HN February 2024 by Hospital News

Inside: Safe Medication | Special Focus: Wound Care | Nominate your Nursing Hero pg. 17

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“I feel that people don’t really understand how short-staffed we are.”

No relief in sight. A recent report on emergency departments by the Office of the Auditor General of Ontario confirms the truths nurses have been talking about. It’s a damning assessment of the Ford government: “We found that there was no comprehensive province-wide and centralized strategy to help hospitals maintain nurse staffing levels to avoid closures or to reduce the duration of the closure. Instead, the Ministry and Ontario Health generally relied on hospitals to manage these situations independently, typically by closing their emergency department or using more-expensive agency staff where possible. These closures create risks to patients’ health that increase in proportion to the time needed to travel to the next nearest emergency department.” Value-for-Money Audit: Emergency Departments, December 2023

Nurses talk truth.

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Contents February 2024 Edition

IN THIS ISSUE:

Inside Unity Health’s efforts to better understand the care experience

Inside: Safe Medication | Special Focus: Wound Care | Nominate your Nursing Hero pg. 17

February 2024 Edition

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New device for deep vein thrombosis Page 10 Part-time | Casual | Contract | Temporary Hospital Employees

Guaranteed Benefit Coverage. No Medical Questions Asked. 1-866-768-1477 | www.healthcareproviders.ca

s Cover story: New device helps to tackle challenging deep vein thrombosis cases

s Special Focus Wound care:

s Testing new technology to help older adults age at home

COLUMNS Guest editorial .................4

In brief ..............................6 Safe medication .............30

s Opening the conversation about palliative care

Study projects 187% increase in people living with dementia in Canada by 2050

s Tiny trailblazer: First baby treated in world-first trial for chronic lung disease

Wait times

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in EDs are nothing new – and that’s the problem By Anthony Dale

he respiratory virus season is upon us, and those working in the emergency departments of Ontario’s hospitals understand the many challenges of delivering timely access to care when demand is at its peak. As of November 2023, the average length of stay in emergency departments (for patients waiting to be admitted to hospitals) across the province was the highest it has been in the last 12 months. Unfortunately, this reflects a historic seasonal pattern of increased demand for care that is being exacerbated by inadequate capacity across the health care system, and rampant respiratory illnesses circulating across Ontario during the winter months. As of January 13, there were 1,274 COVID-19 patients, 445 flu patients and 158 RSV patients receiving care at Ontario hospitals. Wait times at emergency departments is a critical issue for both Ontario hospitals and patients requiring immediate care. This long-term, systemic problem is largely a consequence of staffing constraints, high numbers of patients in hospitals awaiting discharge to another, more appropriate setting or alternate level of care (ALC), and low acute care bed capacity in Ontario compared to other jurisdictions. While Ontario’s hospitals are working closely with the Government of Ontario in increasing the number of health care workers and professionals, they are also con-

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tinuing to provide care to increasing numbers of patients waiting in hospitals for other forms of care that are more appropriate and suitable to their needs. For example, as of late December, there were more than 4,200 ALC patients in acute care beds, with almost 40 per cent waiting for a long-term care bed. In this environment, it becomes very difficult for health care workers to admit patients in a timely manner – leading to longer-than-usual wait times and patients waiting in spaces that are not always conducive to optimal care. Growing wait times and high levels of hospital occupancy are also directly related to Ontario’s very rapidly changing population. A huge spike in population growth in recent years, and a growing population of elderly people with complex health needs is increasing demand for health services, alongside an increase in the acuity levels of patients presenting in emergency departments. In the next five years, Ontario will grow by 1.5 million under medium growth rates and by over 2 million under high growth rates, with seniors as the fastest growing age category. These challenges aren’t exclusive to Ontario. In fact, health systems all over the world are facing the same challenges. However, there is a growing recognition that the status quo is no longer tenable, and that technology and innovation can be leveraged to help prepare for the future health care needs of the province. Continued on page 6

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NEWS

Tiny

trailblazer: First baby treated in world-first trial for chronic lung disease

t two weeks old, Emerson Cogan was already a pioneer. Born February 20, 2023, at 23 weeks gestation and weighing 515 grams, Emmy was the first baby to receive cell therapy in a world-first Phase 1 clinical trial. The goal of this therapy is to prevent or lessen the effects of a chronic lung disease called bronchopulmonary dysplasia (BPD). Around 1,000 premature babies in Canada develop BPD every year, and there is no cure. “Treating our first patient in this trial was a dream come true,” said study lead Dr. Bernard Thébaud, a neonatologist and senior scientist at The Ottawa Hospital and CHEO and professor at the University of Ottawa. “Our team had been working toward this moment for 18 years, ever since we discovered that stem cells from the umbilical cord could protect and heal newborn lungs in the lab.”

JOINING THE STUDY: A CAREFUL DECISION

Emmy arrived much earlier than expected, and the first weeks of her life were challenging. She needed a ventilator and extra oxygen to help her breathe, which put her at risk of BPD. The research team told Emmy’s parents Alicia Racine and Mike Cogan that she was a good candidate for the trial. After consulting with trusted friends, family and healthcare providers, Alicia and Mike decided to enroll her. “Being a preemie, Emmy’s going to have some health issues. And anything that could help, we wanted to give her that extra shot,” said Mike. “The few days after she got the treatment she improved really well, www.hospitalnews.com

so that made us feel like we had made the right decision,” remembers Alicia. “We don’t know what she would be like without it. But she’s pretty awesome right now, and we don’t think it had any negative effects.”

TRIAL IS JUST THE BEGINNING

The goal of this Phase 1 trial is to determine whether the cell therapy is safe and feasible for premature babies, and to find the best dose for future trials. “As much as it was just the beginning stages of a trial and the dosage was fairly low, it was still a very positive step for her and for future babies in her position. We were all for it,” said Mike. After four months in the neonatal intensive care unit (NICU), Emmy finally got to go home on June 30, 2023. “Emmy does have BPD from being on a ventilator,” says Alicia. “The winter will be the true test of the BPD. We’ll see what kind of load that’s going to put on us, trying to keep her and ourselves healthy and not ending up back in the hospital.”

Emmy Cogan was the first baby treated in a world-first clinical trial of a cell therapy for bronchopulmonary dysplasia. “All of the babies in the trial are doing well so far,” said Dr. Thébaud. “We’re seeing promising signs that the cells are not only safe, but may also be improving their outcomes. But we won’t know that for sure until we can do a larger trial. This safety trial is a critical step towards a potential breakthrough therapy that could help premature babies in Canada and around the world.” This trial is funded by the Stem Cell Network with in-kind matching funds from MDTB Cells GmbH. Dr. Thébaud’s research is also possible because of funding from the Ontario Institute for Regenerative Medicine, the Canadian Institutes of Health Research, The Ottawa Hospital Foundation and the CHEO Foundation. His research is

also enabled by Core Resources at The Ottawa Hospital such as the Ottawa Methods Centre, the Biotherapeutics Manufacturing Centre, and the BLUEPRINT Translational Research H Group. n

“WE’RE SEEING PROMISING SIGNS”

“Treating our first patient in this trial was a dream come true,” said study lead Dr. Bernard Thébaud, a neonatologist and senior scientist at The Ottawa Hospital and CHEO and professor at the University of Ottawa. This trial has completed recruitment of nine very premature babies. They were recruited from NICUs at The Ottawa Hospital and Sunnybrook Health Sciences Centre. The Ottawa participants will have regular follow-up visits at CHEO as part of the trial. FEBRUARY 2024 HOSPITAL NEWS 5

Discovery unravels the mystery of a rare bone disease

esearchers pinpoint gene causing autosomal dominant spondyloepiphyseal dysplasia A McGill-led team of researchers have made an important discovery shedding light on the genetic basis of a rare skeletal disorder. The study, published in Nature Communications, reveals that a defect in a specific gene (heterozygous variants in the matrix Gla protein, or MGP) may cause a disorder that affects the structure of connective tissues that supports the body. MGP is a special protein found in blood vessels and cartilage that helps prevent the hardening of these tissues in the body. If MGP is completely missing, it can lead to Keutel syndrome, a rare condition where tissues become calcified, causing issues in the skeleton and blood vessels. However, in this case, the variance in the MPG gene observed by the researchers is different from Keutel syndrome in both how it shows up in people and what is happening at the cellular and molecular level. “Our paper reports four people from two different families who had a slight

change in their MGP gene. These changes made the protein a bit different, and these individuals showed a specific bone disorder,” explains Monzur Murshed, Full Professor in the Department of Medicine, Divisions of Endocrinology and Metabolism and Experimental Medicine and the Faculty of Dental Medicine and Oral Health Sciences, and lead author of the study. After testing these genetic changes on mice to better understand the situation at the cellular and molecular levels, the researchers found that the changed MGP caused similar bone issues in both mice and humans. Unlike the normal protein, the changed protein does not go out of the cells, which in turn leads to stress in a part of the cell called the endoplasmic reticulum. Cartilage cells making the changed protein cannot cope with the stress and eventually die, causing the bone abnormalities.

A STEP FURTHER IN UNDERSTANDING RARE DISEASES

This research not only expands the understanding of the genetic factors

Continued from page 4

Wait times

There has been significant growth in the hospital sector workforce these past several years and Ontario has dramatically improved its health workforce recruitment and retention measures. But given the expected exponential growth in patient care demand, it will not be possible to simply hire more health care workers to address the expected long-term capacity challenges. In the face of these anticipated capacity limitations and challenges, innovation and technology also have enormous potential to reimagine and redesign health-based services in Ontario to meet the future demands that will be placed on it. At this key juncture, there’s a real appetite and opportunity ahead of us to drive change and innovate to meet the needs of the people of Ontario into the future. While short-

term financial stability will be needed first and foremost by hospitals, we must also begin thinking about the delivery of care in new and innovative ways. Technology and innovation offer great potential for creating capacity and capability in the health system. Ontario is home to world-class researchers and experts in the application of innovations like artificial intelligence. The untapped potential of this research ecosystem should be prioritized and scaled and spread across the hospital system. While lengthy emergency department wait times have unfortunately become a historic component of health care delivery in Ontario’s winter months, they are a glaring reminder of the need for significant systematic change and the vital need to rethink the way that health care is delivered – now and for the H years to come. n

Anthony Dale is President and CEO, Ontario Hospital Association. 6 HOSPITAL NEWS FEBRUARY 2024

contributing to skeletal dysplasia, but also paves the way for potential therapeutic interventions. The findings highlight the importance of the MGP gene and its role in skeletal development, providing hope for improved diagnosis and treatment of individuals affected by this rare condition. “There are many rare diseases with similar skeletal problems. We are hopeful that if more people are familiar with our work, they may come forward to consult with the clinicians and researchers,” adds Prof. Murshed. “After the publication of our paper last

IN BRIEF

month, we have been contacted by a clinician who has examined another individual with skeletal dysplasia carrying the same mutation in the MGP gene. This may help further research and also improve the treatment and management of these diseases in the long run.”

