggott is a Family Doctor in Hamilton, ON and finishing his specialty training in Public Health and Preventive Medicine. 58 HOSPITAL NEWS MAY 2019
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FROM THE CEO’S DESK
Leading change through authentic engagement By Dr. Suzanne Johnston eally, a patient should be writing this column, and not me. As our new Niagara Health Engagement Network (NHEN) evolves, the next column you will likely read about patient and family engagement at our hospital organization will be written by one or more of our Patient Partners. We have done a tremendous amount of work at Niagara Health to make our engagement network as authentic as possible for our patients and families and for our staff and physicians. We set out to create a network that would provide patients and family members with opportunities to share their time, experiences and perspectives in ways that would help us make meaningful improvements in quality, safety and the care experience. I am proud to say that we are doing just that. Although it is still early days in the life of this important partnership, the feedback we are receiving from our Patient Partners is overwhelmingly positive. Some of them have not had positive experiences with Niagara Health, and they are using these experiences in productive ways to help improve care for others. We are hugely indebted to all of our Patient Partners for their passion and willingness to contribute to a healthier Niagara. They are telling us that they are excited about the opportunity to partner alongside Niagara Health staff and witness firsthand changes that arise from their involvement. We are also grateful for the enthusiastic response of our leaders, who have warmly welcomed our Patient Partners to the Niagara Health team.
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WE BELIEVE THAT PEOPLE WHO ARE IMPACTED BY A DECISION HAVE A RIGHT TO BE INVOLVED IN THE DECISION-MAKING PROCESS. Being a learning organization, learning is embedded in our organizational culture. Our network takes that learning to a new level by embedding the voice of patients and families into all that we do – just as it should be. We believe that people who are impacted by a decision have a right to be involved in the decision-making process. Founding members of the NHEN are helping to co-create the model for the new network. There are a few unique features about this network that I would like to share with you. Most significant is the rostered approach we are using to continuously seek a variety of perspectives from Patient Partners whose interests and experiences align with the initiatives at hand. I envision having 100 or more Patient Partners on the roster at any given time. The more patients, loved ones and community members participating, the better. We look forward to welcoming people from various backgrounds and experiences to diversify the network and accurately represent the needs of the community we serve. As we begin this work, Patient Partners are being invited to come alongside Niagara Health staff on committees, working groups, special projects, and other types of initiatives. Patient Partners have the opportunity to choose when, how, what and where they want to donate their time. They can participate in as many or as few
opportunities as they would like depending on their interests, the amount of time they can dedicate and what is required for the project. We are finding that some have an interest in specific areas, like improving patient experience in the Emergency Department, while others are interested in reviewing policies and procedures through the lens of a patient. Depending on the project, Patient Partners can participate in person, online or virtually using technology. Regular communication will keep all of our Patient Partners connected, and we will share partnership opportunities in advance to give them the time to reflect on their potential participation in the initiatives. We will help match them with initiatives that fit within their timelines, schedules and interest. A fulsome onboarding strategy will set up our Patient Partners for success. Dedicated Patient Partnership staff guide our partners through the process and connect them with the Niagara Health staff lead of the initiative in which they will be participating. Members of our team also receive training on how to effectively partner with members of the community. We
have prepared a resource guide to assist our staff with choosing the appropriate level of engagement (consistent with the IAP2’s Public Participation Spectrum) to ensure they engage early on in a process initiative and bring full value to the partnership. We are excited about the opportunities to genuinely partner with our patients and families in meaningful ways that create lasting impacts on future patients and families. It is fast becoming our way of doing things here at Niagara Health. The user sometimes has the answer that the provider doesn’t always see. We are listening, and look forward to hearing more about the endless possibilities that authentic engagement will reveal as we continue on our journey H to a healthier Niagara. ■
Dr. Suzanne Johnston is President of Niagara Health, a regional healthcare provider with multiple sites and a growing network of services in community settings. As a communitybased academic centre, teaching and learning, research, innovation and partnership are propelling us as we imagine a healthier Niagara. www.hospitalnews.com
MAY 2019 HOSPITAL NEWS 59
NURSING PULSE
A professional association with purpose By Catherine Harley urses Specialized in Wound, Ostomy and Continence Canada (NSWOCC) launched it’s not for profit association and registered charity, thirty-eight years ago under the name Canadian Association for Enterostomal Therapy( CAET).With a name change in May 2018 to support a stronger understanding of the role of Nurses Specialized in Wound, Ostomy and Continence (NSWOC ), we continue to serve more than one million patients with complex wounds, over 70,000 ostomy patients and up to four million patients with continence issues. Despite a name change and subsequent growth, the purpose has remained as follows: • Deliver comprehensive quality care to all patients with nursing challenges in the areas of wound, ostomy, and or continence. • Define and evaluate and update core competencies for Nurses Specialized in Wound, Ostomy and Continence. • Advocate adherence to the NSWOCC code of ethical conduct for Nurses Specialized in Wound, Ostomy and Continence. • Review federal and provincial legislation and advise membership regarding that which would effect Nurses Specialized in Wound, Ostomy and Continence. • Promote continuing education for Nurses Specialized in Wound, Ostomy and Continence and educational programs for allied health professionals and students. • Define and promote the philosophy and practice of Nurses Specialized in Wound, Ostomy and Continence to the public and to professional, community, and government groups. • Actively recruit nurses who demonstrate an interest in working with patients facing challenges of wound, ostomy, and or continence. • Accredit educational programs for Nurses Specialized in Wound, Ostomy and Continence in conjunction with the World Council of Enterostomal Therapists (WCET).