ABOUT THE STUDY

“Specific heterozygous variants in MGP lead to endoplasmic reticulum stress and cause spondyloepiphyseal dysplasia” by Monzur Murshed, Ophélie Gourgas and al. was published in H Nature Communications. n

Organ donations after MAiD made up 14% of deceased donations in Quebec

rgan donation after medical assistance in dying (MAiD) represented 14 per cent of Quebec’s total deceased donations in 2022, according to a new study in CMAJ (Canadian Medical Association Journal). To understand the impact of organ donation after MAiD, Quebec researchers analyzed data on all patients referred to Transplant Québec for possible organ donation after MAiD from January 2018 to December 2022. This represented the first 5 full years when organ donation after MAiD was allowed in the province. Over the 5-year period, Transplant Québec received 245 referrals for donation after MAiD, with an increase in annual referrals from 21 in 2018 to 109 in 2022. The total number of donor patients after MAiD was 64, increasing from eight in 2018 to 24 in 2022. Donations after MAiD represented 14 per cent of all deceased organ donations in 2022, and the majority of the donors had neurodegenerative diseases, with amyotrophic lateral sclerosis the most common condition. The average age of donors after MAiD was 60 years, and 64 per cent were male. “Our analysis of data related to organ donation after MAiD in Quebec shows that organ donation organiza-

tions can establish systems that honour the wishes of patients pursuing MAiD to donate their organs after their death,” writes Dr. Matthew Weiss, a pediatric critical care physician at Centre Mère-Enfant Soleil du CHU de Québec, Quebec, and medical director at Transplant Québec, with coauthors. “However, much remains to be learned regarding how to optimize the system to ensure that donation requests are treated in the most ethical and medically effective way.” The authors note that it is not known how many patients were offered the choice to donate after MAiD or what the consent rate is in that group, as there is currently no system to track this information. “Patients considering MAiD are among the most vulnerable patients in the health care system, as they have intractable diseases that cause them immense suffering. The desire of some patients to help others after their death must be honoured, but in doing so, donation professionals must assure the system respects their autonomy and dignity,” the authors conclude. “Organ donation after medical assistance in dying: a descriptive study from 2018 to 2022 in Quebec” was H published January 29, 2024. n www.hospitalnews.com

IN BRIEF

Canadians give governments an ‘F’ in meeting their mental health and substance use health needs

ederal and provincial governments are getting a resounding ‘F’ from Canadians when it comes to providing mental health and substance use health care services, according to the second annual National Report Card survey from the Canadian Alliance on Mental Illness and Mental Health (CAMIMH). Finding and getting timely access to publicly funded mental health care services is important to 90 per cent of Canadians, while 83 per cent agree that provincial governments should hire more mental health care providers to improve access to care. Yet, across the four report card categories of (1) access, (2) confidence, (3) satisfaction, and (4) effectiveness of publicly funded mental health services, Canadians gave federal and provincial governments a collective grade of ‘F’, representing a decline over last year’s grade of ‘D’. Similarly, governments were given a collective grade of ‘D’ when it comes to substance use health services. “This report card tells us that all governments are not moving nearly fast enough nor making the necessary investments to improve timely access to mental health and substance use health services,” said Florence Budden, CAMIMH Co-Chair and a registered nurse. “Canadians are

MENTAL HEALTH SERVICES RECEIVE FAILING GRADES ACROSS CANADA CAMIMH 2nd Annual Report Card – Selected Findings Total Score BC AB SK MB ON QC NS NB NL Access

Public Confidence

Satisfaction

Effectiveness

Total Mental Health Score

SUBSTANCE USE HEALTH SERVICES RECEIVE POOR GRADES ACROSS CANADA CAMIMH 2nd Annual Report Card – Selected Findings Total Score BC AB

SK MB ON QC NS NB NL

Access

Public Confidence

Satisfaction

Effectiveness

Total Substance Use Health Score

even more dissatisfied that our governments are woefully out of touch when it comes to meeting their mental health and substance use health needs and clearly, much more needs to be done.”

NEED FOR ACCELERATED ACTION AND ACCOUNTABILITY

Compared to other developed countries like France and the United Kingdom, Canada has the lowest

Polycystic ovarian syndrome: New review to help diagnose and manage

new review in CMAJ (Canadian Medical Association Journal) is aimed at helping clinicians diagnose and manage polycystic ovarian syndrome (PCOS), an endocrine disorder that affects about 10 per cent of females. This disorder affects females of reproductive age and is associated with infertility, miscarriage and pregnancy complications. Its long-term health consequences include hypertension, cancer risks, and metabolic and psychological impacts. Patients usually present to health care between ages 18 www.hospitalnews.com

and 39 years complaining of menstrual cycle irregularities, acne and excessive hair growth, but diagnosis and treatment are often delayed. The authors of the review hope it will raise awareness of PCOS and help clinicians diagnose and manage the disorder. “Polycystic ovarian syndrome can be treated effectively, and early diagnosis can allow for close monitoring and preventive care,” said lead author Dr. Ebernella Shirin Dason, a reproductive endocrinology and infertility fellow at Sinai Health System, Toronto, Ontario.

Management of the condition may include support for weight loss, combined hormonal contraceptives and nonhormonal medication like metformin. Though people with PCOS are more likely to be overweight or obese, the authors caution that “clinicians should be particularly sensitive to weight stigma as patients with PCOS are at risk of dysmorphic body image and disordered eating.” “Diagnosis and management of polycystic ovarian syndrome” was pubH lished January 29, 2024. n

proportionate spending on mental health, leaving significant room to increase its public investments to improve and expand coverage for both mental health and substance use health care services. It also needs to introduce new federal legislation – a Mental Health and Substance Use Health Care Parity Act – that places the importance and value of mental health and substance use health services on an equal footing with physical health care. “Without additional sustained government funding and system innovation, a national legislative framework, enhanced public accountability and data measurement, Canadians will not see the critical changes they need to have timely access to mental health and substance use health care services,” said Ellen Cohen, CAMIMH Co-Chair. “Our governments need to do more and act faster – failure cannot be an option.”

SUBSTANCE USE HEALTH SERVICES ARE VITAL

This year’s survey also included specific questions on substance use health services across the same four categories and again found that Canadians gave the government a collective poor grade of ‘D’. Notably, three-quarters of respondents feel that it is important for governments to support the healthcare workforce with education on substance use health (72 per cent), as is access to timely substance use health services (74 per cent). “Historically, people with substance use health concerns have had no place to go except through a mental health door and then are often told they are in the wrong place,” said Anthony Esposti, CEO of CAPSA, a member of CAMIMH. “This report card reveals how services for people with substance use health concerns are lacking. Canadians deserve better and CAMIMH members are committed to working with governments to improve the lives of the people in Canada.”

For more details on the results of the Report Card, please visit H camimh.ca n

FEBRUARY 2024 HOSPITAL NEWS 7

Enhancing Patient Care Through Caregiver Inclusion Family Caregivers are essential care partners, providing an estimated 75% of the care delivered in the healthcare system, making their roles vital for patients’ physical, emotional, and cognitive well-being. Different from visitors, essential care partners play an active role providing physical, psychological and emotional support to a family member, partner or close friend. This care can include support in decision making, care coordination and continuity of care. Evidence shows that including essential care partners as part of the care team leads to  Improved quality of care  Improved patient outcomes  Improved working conditions for healthcare professionals  Less pressure and reduced cost on the health system Contact the Essential Care Partner Support Hub at ontariocaregiver.ca/essentialcarepartner. The Support Hub provides hospitals with free expert guidance, coaching, and ready-to-use, evidence-informed resources to build or enhance an Essential Care Partner program and adopt essential care partner practices.

COVER

Dr. Andrew Brown (R) and Crystal Ellis (L) the morning of her treatment to remove the blockage in a stent that was put into a vein to help treat her deep vein thrombosis. Photo credit: Yuri Markarov

A Canadian first: New device helps to tackle challenging deep vein thrombosis cases By Robyn Cox hen Crystal Ellis arrived at the hospital in July, her left leg had swollen to nearly twice its size. “The pain was from my foot to my stomach,” she describes. “My stomach was swollen and I could barely walk.” This wasn’t her first experience with these symptoms. Ellis had a blood clot in one of the main veins that went from her left leg into her abdomen in 2014. The condition – called deep vein thrombosis or DVT – happens when the main veins from the legs or arms are blocked, stopping blood from going back to the heart to be re-oxygenated and recirculated. An estimated 45,000 Canadians are impacted by DVT each year. The common symptoms are swelling and pain, as

well as redness and warmth in the impacted area. DVTs are typically treated with anti-coagulant medications – commonly known as blood thinners. One of the risks of a DVT is that the blood clots can travel to other parts of the body. In 2014, Ellis also experienced a pulmonary embolism, where a blood clot travelled to her right lung. She ultimately spent over a month in hospital for care and recovery. At that time, Ellis had a stent put into the vein in her left leg as part of her DVT treatment. A stent is a small mesh tube that is placed in the vein to hold it open. This past July – when Ellis was experiencing significant swelling and pain – it was because blood clots had formed and hardened inside the stent, blocking it completely. She was

10 HOSPITAL NEWS FEBRUARY 2024

transferred by ambulance to St. Michael’s Hospital where the Interventional Radiology team did their best to clean out the stent and open it up. The Hematology team at St. Michael’s continued to follow Ellis and – while the procedure at St. Michael’s had helped – she was still experiencing swelling and pain in her left leg. “I can’t run like I used to. I have a seven-year-old child and I can’t play with him at the park,” says Ellis, when describing the impact of the DVT on her day-to-day life. “Walking up and down stairs is a challenge for me. The building I live in has 25 floors. We have three elevators but a lot of the time the elevators don’t work.” Around this time, the Interventional Radiology team was discuss-

ing bringing in a new device called a RevCore Thrombectomy Catheter. The new device has an adjustable metal coring element that shaves off and clears out blood clots that have formed and hardened within a stent. Ellis is the first patient in Canada to receive treatment with this device. “Without these new types of tools, our ability to treat the blocked stent is limited,” says Dr. Andrew Brown, an interventional radiologist at St. Michael’s. “Essentially, these patients were left to manage as best they can with their pain and reduced mobility.” Interventional radiology is a specialty of medicine where physicians use imaging tools – like ultrasounds, CT scans and X-rays – to provide image-guided, minimally-invasive treatment and care. www.hospitalnews.com

COVER

NEW INNOVATIONS LIKE THIS COMPLIMENT ONGOING EFFORTS TO CREATE A MULTIDISCIPLINARY APPROACH TO DVT CARE THAT HAS SET ST. MICHAEL’S HOSPITAL APART AMONG ITS PEERS. During the procedure, which took place in late November, Brown placed the device through a vein behind Ellis’ knee. Once the device arrived at the stent, he increased the diameter of the coring element and rotated it by hand to carve away at the blockage in the stent. Throughout the procedure, he and his team used X-rays and ultrasounds to help guide them. Ellis returned home the same day as the procedure and has regular checkins with the Interventional Radiology team. For Brown, using the new device accomplished exactly what he had hoped. “I was extremely happy with the results. Now we have to let the medicine do its work,” says Brown, referring to

the blood thinners Ellis will continue to take. “Immediately after the procedure, the area where we shaved off the blood clots becomes prothrombotic – essentially looking for platelets and coagulation factors to grab onto and form more blood clots,” Brown describes. “After a period of time, it becomes dormant and patients can come off the medication.” “Monitoring is the big key,” says Brown. “Sometimes it’s just peace of mind for the patients and sometimes it actually is incredibly important because we do begin to see that there’s a portion of the stent that looks like it’s narrowing again.” In the months following the procedure, Ellis has noticed significant improvements.

“Before, even just walking to another room my leg would balloon and I would have a lot of pain,” says Ellis. “Now I still have some swelling but I don’t have much pain unless I walk a longer distance.”

ADDRESSING GAPS IN DEEP VEIN THROMBOSIS CARE

Adding this new device to their toolbox is an exciting development for Brown and the Interventional Radiology team at St. Michael’s. “The majority of the people that I see are in their 20s, 30s and early 40s,” says Brown. “For them to not be able to exercise, not to be able to walk up a set of stairs without pain or shortness of breath – that is a significant impediment. It doesn’t feel good to have to say to a patient that we did the best we could but there’s nothing left to offer you.” It also helps to address a gap that Brown knows has long existed for his patients. He recounts one patient in particular from the hospital he worked

at before coming to St. Michael’s. She had a DVT blocking the big vein in her abdomen, causing swelling and inflammation in both of her legs. He and a colleague did all that they could to help her but the tools and options available at the time weren’t enough. “Even today, I think about her a lot because she ultimately died of her disease,” recounts Brown. “The opportunity to bring something new to St. Michael’s that potentially could help patients like her – when I couldn’t help her at that time – is very important to me.” New innovations like this compliment ongoing efforts to create a multidisciplinary approach to DVT care that has set St. Michael’s Hospital apart among its peers. “To my knowledge, it really is the only place in the province where folks from Hematology, Vascular Surgery, Interventional Radiology and Emergency Medicine are bringing their resources and expertise to bear on DVT patients,” explains Brown. “Some cases can be very complicated, so to do H this well requires a team effort.” n

Robyn Cox works in communications at Unity Health.

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FEBRUARY 2024 HOSPITAL NEWS 11

NEWS

First clinical guidelines to address anxiety in older adults group of multidisciplinary leading subject matter experts across Canada in the field of anxiety disorders in older adults and a lived experience group have collaborated with the Canadian Coalition for Seniors Mental Health (CCSMH) to develop the first-ever clinical guidelines for anxiety in older Canadians. Canadian health care providers now have access to clinical tools and resources they need to better support older adults at risk of or living with anxiety. Produced by the CCSMH and led by geriatric psychiatrist Dr. Andrea Iaboni (associate professor at the University of Toronto) and psychologist Dr. Sébastien Grenier (associate professor at the Université de Montréal), the Canadian Guidelines for the Assessment and Treatment of Anxiety in Older Adults provides evidence-based recommendations for the prevention, assessment, diagnosis and treatment of anxiety in seniors. Older adults will also benefit from a variety of resources, including this pamphlet about anxiety in older adults developed to inform them of the symptoms and treatments of anxiety and when they should seek help from a health care professional.

“These evidence-based guidelines provide primary care providers with a stepwise range of effective tools and therapies to detect, reduce the risk of and treat anxiety in older adults, including psychotherapy options for those who can access or deliver them,” says Dr. Erica Weir, (Member, Working Group) Care of the Elderly and Public Health Physician and Assistant Professor at Queen’s University. Anxiety disorders represent the most common mental health problem across the lifespan, including in late life. Every year, 18 per cent of older Canadians experience symptoms of anxiety or depression that they find difficult to cope with. Clinical guidelines and resources to best support older adults’ mental health are increasingly important to meet the needs of our aging demographic. Dr. Iaboni emphasizes that “These evidence-based clinical practice guidelines have the potential to improve care by increasing awareness of best practices and promoting a more consistent delivery of quality mental health services for older adults across Canada.” Addressing the stigma around aging and mental health and

“ANXIETY IS NOT A NORMAL PART OF AGING AND MISCONCEPTIONS ABOUT ANXIETY IN OLDER ADULTS HAVE LED TO IT BEING UNDERRECOGNIZED AND UNDERTREATED.

12 HOSPITAL NEWS FEBRUARY 2024

ANXIETY DISORDERS REPRESENT THE MOST COMMON MENTAL HEALTH PROBLEM ACROSS THE LIFESPAN, INCLUDING IN LATE LIFE. empowering older adults to take steps to support their mental health and well-being is also an important goal of this project. “Part of our work at CCSMH is also making best practice information readily accessible and easy to understand for older adults, care partners and the general public. We develop tools and resources to help them (or a loved one) connect with their health care providers and make informed decisions,” explains Claire Checkland, executive director at CCSMH. “Anxiety is not a normal part of aging and misconceptions about anxiety in older adults have led to it being underrecognized and undertreated. It is a treatable mental health condition and evidence-based interventions exist and can be helpful” shares Dr. Grenier.

QUICK FACTS

• Over the next 20 years, Canada’s seniors population – those age 65 and older – is expected to grow by 68 per cent. • 6 per cent of older Canadians have a diagnosed anxiety disorder with generalized anxiety disorder (GAD) and phobias being the most common.

• Anxiety has a negative impact on other aspects of health, including increasing the risk of heart disease and dementia. • Mental illness is not a normal part of aging. All seniors deserve, and have the right to, receive services and care that promote their mental health and respond to their mental illness needs. In September 2022, a Working Group was formed to develop and synthesize the guidelines. This group consists of multidisciplinary leading subject matter experts across Canada in the field of anxiety disorders in older adults. Members met monthly to advance this work by offering their clinical expertise, evaluating research evidence, voting on recommendations, and drafting the guidelines. The guideline development process also included a bilingual Lived Experience Advisory Panel consisting of older adults across the country with anxiety or informal caregiving experience to older adults with anxiety. The personal experiences and expertise shared by our panel members played a key role in informing the development H of these guidelines. n

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Infusion system innovations:

Elevating patient care and clinician support rowded hospitals, long wait times and nurse burnout have become common news stories, reinforcing the ongoing strain on our healthcare system. In fact, a survey conducted by the Registered Nurses’ Association of Ontario (RNAO) found that over 75 per cent of Canada’s nurses are “burnt out”. While stories like this are common, rarely are solutions presented to help address the challenges. Though there are multiple factors across the healthcare system that contribute to this, nurses who support infusion care can face a particular set of challenges that, if addressed, could alleviate some of the burden. Lynne Ross, Director, Infusion and Nutrition Systems at Fresenius Kabi Canada and registered nurse, reflects on a time when everything related to infusion care was manual. During the quiet, early morning hours, she and her nurse colleagues worked diligently to ensure the correct treatment doses were administered at the correct rate, fully aware that even a minor mistake could have serious consequences for patients. Infusion systems have come a long way since this time. Technologies like drug libraries and electronic health record (EHR) interoperability are taking the place of calculations by hand and manual reconciliation with medication orders. “We become nurses because we want to help patients get better. Throughout my career it’s been incredible to see how advancements, that I could not have imagined, have improved patient safety in significant ways,” explains Lynne. “On the flip side, we have also seen an increase in complexities associated with medical technologies which have shifted nurses away from delivering bedside care at a time where they are needed most.” Despite the growing nurse shortage, valuable clinician time is often spent on complex pump set-up and programming, a high volume of associated manual documentation, troubleshooting device errors and addressing the

associated alarms. Often, nurses need to know as much about the anatomy of infusion pumps as the anatomy of patients. Not only does this impact the quality of care a patient may receive, but it also compounds organizational inefficiencies and clinician stressors in an already stretched healthcare system. As infusion pump technology advances, how technology is designed to support the clinician must be a central consideration. Recently approved in Canada, Fresenius Kabi’s Ivenix Infusion System was built to tackle many of these challenges. To start, the System uses a novel pumping mechanism that automatically compensates for external factors like bag height, fluid viscosity, or patient movement. This means the mechanics of the pump provide accurate and consistent fluid delivery, giving nurses fewer factors to worry about when administering an infusion.

“Unfortunately, a nurse is often blamed for medication administration errors when, in fact, these events should be viewed from a systems perspective,” Lynne continues. “Pump advancements like the ones we see with Ivenix are designed to reduce the cognitive load of remembering essential set-up requirements and implications of operating conditions when delivering an infusion, while also helping clinicians feel more confident in the care they are providing.” In addition to this, the intuitive, smartphone-like, interface supports accurate programming with each infusion. The reduced complexities associated with navigating through the Ivenix Infusion System, means nurses can quickly adapt once the new pumps are introduced. Finally, the Infusions Dashboard allows for a remote view of ongoing infusions for multiple patients, giving nurses access to critical treatment in-

formation, whenever, and wherever they are in the hospital. It also assists with consistent and accurate communication between nurses during handoffs at shift changes. “Providing nurses with continual real-time infusion data and insights means they can make more informed and immediate care decisions, without the need to travel unnecessarily to check each device,” explains Lynne. “This in turn means more time for patient-focused activities like patient education, clinical assessment or monitoring.” Infusion technology has come a long way to improve patient safety, and now advanced infusion care is offering a brighter future for healthcare workers as well. As we evaluate and adopt new technologies, we need to ensure that they not only improve safety for patients, but also improve clinicians’ ability to deliver the best care possible. Ultimately this will contribute to a healthier H healthcare system for everyone. n

This article was contributed by Fresenius Kabi Canada. www.hospitalnews.com

FEBRUARY 2024 HOSPITAL NEWS 13

NEWS

Testing new technology to help older adults age at home By Ellie Stutsman hen 72-year-old Hamilton resident Shirley was asked if she’d be interested in participating in a research study that aims to help prevent falls in older adults using new technology, she said yes right away. “I know at my age falling can be a big issue,” she says. “Some of my friends have an alert bracelet or necklace that provides them some peace of mind knowing they can call for help if they fall and are unable to get up. So, I was happy to be part of testing for a new medical alert device.” Geras Centre for Aging Research, a joint institute of Hamilton Health Sciences (HHS) and McMaster University, has teamed up with local health tech company Chirp to test their inhome monitoring device that hopes to detect when someone has fallen, and even help prevent falls from happening. “Falls are the leading cause of injury of older adults in Canada, the majority of which happen at home,” says Dr. Patricia Hewston, study co-lead and research associate at Geras. “So we are researching innovative ways to prevent falls and help older adults age well at home.”