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• Promote scientific research and publication. Nurses Specialized in Wound, Ostomy and Continence are the only registered nurses in Canada who are eligible for Canadian Nurses Association (C.N.A) Certification in Wound, Ostomy and Continence management with the credential of WOCC (C) . C.N.A Certification is recognized nationally for practice excellence and commitment to lifelong learning. It is valued by employers, because certification demonstrates specialized knowledge that brings many benefits to organizations, and it supports enhanced professional credibility- NSWOC must renew their certification every five years to ensure an ongoing evaluation process. The NSWOCC has been forming strategic partnerships to look at pan-Canadian issues like provincial ostomy reimbursement, reimbursement of off-loading devices, intermittent
catheterization policy, improving patient outcomes with pre-operative stoma marking and Indigenous wound, ostomy and continence health. A search engine on the NSWOCC website at nswoc.ca called “Find a NSWOC”, assists the Public or Allied Healthcare Professionals in finding a nurse specialized in wound, ostomy and continence in their area. National Standards of Practice for Nurses Specialized in Wound, Ostomy and Continence are reviewed and updated every five years in order to ensure the highest standard of care delivery. This pan-Canadian expertise has grown, but always while preserving our “provincial perspective.” . NSWOCC has also become a national voice presenting wound, ostomy and continence solutions across Canada. In 2016, the International Skin Tear Advisory Panel ( ISTAP) became an official interest group of NSWOCC bringing a global perspective to the
work of this unique association. NSWOCC provides business oversight to ISTAP and supports initiatives on skin tear management. This appetite for expertise and a unique perspective continues to grow as projects and communications explode in every region of the country. The re-development of a wholly owned and operated Wound, Ostomy and Continence Institute led by Dr. Kimberly LeBlanc, PhD, RN, BScN, MN, WOCC (C) has resulted in a higher number of Wound, Ostomy and Continence Education program (WOC-EP) students becoming educated in the tri-specialty of wound, ostomy and continence management. This in turn had allowed NSWOCC to meet the growing market demand for NSWOC as evidenced in an increase of job postings through our website and beyond. The NSWOCC Board of Directors led by President, Christine Murphy, Continued on page 61
Catherine Harley is the Executive Director for Nurses Specialized in Wound, Ostomy & Continence Canada (NSWOC). 60 HOSPITAL NEWS MAY 2019
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NEWS
Overdose dealths in Canada Continued from page7 These findings are concerning, and the Government of Canada continues to take action to address the opioid crisis by improving access to harm reduction services, raising awareness of the risks of opioids, and removing barriers to treatment such as addressing stigma. Ongoing collaborative efforts of the federal, provincial and territorial governments to collect and share data are crucial to informing policies and interventions to help those affected by the opioid crisis. Efforts must continue at all levels to address this crisis. A major priority must be eliminating the stigma and discrimination associated with substance use, which act as barriers to treatment. The adoption of equitable and compassionate policies, practices and language, will help ensure that more Canadians can get the help they need and want. The opioid crisis is a complex health and social issue and concerted efforts across the whole of society are required to address it. This includes all levels of government, stakeholders, partners and people with lived and living experience working on the vital areas of prevention, data collection, stigma, and access to harm reduction and treatment services in order to help save H lives. ■
Professional association Continued from page 60 PhD, RN, BSc (Hons) MClinSc-WH, WOCC (C) of Ottawa, Ontario and Vice President Nevart Hotakorzian, RN, BScN, NSWOC of Montreal, Quebec, is engaged and responsive to the needs of NSWOCC Members. NSWOCC has become an indispensable source for anyone interested in the tri-specialty of wound, ostomy and continence management. NSWOCC will continue to work hard to support the fundamental belief- that every person deserves specialized wound, ostomy and continence care. To “Find a NSWOC” or to obtain further information, please go to www.nswoc.ca or H email office@nswoc.ca. ■ www.hospitalnews.com
Continuous evolution of
SPONSORED CONTENT
medical isoopes By James Scongack