NEW DEVICE TO DETECT FALLS AND ALLOW TWO-WAY COMMUNICATION

Traditional medical alert devices are worn by an individual and require a button to be pushed when medical help is needed. Chirp has taken an entirely different approach by creating an in-home device that is simply mounted to the wall. It has sensors that monitor activity without cameras or the need to wear any equipment or push a button. The Chirp device is connected to an app that allows a family member or caregiver to monitor an older adult without having to be in the home with them. Using artificial intelligence, it

Geras Centre for Aging Research, a joint institute of Hamilton Health Sciences (HHS) and McMaster University, has teamed up with local health tech company Chirp to test their in-home monitoring device that hopes to detect when someone has fallen, and even help prevent falls from happening. Photo credit: Owen Thomas, Hamilton Health Sciences

will identify inconsistent activity to help prevent falls, as well as detect if falls occur. It also provides easy two-way communication between the person in the home and the caregiver using the app. A branch of the HHS research administration team called Research, Development and Innovation facilitated the partnership between Chirp and Geras and helped secure project funding from Innovation Factory’s Southern Ontario Pharmaceutical & Health Innovation Ecosystem (SOPHIE) Program. This Hamilton-based funding program supports the advancement of commercialization activities, by facilitating and funding collaboration projects between the industry partner and various delivery partners in the Hamilton region, providing Chirp with the opportunity to test their innovation in a real clinical setting and leverage the clinical and research experts to validate feasibility and utility. “With our aging population, health innovations focused on proactively enabling people to age well at home to reduce demand on our acute hospital

services,” says Andrea Lee, manager of research development and relations at HHS. “We see the potential to do just that with Chirp’s innovative approach that incorporates caregivers.”

INITIAL DEVICE TESTING

In this first phase of the study, a small group of participants, including Shirley, visited Geras to have the device track them walking at different speeds in a controlled environment. They were then sent home with three devices to be secured to the wall in the living room, kitchen and bedroom. For a two-week period, the devices then tracked their movement throughout the home. The real-time data was sent to Geras for the team to compare to the control data. The research team also collected participant feedback. “Chirp’s artificial intelligence algorithms continuously monitor sleep patterns, walking speeds, sedentary behaviors, and more, using privacy-preserving radar sensors,” says Hewston. “Research is important to support the development of new AI devices and to

ensure their effectiveness before going on the market.” Preliminary results from this phase show the device is reliable and accurate at tracking participants’ movement throughout their homes. Feedback was positive, with participants identifying that it was easy to install and provided a sense of security.

INCORPORATING CAREGIVERS

The next stage of the study will assess the device’s ability to detect falls and its integration with the app. This means that caregiver participation with study participants will be crucial in determining if the device is effective. “Working with the Geras team has been a fantastic opportunity,” says Dr. Parthipan Siva, co-founder and CTO at Chirp. “The data from this study is invaluable for improving and developing our in-home mobility assessment metrics. And feedback from participants helps us develop a system that is easy to install, easy to use, and provides peace of mind and proactive care H for those aging in place.” n

Ellie Stutsman works in communications at HHS. 14 HOSPITAL NEWS FEBRUARY 2024

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Studies have shown that patient satisfaction goes up by 2.5%, and staff turnover can plummet over 8 percentage points (from 16.7% to 8.1%), when certified nurses are increased by 60% in an acute care unit.1 Further studies indicate that healthcare facilities will see a 2% decrease in the odds of mortality and failure to rescue for every 10% increase in certified nurses.2 Research has also found significantly lower rates of falls in units with two

or more geriatric-certiﬁed nurses,3 with average length of hospital stay reduced by one day after a 6% increase in certiﬁed nurses.4

Nurses committed to high practice standards

The CNA Certification Program says this is all possible because specialty certification confirms that a nurse’s practice is consistent with national standards.5 Certified nurses are committed to an advanced standard of professional competence, and this is directly correlated with improved patient outcomes, such as fewer central-line-related infections in surgical ICUs.6

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CNA certiﬁcation is effective, studies say

S OC

Increasing the number of CNA-certiﬁed nurses improves recruitment and retention, and leads to safer patient care, research shows.

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CNA Certiﬁcation Offers Proven Path to Better Workplaces and Patient Care

CERTIFIED

Health-care facilities that offer CNA certification, and encourage nurses to pursue it, are able to retain and attract nursing talent. CNA offers a voucher system, where workplaces can pay for their staff to pursue specialty certification (valid for 1 year, minimum 15 exam registrations required). CNA certification is the only bilingual, nationally recognized nursing specialty credential. The program offers 19 specialties, and over 12,000 nurses in Canada are certified. To help retain and attract the best nurses for your organization, contact the CNA Certification Program at certification@cna-aiic.ca.  1 Craven, H. (2007). Recognizing excellence: Unit-based activities to support specialty nursing certification. MedSurg Nursing, 16, 367-371. 2 Kendall-Gallagher, D., Aiken, L. H., Sloane, D. M., & Cimotti, J. P. (2011). Nurse specialty certification, inpatient mortality, and failure to rescue. Journal of Nursing Scholarship, 43, 188-194. doi:10.1111/j.1547-5069.2011.01391.x 3 Lange, J., Wallace, M., Gerard, S., Lovanio, K., Fausty, N., & Rychlewicz, S. (2009). Effect of an acute care geriatric educational program on fall rates and nurse work satisfaction. Journal of Continuing Education in Nursing, 40, 371-379. doi:10.3928/00220124-20090723-03 4 Nelson, A., Powell-Cope, G., Palacios, P., Luther, S. L., Black, T., Hillman, T., . . . Gross, J. C. (2007). Nurse staffing and patient outcomes in inpatient rehabilitation settings. Rehabilitation Nursing, 32, 179-202.

Wound, ostomy and continence is one of the 19 specialty certiﬁcations available through the CNA Certiﬁcation Program. Visit cna-aiic.ca to learn more.

5 Straka, K. L., Ambrose, H. L., Burkett, M., Capan, M., Flook, D., Evangelista, T., . . . Thornton, M. (2014). The impact and perception of nursing certiﬁcation in pediatric nursing. Journal of Pediatric Nursing, 29, 205-211. doi:10.1016/j. pedn.2013.10.010 6 Boyle, D. K., Cramer, E., Potter, C., Gatua, M. W., & Stobinski, J. X. (2014). The relationship between directcare RN specialty certiﬁcation and surgical patient outcomes. AORN Journal, 100, 511-528. doi:10.1016/j. aorn.2014.04.018

NEWS

Study projects 187% increase in people living with dementia in Canada by 2050 eople living with dementia are as diverse as the different diseases and conditions that cause these brain disorders. In Canada, we are in danger of failing the rapidly growing number of people living with dementia and their care partners if services and supports are not tailored to their unique needs, according to a new study released today by the Alzheimer Society of Canada. The Landmark Study: The Many Faces of Dementia in Canada is the second of three volumes detailing the demographic, social and economic impact of dementia in Canada. With the rapid rise of Canada’s aging population, the study projects that the number of people living with dementia in the country will increase by 187 per cent by 2050. This is one of the first Canadian studies that seeks to better understand the many faces of dementia and find equitable solutions for future dementia challenges, so that no one is left behind. “Structural barriers and social determinants of health have had an impact on the brain health of a large segment of the population,” said Dr. Joshua Armstrong, Alzheimer Society of Canada research scientist and lead author of the study. “Our findings highlight that we need to adapt how we help ev-

eryone – including Indigenous, racialized and younger adults – live with dementia, while supporting access to care, diagnosis and prevention tools for all.” Almost one million Canadians will live with dementia by 2030 and its impact will be felt across borders, sectors and cultures. To create positive outcomes, more must be done to fight stigma, discrimination and stereotypes. “We have to work together to make diversity and inclusion part of a more holistic approach to dementia prevention and management,” said Natasha Jacobs, Advisory Group Lead, Alzheimer Society of Canada. Natasha’s grandfather, originally from Guyana, developed young onset dementia, and as a youth, she was part of his circle of care. “We have often isolated racialized families, or those who have immigrated here. Fear plays a large role in why folks do not reach out for assistance in a timely manner. Support that recognized my family’s needs would have made all the difference for us.” “From coast to coast to coast, dementia touches us all, if not today then tomorrow,” said Christopher Barry, Chief Executive Officer, Alzheimer Society of Canada. “The Alzheimer Society of Canada is committed to leading the way in transforming the landscape of dementia care and research, from prevention to support.

16 HOSPITAL NEWS FEBRUARY 2024

There is a wide range of actions we can take – individually and collectively – to be part of the solution for optimizing our healthcare and support systems. We have a National Strategy in place and are making progress, but much more work needs to be done, and we have a shared responsibility to see it through.”

FINDINGS FROM THE REPORT INCLUDE:

• The number of people living with dementia in Canada is expected to increase by 187 per cent from 2020 to 2050 – with more than 1.7 million people likely to be living with dementia by 2050. • By 2050, the number of people of Indigenous ancestry living with dementia in Canada is expected to increase by 273 per cent, from 10,800 to 40,300. • By 2050, almost one out of every four people who develop dementia in Canada will be of Asian origin. • In 2020, an estimated 4,800 people of African ancestry in Canada were living with dementia, which is predicted to reach over 29,100 in 2050 – a 507 per cent increase. • In 2020, an estimated 3,500 people of Latin, Central and South American ancestry in Canada were living with dementia, which is predicted to

reach over 18,500 in 2050 – a 434 per cent increase. • In 2020, an estimated 61.8 per cent of persons living with dementia in Canada were female and more than half of care partners were women. By 2050, projections show that over 1 million women will be living with dementia in Canada. • Young onset dementia (people under age 65) presents distinct challenges, which often lead to delayed diagnoses and difficulty in obtaining workplace accommodations. By 2050, there could be over 40,000 people under the age of 65 living with dementia in Canada, up from an estimated 28,000 in 2020. The report concludes with a list of actions that Alzheimer Societies across Canada, health-care providers, governments, and researchers can take to better understand dementia in Indigenous populations and diverse communities, along with suggestions on how to tackle the gender gap and young-onset dementia. Alzheimer Societies across the country support people living with dementia and care partners. Find an Alzheimer Society near you by visiting www.alzheimer.ca/Find. The Landmark Study, Volume 2, is available for download at H alzheimer.ca/ManyFaces. n www.hospitalnews.com

2024

NOMINATE A NURSING HERO!

19th Annual Hospital News

NURSING HERO AWARDS Celebrating Canada’s Nurses and Their Contributions Along with having their story published, the winner also will take home: CASH PRIZES: 1st PRIZE $1,500 2nd PRIZE $1000 3rd PRIZE $500 Have you been inspired, encouraged or empowered by an employee or a colleague? Have you or your loved one been touched by the care and compassion of an outstanding nurse? Do you know a nurse who has gone above and beyond the call of duty? Hospital News will once again salute nursing heroes through our annual National Nursing Week (May 7th to 13th) contest. Nominations can be submitted by patients or patients family members, colleagues or managers.

Please submit by April 6 and make sure that your entry contains the following information: • Full name of the nurse • Facility where he/she worked at a time • Your contact information • Your nursing hero story Please email submissions to editor@hospitalnews.com or mail to: Hospital News, 610 Applewood Crescent, Suite 401, Vaughan, ON, L4K 0E3

If you do not recieve confoirmation within 24 hours of emailing your nomination, please follow up at editor@hospitalnews.com or by telephone 905.532.2600 x2234.

Opening the conversation about palliative care By Kristen LoSchiavo

Matthew Kettings works as a social worker He is pictured here with a patient in the palliative care unit at Hamilton Health Sciences’ St. Peter’s Hospital (SPH).

alliative care is often misunderstood, with many assumptions of what it’s about. In reality, palliative care helps improve a patient’s quality of life until the very end, regardless of age. Matthew Kettings works as a social worker in the palliative care unit at Hamilton Health Sciences’ St. Peter’s Hospital (SPH). The unit is one of the largest in Canada and provides a holistic approach to care while managing pain and symptoms.

THE SCOPE OF SOCIAL WORK

The SPH palliative care unit consists of social workers, physiotherapists, occupational therapists, therapeutic recreationists, speech-language pathologists, dietitians and spiritual staff. All provide professional end-oflife care to those with critical illnesses. Kettings works closely with patients and their families to help them make decisions that preserve comfort, spirituality, autonomy, and dignity for every patient, which may look different for every individual. Despite the sensitive nature of his work, Kettings notes that laughter is common in the unit. “This may seem odd to the audience outside of our unit, but laughter is much more common here than you think,” he says. “I’m privileged to spend quality time with patients and their families to learn more about them, and what’s important to them. My job requires understanding patients’ goals and essential information for better care.” Kettings also offers financial support resources, discharge planning, crisis intervention, supportive counselling and safety planning.

clude their comfort level, priorities, and preferred care location. Making the best decisions for their care can be challenging. Kettings assists with coordinating referrals, home care, and outreach services from palliative care teams. “I meet with new patients to help support their transition into the unit while asking questions such as who I can contact to ensure their loved ones know they’re safe,” says Kettings. “As patients settle into this new stage of life, every situation is new and unique,” says Kettings. “Every patient requiring social work interventions is met with compassion and open-mindedness.” Patients are encouraged to bring personal belongings from home to make their stay more comfortable, and many also decorate their rooms for holidays with staff’s help. “Several patients, who are very holiday-driven, decorate their space for Christmas and Halloween, giving out candy and presents at times,” says Kettings.

EVERY SITUATION IS NEW AND UNIQUE

MORE THAN A HOSPITAL

When seriously ill patients discuss their goals of care, considerations in-

Photo credit: Owen Thomas, Hamilton Health Sciences

Within the unit, there are many activities and spaces to help promote

overall well-being, including areas for painting, drawing, and cooking. “We have a wonderful therapeutic recreationalist who can support anything from baking cookies to arranging a space for families to have their meals together,” says Kettings. “Additionally, staff members support activities like bocce, yoga and mindfulness exercises, while also creating spaces for those who wish to be more private.” During the pandemic, visiting restrictions were in place at SPH. However, the medical team found a way for one patient to have a special visitor. “There was one patient of mine who had a great-grandchild born during this time but was only able to see them through Zoom calls,” says Kettings. “We arranged a surprise window visit with his granddaughter so he could meet the great-grandchild ‘in person’ through window visiting. We were all quite emotional that afternoon as it was a reunion that had everything stacked against it but we made it work.” Kettings’ work is not necessarily just within the four walls of a patient’s room. “I’m not always at the bedside with patients,” says Kettings. “The care we provide extends so much more than that.”

NEWS

AGE IS NO BARRIER TO PALLIATIVE CARE

“I think one of the great myths about palliative care is that it’s strictly for the elderly who are dying, and not for those who are younger with complex medical conditions and symptoms,” says Kettings. “I encourage families and patients to advocate for this with medical teams or family physicians. Our population for our unit at St. Peter’s is 18 years of age and up. Age, sex, culture, gender, and race should be barriers we dismantle for palliative care.” Kettings recently worked with a patient in her early thirties who had very complex care needs. “Despite her illness, she had a resilient and humorous way of interacting with others,” says Kettings. “This patient was exceptional at demonstrating that not everyone in adult hospitals receiving end-of-life care is elderly.” Palliative care can be included in a patient’s care plan from the beginning of a diagnosis, leading to the end of life. Although it may be a hard topic, initiating palliative care in the earlier stages of a serious disease provides practices that help improve the quality of living. Kettings adds, “To provide successful palliative care, it’s not the medical team telling you what is best, it’s you telling your medical team what is important to you, and how we can support you. These aspects of life outside of the hospital are important, and should continue within palliative care settings too.”

INSPIRED BY PATIENTS AND COWORKERS

Kettings says he’s inspired every day by his patients, families, and his team. “I take great pride in working alongside our physicians, allied health team, and exceptional nursing team that consistently goes above and beyond,” says Kettings. “Along with my patients and their families who welcome our staff into their care, this is what inH spires me to do my job every day.” n

Kristen LoSchiavo works in communications at Hamilton Health Sciences. 18 HOSPITAL NEWS FEBRUARY 2024

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NEWS

Program helps primary care providers deliver quality care, faster By Shahana Gaur n January 2021, Humber River Health (Humber) launched a program aimed at solving one of the most persistent challenges in healthcare: administrative and logistical tasks that consume the time of Primary Care Providers (PCPs), including family physicians and nurse practitioners. SCOPE stands for Seamless Care Optimizing the Patient Experience and is designed to support PCPs by facilitating enhanced access to care pathways for patients and alleviating the burden of administrative tasks, such as finding the right specialists for referrals and coordinating diagnostic imaging. As a member of the North Western Toronto (NWT) Ontario Health Team (OHT), Humber is part of a network that includes 258 family physicians and over 300 PCPs – individuals that SCOPE is specifically designed to help. Since its launch at Humber, SCOPE has grown to support over 200 PCPs in providing care for their patients, diverted over 300 Emergency Department (ED) visits, and continues to increase access to equitable care for our community.

The SCOPE team.

MEETING THE NEEDS OF PCPS

SCOPE provides a web of support for PCPs through an interprofessional care team, all accessible through a single point of entry that is convenient for them – a phone call, fax, or email. When PCPs reach out to SCOPE, they can access nurse navigators, internists, outpatient services, diagnostic imaging, and home and community care services. These supports help coordinate care in a variety of pathways, including diagnostic imaging, mental health, neurology, fractures, plastic surgery, vascular, and lower limb preservation. Each of the care pathways and how they are delivered was established in response to the insight and feedback of PCPs, and Humber has continued to seek ongoing input to ensure the program is developing and adding new www.hospitalnews.com

AS A MEMBER OF THE NORTH WESTERN TORONTO (NWT) ONTARIO HEALTH TEAM (OHT), HUMBER IS PART OF A NETWORK THAT INCLUDES 258 FAMILY PHYSICIANS AND OVER 300 PCPS – INDIVIDUALS THAT SCOPE IS SPECIFICALLY DESIGNED TO HELP. pathways that effectively addresses their most pressing challenges. In doing so, SCOPE accelerates timelines for care by pairing PCPs with an expert in the healthcare system who can quickly and seamlessly arrange the care patients need. In fact, ninety percent of requests filed through the program are completed within a single day. To-date, Humber’s SCOPE program has received over 2,500 calls from PCPs with each taking a mere five minutes (on average) to transfer the coordination of patient care. This enables PCPs to spend more time di-

rectly with patients, the ability to work more sustainable hours, and reduces administrative burnout – something that is being increasingly discussed in the media, medical journals and regulatory bodies as a problem needing a solution. Family physician, Dr. Ferase Rammo, shares how SCOPE at Humber has impacted himself and his practice. “It has been a game-changer. Before SCOPE, wait times for specialists and other referrals were extremely long, which of course resulted in delays and frustrations for both patients and our

team. With SCOPE, we have access to a five-star service that streamlines these steps, and impressively parallel-processes our requests. It is my go-to resource when I encounter complex patient presentations that require immediate attention. Patients have noticed the change in workflow and are very appreciative of the expedited services. SCOPE has fundamentally and permanently changed the way my practice is able to interact with our healthcare system.”

REDUCING AVOIDABLE EMERGENCY DEPARTMENT VISITS

SCOPE also plays a significantly role in reducing ED visits by being a conduit to timely care. Humber has one of the busiest EDs in Ontario, averaging 384 visits per day and roughly 90 per cent of patients not requiring admission. Continued on page 31

FEBRUARY 2024 HOSPITAL NEWS 19

WOUND CARE

Project ECHO:

Building wound care knowledge for healthcare professionals roject ECHO® (Extension for Community Health Care Outcomes) is an international learning community representing more than 220 hubs in 31 countries. The Project ECHO Ontario Skin and Wound Care Hub features live online sessions, de-identified patient cases, and case discussions. Dr. R. Gary Sibbald helped launch the ECHO Ontario Skin and Wound Care Hub in 2019. Recognized internationally for his research and clinical work, Dr. R. Gary Sibbald is a dermatologist, internist and wound care specialist based in Ontario. Project ECHO is for Ontario Healthcare providers who have an interest in skin and wound care. It features live online sessions, de-identified patient cases, and case discussions.

Healthcare providers and specialists learn from each other, acquire knowledge, skills, increase competency and build a strong community of practice. Project ECHO® follows the Hub and Spoke model where an inter-professional specialist resource team form the hub and participants, supported by community of practice, are the spokes.

Q AND A WITH DR. SIBBALD:

Q: What is ECHO as a model for skin and wound care? A: Skin and wound care has traditionally been practiced in silos. Providers often work independently of each other, whether acute care, long-term care, nursing homes, complex continuing care, home care or other sectors. Doctors, nurses and allied health professionals are working in different

Two RCTs: two amazing outcomes using the geko™ device

COMMUNITY: The geko™ device doubles the rate of healing in venous leg ulcers versus compression alone1

HOSPITAL: The geko™ device reduces edema and improves wound healing postkidney transplantation2,3

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www.gekodevices.com info@perfusemedtec.com

1. Bull R et al. Int Wound J. 2023; 1–9. 2. Yan Xie W, et al. Daily use of a muscle pump activator device reduces hospitalization and improves graft function post-transplantation: A randomized controlled trial. Can Urol Assoc J. 2019;13(4Suppl3). 3. Aquil S et al. Can Urol Assoc J 2019;13(11):E341-9.