adioisotopes are critical to serve the broad needs of modern society for a variety of applications in the health, energy, and sterilization sectors. For more than 60 years, Canada has played an important role in researching, developing, and producing medical isotopes and radiopharmaceuticals for both domestic and international use. Isotopes are the foundation to advance research for improved drug discovery and development. They are also our pathway to personalized medicine - enabling health care professionals to improve lives through targeted imaging and therapy, thereby providing medical diagnosis and treatment specific to an individual. The field of medical isotopes is continuously evolving. Several new isotopes are gaining prominence in both diagnostic and therapeutic nuclear medicine, but are not currently produced in Canada. At the same time, Canada’s mainstay of isotope production, the National Research Universal (NRU) reactor, has recently reached the end of its lifespan, rendering access to some traditional medical isotopes precarious. Retaining a secure supply of isotopes and infrastructure in Canada will allow us to maintain a leading position in the development of new nuclear medicine technologies, benefitting both Canadians and the advancement of science. To maintain our leadership role, we need to continually invest in our isotope industry. Through Ontario’s nuclear assets and companies like Bruce Power, we can ensure a steady supply of the isotopes the world needs. Isotopes like Cobalt-60, a medical isotope used for sterilization of medical equipment in hospitals around the world. When it was announced the NRU reactor at Chalk River was to be retired in 2018,
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James Scongack Bruce Power quickly developed a process to produce medical-grade Cobalt-60 in order to prevent a shortage of this cancer-fighting isotope. By doing so it is ensuring a long-term, stable supply of medical isotopes, advancing human health and saving lives. Canada has been a world-leader in producing Cobalt-60, which is used in approximately 70 per cent of cancer therapies that use external radiation. Each year, Canadian exports of Cobalt-60 are used to provide affordable cancer care to 10 million patients. Medical-grade Cobalt-60 also powers the Gamma Knife, which is a non-invasive treatment for brain tumours. It focuses 200 beams of radiation on the site of the tumour, reducing impact to the healthy tissue that surrounds the site. The precision of Gamma Knife radiosurgery results in minimal damage to healthy tissues surrounding the target. In some cases, Gamma Knife radiosurgery may have a lower risk of side effects compared with other types of radiation therapy. Also, Gamma Knife radiosurgery is often a safer option than traditional brain surgery. Gamma Knife radiosurgery is usually a one-time therapy, completed in a single day.
Medical-grade Cobalt-60 cancer treatment has been used for more than 60 years to treat an estimated 35 million patients worldwide. About 70,000 patients undergo Gamma Knife surgery every year, and this unique procedure has an impressive scientific track record. In Canada there are six Gamma Knife machines, with three located in Ontario. Stereotactic Radiosurgery using Cobalt-60 therapy also allows doctors to deliver higher doses of radiation to tumours, while limiting damage to the surrounding healthy tissue and organs. For many brain cancers, Cobalt-60 therapy is one of the most precise and advanced forms of radiation treatment available. The unique design of the CANDU reactor, like those at the Bruce Power Nuclear Generating Facility in Tiverton, is perfectly able to produce these live-saving isotopes without ever interrupting electricity production. In March 2019, Bruce Power completed its first successful medical-grade Cobalt harvest during a planned maintenance outage, helping to ensure a steady supply of this critical isotope. To support this technology and its benefits, organizations like Bruce Power and the Brain Tumour Foundation of Canada have collaborated to form the Canadian Nuclear Isotope Council (CNIC). The CNIC is an independent organization consisting of representatives from various levels within the Canadian health sector, nuclear industry and research bodies, convened specifically to advocate for Canada’s role in the production of the world’s supply of radioisotopes. Leveraging Ontario’s nuclear advantage will have a significant positive impact on human health across the globe, keeping the world’s populations clean and safe, while expanding Canada’s leadership role in the global community. Learn more at H www.canadianisotopes.ca. ■
James Scongack is Chair, Canadian Nuclear Isotope Council. MAY 2019 HOSPITAL NEWS 61
NEWS
3-D virtual reality
helps neurosurgeon treat Parkinson’s