20 HOSPITAL NEWS FEBRUARY 2024

Gary Sibbald locations under various models. This creates obstacles in providing integrated interprofessional care. ECHO helps address this. ECHO moves knowledge, not patients. Our program is part of a collective of over 40 ECHO programs in Ontario. We connect with 100+ clinics at once via Zoom in weekly 2-hour sessions plus an extra 1 hour of skills training. We use a ‘Hub and Spoke’ model. The ‘Hub’ teaches a short didactic lecture based on International Interprofessional Wound Care Course (IIWCC) curriculum, Best Practice Guidelines and other expert resources. We then collectively discuss real, deidentified, patient cases submitted by ‘Spoke’ participants. Q: How is ECHO different from telemedicine? A: ECHO is designed to build capacity in the community and to link together the three key wound care professional groups: doctors, nurses and allied health. We do not take over responsibility for the care of patients. Instead, we help participants care for their own patients, in their own communities.

Q: Who are the partners in this ECHO program and who is on your “hub” team? A: The Ontario Ministry of Health funds our program. The three partners are WoundPedia, Queen’s University and Nurses Specialized in Wound Ostomy and Care Canada (NSWOCC). The Hub team includes family doctors, advance practice nurses, and allied health providers. We also have a roster of guest experts. We are accredited by Queens University and award CME/CE credits to attendees. Q: What can a participant expect to gain? What are the obligations? A: Participants gain experience through situational learning with an interprofessional collaborative approach. We discuss their patient cases. Many participants have found this extremely helpful for their wound care patients Based on requests from healthcare professionals in other provinces, The next step for the Project ECHO Skin and Wound Care Hub is to expand it across Canada. Planning is underway in order to make this happen and knowing Dr. R Gary Sinbbald- it H certainly will. n www.hospitalnews.com

Two RCTs: two amazing outcomes using the geko™ device COMMUNITY: The geko™ device doubles the rate of healing in venous leg ulcers (VLUs) versus compression alone1 ʅ

The study compared standard of care (SoC) with and without the geko™ device in patients with VLUs.

Results show the geko™ device, combined with multi-layer compression doubles the rate of healing vs. SoC alone1.

The geko™ device, (a muscle pump activator), increases venous, arterial and microcirculatory flow, transporting oxygenated blood to the wound bed, treats edema, and accelerates wound healing.

Patient adherence to therapy was extremely high at a rate of 94%.

HOSPITAL: The geko™ device reduces edema and improves wound healing post-kidney transplantation2,3 London Health Sciences Centre (Canada): The geko™ device in the immediate postoperative period leads to a significant improvement in early wound healing, edema management (measured by urine meter), and the study concluded that there was a significant decrease in the number of complex wound infections following kidney transplantation compared to standard TED + IPC therapy. Results: 2,3

Metric

SoC

SoC + gekoTM

P value

Leg Edema

IPC 3.6 cm

2.5 cm geko™ device

P=.001

Weight Gain

IPC 5.18 kg

4.06 kg geko™ device

P=.003

Urine Output Total

IPC 12.6 L

15.99 L geko™ device

P=.003

Wound Infections (104 patients)

IPC (n=15) (29%)

(n=7) (13%) geko™ device

Day 3 P=.004 Day 5 P=.003

Blood flow is critical in the wound healing trajectory. Increased blood flow reduces edema and the sooner a wound closes the sooner the patient is protected from infection - nature’s way of healing

References 1. Bull R et al. Int Wound J. 2023; 1–9 2. Yan Xie W, et al. Daily use of a muscle pump activator device reduces hospitalization and improves graft function post-transplantation: A rand-omized controlled trial. Can Urol Assoc J. 2019;13(4Suppl3) 3. Aquil S et al. Can Urol Assoc J 2019;13(11):E341-9.

www.gekodevices.com

info@perfusemedtec.com

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WOUND CARE

Equitable healthcare

for Indigenous Peoples: The development of a website to provide a culturally safe method to communicate wound, ostomy and continence information and resources By Catherine Harley and Troy Curtis espite Canada’s commitment to primary health care and principles of social justice, health inequities remain a pressing national concern for Indigenous peoples. In Canada, healthcare for Indigenous peoples, which include First Nations, Inuit and Métis, is shared by the federal, provincial and territorial levels of government. With a complex mix of policies, legislation and relationships, the Canadian healthcare system includes Indigenous peoples in the per capita allocations of funding from the federal transfer and are entitled to access insured provincial and territorial health services as residents of a province or territory. Indigenous Services Canada funds or directly provides services for First Nations and Inuit that supplement those provided by provinces and territories, including primary health care, health promotion and supplementary health benefits.1 Indigenous Services Canada also funds or directly provides certain health care services to First Nations communities and funds the provision of certain community health programs for Inuit peoples. This is in addition to federal funding provided to territorial governments. Indigenous Services Canada similarly funds non-insured health care benefits to eligible First Nations and recognized Inuit regardless of where they live in Canada. A coordinated approach to address the health needs of First Nations, Inuit and Métis, and health care delivery among all levels of government remains an ongoing challenge. The inequities in access to healthcare and social determinants of health ex-

perienced by Indigenous peoples in Canada are known and documented, however, this relevant information and evidence has not been translated into improved health.2 The root causes of inequitable access to healthcare for Indigenous peoples are complex and need further assessment within the social, historical, and political context in order to develop solutions. In June 2018, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC) launched the Indigenous Wound, Ostomy and Continence Health Core Program to address the inequity of healthcare delivery. There was a commitment to gain a better understanding of the gaps in patient care delivery of wound, ostomy, and continence, looking at the unique perspectives in First Nations communities including rural, remote, and urban areas. Healthcare delivery solutions that were equitable to non-indigenous communities and supported cultural safety were at the forefront of the thinking. One gap that was identified by this Core Program was the lack of a consistent process to deliver culturally safe information on the topic of wound, ostomy and continence to First Nations medical practitioners, nurses, family caregivers and patients. In January 2022, this Core Program put together a project team, that in addition to Catherine Harley, NSWOCC Chief Executive Officer, and Troy Curtis, NSWOCC Director of Operations, was made up of representatives who work in the frontline with Indigenous, Metis, and Inuit people. This project team met to set objectives to develop a national

22 HOSPITAL NEWS FEBRUARY 2024

Michelle Buffalo, RN, BScN, NSWOC, WOCC ( C) is a nurse specializing in wound, ostomy and continence. communication tool in the form of a website which would be an online informational and educational resource hub. The goal of this website was to enhance accessibility to information and ultimately improve healthcare for Indigenous peoples. To achieve this goal, the objectives were to create a website that would: • Act as a single directory whereby hyperlinks to culturally safe Indigenous healthcare information and educational resources for patients, Nurses Specialized in Wound, Ostomy and Continence (NSWOCs), and other healthcare professionals could be found; Display hyperlinks to Indigenous • Wound, Ostomy and Continence health resources broken down by Province/Territory to help patients, NSWOCs, Skin Wellness Associate Nurses (SWANs) and other healthcare professionals disseminate pertinent information that exists elsewhere online for the respective region they live and work in; Share news related to Indigenous • Wound, Ostomy and Continence health; Welcome visitor-submitted sugges• tions for new links to resources to be added to the website; • Support website visitors getting in

contact with an NSWOC closest to their area using the NSWOCC “Find an NSWOC” tool; • Provide information in multiple mediums including video, blog, external hyperlinks, and images; • Establish a common language by providing a glossary defining key ostomy-related terms adapted from the 2022 NSWOCC Ostomy Patient Teaching Guides for Ileostomy, Ileal Conduit, and Colostomy as well as establishing a glossary of terms, in the future, for wound care and continence. The NSWOCC Indigenous Wound, Ostomy and Continence Health Core Program project team met several times over the following seven months to refine the design, content, and navigation of the website. The group collectively came up with the name of the “Sharing Circle” for this website in order to support that healthcare for Indigenous peoples must be shared by everyone. Sharing circles provide opportunities for each voice to be heard, respected, and valued. They are a traditional practice in some Indigenous communities in North America and are designed to ensure everyone has an equal opportunity to share their opinions and ideas. Continued on page 24 www.hospitalnews.com

SPONSORED CONTENT

Wounds Canada Canada’s leading wound management organization

stablished in 1995, Our goal is to reduce the prevalence Wounds Canada is a and incidence of wounds of all types health charity dedicated and the negative consequences they to the advancement of bring – including patient suffering and wasted health-care wound prevention and dollars. management. For nearly Our partners in action 30 years we have advoare patients, caregivers, cated for a population health-care providers, health approach that researchers, advocates, promotes best practices policy makers, industry to support all persons, particularly those at risk Mariam Botros, CEO, personnel and donors. of or living with wounds Wounds Canada Not only do we educate and advocate, but we and frontline clinicians. also drive change and build community We develop and provide educational in Canada. programs and resources as well as sup2024 marks an exciting time for us as port research to further advance our we reveal our new mission “To build a holistic, risk-based approach.

healthier Canada by advancing skin health and excellence in wound management,” a mission that has never been more relevant or critical than it is now. Approximately 30-50 per cent of all health care involves managing wounds1 and Canadians are spending over $11 Billion on wound care each year.2 These numbers are staggering and have been on the rise for years and it is for this reason we continue our advocacy work and continue to expand the programs offered through the Wounds Canada Institute.

WOUNDS CANADA INSTITUTE (WCI)

The Wounds Canada Institute (WCI), a department of Wounds

Canada, builds on our decades of excellence in educational programs for health-care professionals in the areas of skin health and wound management. Through the WCI, health-care professionals at all levels and in all disciplines can access flexible, interprofessional education that supports their learning needs and professional career growth. Why is this important? Because IT’S TIME to prioritize wound prevention and management in Canada. For more information we invite you to visit woundscanada.ca and we hope to see you at Wounds Canada’s National Hybrid Conference in London, ON, October 17-19, H 2024! n

OHA and OACCAC. 2011. Four Pillars: Recommendation for Achieving a High Performing Health System. 2Queen, D., Botros, M. and Harding, K. (2023) ‘International opinion – the true cost of wounds for Canadians’, International Wound Journal [Preprint]. doi:10.1111/iwj.14522.

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Work in Ontario? Register NOW and you may qualify for FREE registration! We gratefully acknowledge the support and funding for the development of the Skin Health Program for Personal Care Providers by the Ontario Ministry of Health (MOH). www.hospitalnews.com

FEBRUARY 2024 HOSPITAL NEWS 23

WOUND CARE

Facing the facts:

Suture materials and

scar prominence post-surgery By Sarah Ripplinger

better than others at reducing the aponcerns about scarring folpearance of facial scars. lowing surgical procedures Erythema – skin redness – was beoften prompt both patients lieved to be greater with the use of braidand surgeons to favour sued absorbable irradiated polyglactin-910 ture materials believed to minimise the or fast-absorbing gut sutures, compared appearance of scars. However, findings to nylon suture material. As such, some published in the journal Dermatologic surgeons may have given preference to Surgery and led by Vancouver Coastal nylon sutures for procedures on areas of Health Research Institute researcher the body where excellent scar appearDr. David Zloty dispel commonly held ance is essential, such as the face. beliefs about three suture types, paving “Many patients whom I have spothe way for potential long-term health ken with over the years are more concare cost savings. cerned about the cosmetic outcomes A surgeon whose practice focuses of a facial scar than about having a on skin cancer surgery and cutaneous facial cancerous tumour removed,” oncology, Zloty frequently heard from states Zloty. colleagues that specific suture matedŚĞƌĂƉĞƵƚŝĐ WƌĞƐƐƵƌĞ ĂƌĞ ZĞůŝĞĨ WƌŽĚƵĐƚƐΠ Π rials weredŚĞƌĂƉĞƵƚŝĐ WƌĞƐƐƵƌĞ ĂƌĞ ZĞůŝĞĨ WƌŽĚƵĐƚƐΠ historically presumed to be Continued onΠpage 27

dŚĞƌĂƉĞƵƚŝĐ WƌĞƐƐƵƌĞ ĂƌĞ ZĞůŝĞĨ WƌŽĚƵĐƚƐΠ Π

Top: Flap closure R cheek with irradiated polyglactin 910 and rapidly absorbing gut, immediately post-operative Bottom: Flap closure R cheek 1 week post-operative Continued from page 22

Equitable healthcare

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dŚĞ ƚŚŽƵƐĂŶĚƐ ŽĨ ƉŽůǇĞƐƚĞƌ ĨŝďĞƌƐ ŝŶ ĞĂĐŚ ůĂǇĞƌ ĐŽŵďŝŶĞ ƚŽ ƚŚĞ dŚĞ ƚŚŽƵƐĂŶĚƐ ŽĨ ƉŽůǇĞƐƚĞƌ ĨŝďĞƌƐ ŝŶ ĞĂĐŚ ůĂǇĞƌ ĐŽŵďŝŶĞ ƚŽ ƚŚĞ dŚĞ ƚŚŽƵƐĂŶĚƐ ŽĨ ƉŽůǇĞƐƚĞƌ ĨŝďĞƌƐ ŝŶ ĞĂĐŚ ůĂǇĞƌ ĐŽŵďŝŶĞ ƚŽ ƚŚĞ ŶĂƚƵƌĂů ďŽĚǇ ĐŽŶƚŽƵƌƐ ŝŶ ďŽƚŚ ƐƵƉŝŶĞ ĂŶĚ ƐĞĂƚĞĚ ƉŽƐŝƚŝŽŶƐ ƚŚĞƌĞďǇ ŶĂƚƵƌĂů ďŽĚǇ ĐŽŶƚŽƵƌƐ ŝŶ ďŽƚŚ ƐƵƉŝŶĞ ĂŶĚ ƐĞĂƚĞĚ ƉŽƐŝƚŝŽŶƐ ƚŚĞƌĞďǇ ŶĂƚƵƌĂů ďŽĚǇ ĐŽŶƚŽƵƌƐ ŝŶ ďŽƚŚ ƐƵƉŝŶĞ ĂŶĚ ƐĞĂƚĞĚ ƉŽƐŝƚŝŽŶƐ ƚŚĞƌĞďǇ ŽĨĨĞƌŝŶŐ ƉƌĞƐƐƵƌĞ ƌĞůŝĞĨ ǁĞůů ďĞůŽǁ ƚŚĂƚ ŽĨ ŶŽƌŵĂů ĐĂƉŝůůĂƌǇ ďůŽŽĚ ŽĨĨĞƌŝŶŐ ƉƌĞƐƐƵƌĞ ƌĞůŝĞĨ ǁĞůů ďĞůŽǁ ƚŚĂƚ ŽĨ ŶŽƌŵĂů ĐĂƉŝůůĂƌǇ ďůŽŽĚ ŽĨĨĞƌŝŶŐ ƉƌĞƐƐƵƌĞ ƌĞůŝĞĨ ǁĞůů ďĞůŽǁ ƚŚĂƚ ŽĨ ŶŽƌŵĂů ĐĂƉŝůůĂƌǇ ďůŽŽĚ ĨůŽǁ ŚĞŶĐĞ ƐŬŝŶ ďƌĞĂŬĚŽǁŶ ĂŶĚ ƐŚĞĂƌŝŶŐ͕ ƉůƵƐ ĨƌŝĐƚŝŽŶ ĂƌĞ ƐŝŵƉůǇ ĨůŽǁ ŚĞŶĐĞ ƐŬŝŶ ďƌĞĂŬĚŽǁŶ ĂŶĚ ƐŚĞĂƌŝŶŐ͕ ƉůƵƐ ĨƌŝĐƚŝŽŶ ĂƌĞ ƐŝŵƉůǇ ĨůŽǁ ŚĞŶĐĞ ƐŬŝŶ ďƌĞĂŬĚŽǁŶ ĂŶĚ ƐŚĞĂƌŝŶŐ͕ ƉůƵƐ ĨƌŝĐƚŝŽŶ ĂƌĞ ƐŝŵƉůǇ ĚŝŵŝŶŝƐŚĞĚ͘ ĚŝŵŝŶŝƐŚĞĚ͘ ĚŝŵŝŶŝƐŚĞĚ͘

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ŽŶƐƵůƚ ŽƵƌ tĞďƐŝƚĞ Ăƚ ǁǁǁ͘ƉĐƌƉͲƉƌŽĚ͘ĐŽŵ ŽŶƚĂĐƚ ƵƐ Ăƚ ŝŶĨŽΛƉĐƌƉͲƉƌŽĚ͘ĐŽŵ ŽŶƐƵůƚ ŽƵƌ tĞďƐŝƚĞ Ăƚ ǁǁǁ͘ƉĐƌƉͲƉƌŽĚ͘ĐŽŵ ŽŶƚĂĐƚ ƵƐ Ăƚ ŝŶĨŽΛƉĐƌƉͲƉƌŽĚ͘ĐŽŵ ƉƌŽĚ͘ĐŽŵ ŽŶƐƵůƚ ŽƵƌ tĞďƐŝƚĞ Ăƚ ǁǁǁ͘ƉĐƌƉͲƉƌŽĚ͘ĐŽŵ ŽŶƚĂĐƚ ƵƐ Ăƚ ŝŶĨŽΛƉĐƌƉͲƉƌŽĚ͘ĐŽŵ

24 HOSPITAL NEWS FEBRUARY 2024

On August 10, 2022, the NSWOCC Indigenous Wound, Ostomy and Continence Health Core Program launched this new “Sharing Circle” website, helping patients, Nurses Specialized in Wound, Ostomy and Continence (NSWOCs), Skin Wellness Associate Nurses (SWANs) and other healthcare professionals access a directory of resources, education, training, and support related to Indigenous Wound, Ostomy and Continence Health. The “Sharing Circle” website was implemented through electronic communications, a social media campaign, posting on the NSWOCC website and the websites of aligned organizations and through personal emails to colleagues. The Sharing Circle can be accessed online at www.sharingcircle.online.

In 2024 it continues to be updated as the NSWOCC Indigenous Wound, Ostomy and Continence Health Core Program receives more feedback and resources to add to the site. The use of this website is evaluated monthly through the use of the website analytics. We hope that by developing and launching the “Sharing Circle” website that we have provided an open, respectful way of obtaining wound, ostomy and continence information and resources for healthcare providers and First Nations people in a culturally safe manner. By having access to this website, we strive to support better access to patient care in a more timely manner. This is one step towards supporting equitable healthcare for H Indigenous peoples. n

Catherine Harley, eMBA, RN, IIWCC is CEO, Nurses Specialized in Wound, Ostomy and Continence Canada, Ottawa, Ontario, Canada. Troy Curtis, BHum, is Director of Operations, Nurses Specialized in Wound, Ostomy and Continence Canada, Ottawa, Ontario, Canada. www.hospitalnews.com

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WOUND CARE

Transforming wound care:

Enzymatic debridement and the future of healing By Dr. Robert Snyder atients with slowly healing ulcers often experience morbidity and a decrease in their quality of life. This is particularly prevalent in patients with diabetes who are prone to infections, sepsis, limb loss and death; neuropathic ulcers in this group can be as serious as some cancers. Despite the need for effective advanced therapies, due to the chronic and often toxic milieu of these ulcers, the field of wound care has seen only a paucity of advancement over the past two decades. Over the last 25 years, the sector has witnessed very few FDA approvals for innovative treatments through the premarket approval (PMA) or Biologics License Application (BLA) processes with many gaining approval or regulation through 510K or homologous pathways leaving practitioners with limited evidenced-based options. Meanwhile, recent advancements in enzymatic debridement, particularly utilizing topical bromelain, are paving the way for transformative therapies that hold the promise of faster debridement, wound healing and improved patient outcomes.

ADDRESSING CHRONIC WOUNDS AND BIOFILM BACTERIA

Chronic wounds, defined by their prolonged healing time and resistance to conventional treatments, represent a significant burden on patients and healthcare systems alike. The intricate interplay of factors, including impaired vascularization, underlying comorbidities, and bacterial infections, often contributes to the persistent nature of these wounds. Debridement represents the centerpiece leading to appropriate wound bed preparation. However, traditional debridement methods, such as sharp debridement, face limitations in addressing the unique challenges posed by chronic wounds, necessitating innovative approaches replace the standard of care. Chronic cutaneous ulcers, often present in patients with diabetes, are

frequently characterized by biofilm bacteria and pose a significant challenge by fostering chronic inflammation. Biofilm bacteria, resistant to traditional treatments, often hinder the healing process. There is evidence to support the hypothesis that treatment, with topical bromelain-based enzymatic debridement could effectively and quickly aid in the disruption of the polysaccharide covering eg. Glycocalyx ultimately decreasing pathogenicity. Collagenase, the lone FDA-approved enzymatic debridement product since 1956, has been the reliable yet time-consuming solution. However, the need for an alternative becomes evident, particularly when considering the extended debridement times and the absence of significant antibacterial effects against biofilm bacteria.

THE BROMELAIN ENZYMATIC DEBRIDEMENT SOLUTION

Bromelain-based enzymatic debridement may significantly reduce biofilm and inflammation, offering a

26 HOSPITAL NEWS FEBRUARY 2024

potential solution to the stagnation in chronic wound treatment. Bromelain, derived from the pineapple stem, brings a multifaceted approach to wound care with proven anti-inflammatory, antibacterial, and fibrinolytic effects, facilitating debridement while also stimulating angiogenesis, promoting robust granulation tissue formation. In the recently published PharmEx Phase II study, the innovative bromelain-based enzymatic debridement agent, EscharEx, demonstrated remarkable efficacy and safety in the treatment of chronic wounds. Explored in 12 patients grappling with venous leg ulcers (VLUs) or diabetic foot ulcers (DFUs), EscharEx showcased a dual impact on wound debridement and bacterial control. Seventy-percent of patients achieved complete debridement within 5.5 days, emphasizing the agent’s swift and comprehensive action compared to the 59 days that Collagenase required to achieve similar parameters. An average 35 per cent reduction in wound size over a 2-week follow-up

period further highlighted a potent role in promoting tissue regeneration. The agent proved instrumental in biofilm elimination, reducing biofilm in all positive patients at baseline, and showcased a remarkable 64% reduction in bacterial load, validating its infection-fighting capabilities. These findings underscore the opportunity for Bromelain to address the intricate challenges associated with chronic wounds, offering hope for enhanced patient outcomes.