By Season Osborne bystander only sees neurosurgeon Dr. Adam Sachs wearing large goggles, looking at the air between the two wands he moves back and forth in front of him. What Dr. Sachs sees is a three-dimensional image of a patient’s brain, with its electrical activity superimposed. This isn’t a video game. It’s the cutting-edge of deep brain stimulation and neurosurgery technology. Wearing virtual reality goggles, Dr. Sachs can view an accurate, computer-generated 3-D image of a patient’s brain with Parkinson’s disease, created using the patient’s own MRIs. The patients’ brain activity recorded from microelectrodes can be visualized in this virtual world. With the two wands, or joysticks, he can move the three-dimensional brain around, seeing it from all angles. He can also remove layers of the brain to look inside at the exact spot where he will place a DBS electrode during deep brain stimulation (DBS) surgery. He is hoping to soon use this technology in the operating room. This medical 3-D virtual reality system was developed at The Ottawa Hospital, and is expected to be the first of its kind in the world to be used for deep brain stimulation surgery. Drs. Justin Sutherland and Daniel La Russa are clinical medical physicists in the hospital’s radiation oncology de-
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62 HOSPITAL NEWS MAY 2019
partment. The two used their imaging expertise to develop a virtual reality system that combines a patient’s MRIs and CT scans to create a 3-D image of a patient’s organ or body part to give surgeons a detailed, accurate representation of the surgical area. “What we are trying to do in our virtual reality lab is come up with new ways to leverage technology to help doctors and nurses, or any medical professional, do what they do better. And how better than with 3-D visualization,” says Dr. Sutherland who is also an assistant professor in the University of Ottawa’s Department of Radiology. “We think the technology has only reached that point now. We’re now at a place where we want to pursue the avenue of clinicians-as-users.” One Ottawa Hospital surgeon interested in using 3-D virtual reality was Dr. Sachs, who performs deep brain stimulation surgery for people with Parkinson’s. During this procedure, a microelectrode, no wider than a human hair, is implanted into a very specific area of the brain. The microelectrode then records activity from and stimulates that part of the brain and alleviates some of the patient’s symptoms, such as tremors and akinesia or the loss of ability to move their muscles voluntarily. The virtual reality system allows the electrical activity, stimulation effects and the MRI to be visualized together.
THE WORLD’S FIRST 3-D VIRTUAL REALITY SYSTEM FOR NEUROSURGERY, DEVELOPED AT THE OTTAWA HOSPITAL, WILL BE USED TO INCREASE THE ACCURACY OF DEEP BRAIN STIMULATION SURGERY FOR PATIENTS WITH PARKINSON’S. THE SYSTEM ALLOWS THE NEUROSURGEON TO BETTER PLACE ELECTRODES IN PATIENTS’ BRAINS. “In deep brain stimulation surgery, because the target is very small and in the middle of the brain this leaves the surgeon with the problem of how to visualize the person’s brain to understand the area and where to put the electrode,” says Dr. Sachs. Dr. Chadwick Boulay, a senior research associate in the neuroscience program, understands the challenges faced by neurosurgeons when implanting an electrode at the optimal position in the brain. When Dr. Boulay learned about the 3-D virtual reality technology being developed at The Ottawa Hospital, he realized the potential this had for increasing the accuracy of deep brain stimulation surgery. He and Dr.
Sachs worked with Drs. Sutherland and La Russa to develop a virtual reality program that would enable them to see the patient’s brain in three dimensions. “This is really exciting,” says Dr. Sachs. “The deep brain stimulation electrodes will be more precisely placed because we’ll be able to integrate accurate images from the patient’s anatomy and visualize it in three dimensions,” says Dr. Sachs. He anticipates that the resulting precision of the placement of the electrode will improve outcomes for patients with Parkinson’s disease, but this will be confirmed through research. About 15 people undergo deep www.hospitalnews.com
NEWS Neurosurgeon Dr. Adam Sachs uses virtual reality wands to manipulate a three dimensional image of the brain.
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brain stimulation surgery at The Ottawa Hospital every year. Dr. Sutherland foresees that this 3-D virtual reality technology will one day be in every department throughout the hospital. He says the overall system is surprisingly inexpensive. The possibilities for this technology are endless. “Nowhere else in the world are they using virtual reality in this fashion,” says Dr. Sachs.
The Ottawa Hospital is quickly being positioned as leaders in 3-D virtual reality technology and has already gained international attention. Drs. Sutherland and La Russa have given demonstrations and been invited to talk at large medical conferences, and other institutions have contacted them with interest in using this H technology. ■
Season Osborne is a freelance writer.
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MAY 2019 HOSPITAL NEWS 63
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Sandra Osbourne RPN Cummer Lodge, North York