TRANSITIONING TO HOME-BASED WOUND CARE

Looking to the future, wound care is shifting from clinic-based treatment towards a home-based model. Ensuring accessibility to quality care is crucial as individuals face barriers due to factors like geography, transportation, or health limitations. Individual patient preferences, particularly among those managing chronic or delicate conditions, are also driving the move to home-based care. This shift will ultimately create a more conducive healwww.hospitalnews.com

WOUND CARE ing environment and prove cost-effective by cutting clinic visits, relieving economic burdens on both patients and the healthcare system. A key advantage of enzymatic debridement t is that it can be applied at home. This can be transforming for those who face logistical challenges or are too ill to return to the clinic for treatment, or are not candidates for sharp debridement due to poor vascularity or other underlying comorbidities. The ability to treat wounds effectively at home may not only accelerate the healing process

but also offer a more cost-effective alternative to traditional clinic-based treatments.

FURTHER INNOVATIONS IN WOUND CARE

The future of wound care is not limited to enzymatic solutions alone. Other technological innovations are emerging as valuable allies in the battle against chronic wounds. Diagnostic tests for protease activity and bacterial loads, along with devices like molecular florescence and microvascular testing, enable healthcare profession-

als to make more informed decisions at the bedside, reducing reliance on laboratory analyses. One of the most promising trends is the potential for replacement of antibiotics with genetic markers. This innovative approach could lead to a targeted therapy cocktail, addressing infections more effectively and mitigating concerns around antibiotic resistance. The prospect of genetic markers signals a paradigm shift in how we combat infections and underscores the need for continued exploration in wound care research.

The wound care industry is evolving, and enzymatic debridement is at the forefront of this revolution. Bromelain-based solutions offer the treatment that practitioners need, delivering faster healing times, reduced biofilm, supporting robust granulation tissue, and transitioning towards home-based care. As we step into this new era of wound care, the combination of enzymatic therapies and technological advances hold the key to unlocking unprecedented possibilities for patients and healthcare H professionals alike. n

Dr. Robert J. Snyder (DPM, MSc, MBA, CWSP, FFPM RCPS) is Dean, Professor, Director of Clinical Research and Fellowship Director in Wound Care and Research at Barry University School of Podiatric Medicine. He is certified in foot and ankle surgery by the American Board of Podiatric Surgery and is also a board-certified wound specialist. Dr. Snyder is past-president of the Association for the Advancement of Wound Care and past-president of the American Board of Wound Management.

Flap closure R cheek with irradiated polyglactin 910 and rapidly absorbing gut, 2 months post-operative

Flap closure R cheek with irradiated polyglactin 910 and rapidly absorbing gut, 6 months post-operative

Continued from page 24

Scar prominence “Facial scars can cause people to be insecure about how others may view them when out in public.” Indeed, prior studies have shown that scars can have a significant impact on a person’s well-being and quality of life. Because our face is so closely linked to our identity, there can be substantial fear among patients that a facial scar could change how they are perceived, negatively impacting their self-confidence and quality of life.

FACT VERSUS FICTION IN SUTURE MATERIAL SELECTION

Zloty and his research team tested the postoperative erythema of 210

patients who had undergone surgery to remove facial lesions diagnosed as non-melanoma skin cancer, which occurs on cells located in the outer layer of the skin. The three most common of such skin cancers are basal cell carcinoma, squamous cell carcinoma and lentigo maligna, says Zloty. “This is likely the first study to quantify scarring redness following the use of different suture materials on the face.” Photographs taken of patients’ scars one week, two months and six months following surgery were assessed and graded by level of redness using computer-assisted image analysis software. None of the three suture materials showed any statistically significant

difference in scar erythema, dispelling the myth that nylon sutures lead to better long-term scarring outcomes. Zloty believes that these results could have widespread implications on suture selection and patient care. Most patients with absorbable sutures do not need to return to a physician’s office to have their sutures removed, and often prefer saving themselves this additional trip to the clinic. However, patients with nylon sutures must book a follow-up appointment to have them removed. “While nylon sutures cost around half the price of the absorbable sutures tested in this study, the few dollars of cost difference is substantially less than the cost of physician and staff time, along with the inconvenience to the patient of a return

visit to the clinic for suture removal,” Zloty explains. “Reducing the number of return visits without compromising overall cosmetic results for patients can be a net positive benefit to patients and the health care system.” One challenge that the research team faced was limitations on demographic variation within the pool of candidates available to include in their study. For example, most of the patients assessed were light-skinned and older, with an average age of 65 years. “This is the demographic most likely to present with non-melanoma skin cancer,” notes Zloty. “Further research is needed to examine scarring outcomes from different suture types on people of varying H ages and skin colours.” n

Sarah Ripplinger is a senior writer for Vancouver Coastal Health Research Institute www.hospitalnews.com

FEBRUARY 2024 HOSPITAL NEWS 27

NEWS

Inside Unity Health’s efforts to better understand the care experience By Robyn Cox

Jamar Stanton, a patient experience coordinator, does a Real-time Feedback interview with a patient on Providence’s Orthopedic and Amputee unit.

t was around lunchtime and the Geriatric and Medical Rehabilitation unit at Providence was bustling. Jamar Stanton, a patient experience coordinator, had stepped into a patient room to ask a patient about his experience at the hospital when the patient let Stanton know that they were hungry. The lunch being served that day wasn’t to their taste, but the patient’s family had prepared them meals for such occasions. Noticing how busy the unit was, Stanton took it upon himself to find the patient’s food in the unit fridge and heat it up for them. “They were able to eat it and really enjoyed it,” recounts Stanton. “I was happy to do that myself and the patient was very grateful and appreciative of that as well.” This happened during an interview Stanton was doing as part of Unity Health’s Real-time Feedback program. Stanton and his counterparts at St. Joseph’s Health Centre and St. Michael’s Hospital go to various units once a month to interview patients, learn about their care experience and get feedback that is delivered back to the units on the very same day. “Our goal is to give patients a voice, to let them be heard and to strive for improvement,” says Stanton. “A lot of patients are glad to be given that opportunity, even if it’s just to say you guys are doing a great job.” Stanton has been doing Real-time Feedback program interviews since February 2023. He can recount many instances where he has directly contributed to a better experience for a patient, or where he has passed along feedback that likely wouldn’t be surfaced otherwise. “We definitely have a positive impact on people’s care,” says Stanton, speaking of himself and his fellow patient experience coordinators. Results from the Real-time Feedback program have been overwhelmingly good, with patients responding positively to 94 per cent of all questions in the interviews.

“OUR GOAL IS TO GIVE PATIENTS A VOICE, TO LET THEM BE HEARD AND TO STRIVE FOR IMPROVEMENT.” Caroline Monteiro, patient care manager, and Tiffany Nicoloff, clinical operations lead, work together on the Orthopedic and Amputee unit at Providence. Both were part of the working group that helped bring the Real-time Feedback program to life. “It provides some validation to the staff that they are doing a good job, especially given how busy it’s gotten throughout the pandemic,” says Nicoloff. “It shows the staff that what they’re doing is meaningful to patients,” adds Monteiro. “And for that small percentage of patients where we didn’t meet their expectations, it opens up an opportunity for quality improvement.” The Real-time Feedback program is live on ten different units at Unity Health with plans to spread the program even further across the organization.

28 HOSPITAL NEWS FEBRUARY 2024

MEASURING TO IMPROVE

The Real-time Feedback program is one part of a broader Care Experience Measurement Framework. Recognizing an opportunity to gather more comprehensive data on the care experience at Unity Health, the Patient Experience and Engagement team began updating the surveys and surveying methods across the network in 2020. Patrick Soo, a project manager who has been leading much of this work, highlights the importance of partnering with patients and families. “We have had patient and family partners involved from the beginning to help co-develop all of the surveys,” says Soo. “Also foundational to all of our work is having all the survey and

interview questions aligned to Unity Health’s Care Experience Charter.” The Care Experience Charter is Unity Health’s road map to creating excellent care experiences together with patients and residents at the network. It was co-created by Unity Health and its patient, resident and family councils. Currently, the Patient Experience and Engagement team coordinates surveys for inpatients at all three sites, where patients receive a call after their discharge. They also do surveys for outpatients at the three sites and Emergency Department (ED) patients at St. Joseph’s and St. Michael’s, where patients receive a call or email after their visit. In October, they began in-person interviews with residents of the Houses of Providence long-term care home. Unity Health response rates for these surveys are quite good – 50 per cent for inpatients, 40 per cent for outpatients and 30 per cent for ED patients. These response rates are up 20 per cent or more when compared www.hospitalnews.com

NEWS to the network’s previous survey vendor. Adding the Real-time Feedback program has helped to give units more insight into the patient experience at different points in the care journey and provides an opportunity to course correct a patient’s experience before they leave. This is an opportunity Unity Health has not had in the past. “The real-time patient data allows us to capture patients throughout the spectrum of their journey, whether at admission, they’re midway or they’re close to discharge,” says Monteiro. The data for each clinical area is summarized and reported back to leaders so they can identify issues, create solutions and monitor their progress.

CREATING MORE EQUITABLE CARE

Unity Health is also taking a thoughtful approach to collecting data about who its patients are – such as how they identify and their education and income levels – as part of the surveys for inpatients and outpatients that are

completed after their hospital stay or visit. These additional questions were developed in partnership with Unity Health’s Office of Anti-Racism, Equity and Social Accountability and in alignment with partners at Ontario Health. The goal is to understand what the experience is like for specific groups of patients and identify opportunities for improvement that might be missed if the organization only looked at the data as a whole. “It’s the whole tenet for our vision – The best care experiences. Created together,” says Soo. “We don’t know if we’re creating the best care experience for everyone unless we know who they are. This is our first step to actualize on that.” This work is setting Unity Health apart as a leader in the field of patient experience measurement in Canada. They have even run a session for their counterparts in the field, hosted by the Ontario Health Association. For Soo, it all comes back to the impact that this work has on patients, residents and their families.

“During post-discharge survey phone calls for inpatients some people will say, ‘Oh, I remember speaking with someone on the floor and then, after they left, the care team came

and talked with me and everything got better,’” describes Soo. “Being able to contribute to a better experience for the patients is really a rewarding H experience to have.” n

Robyn Cox works in communications at Unity Health.

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FEBRUARY 2024 HOSPITAL NEWS 29

SAFE MEDICATION

Orthostatic hypotension: Considerations of safe medication use By Huy Pham, Samir Kanji, and Certina Ho lood pressure is the amount of pressure applied by circulating blood to blood vessels. The measurement and assessment of blood pressure is based on the values for the systolic blood pressure (top number) and the diastolic blood pressure (bottom number). Systolic blood pressure is the maximum pressure exerted on blood vessels during a contraction of the heart, while diastolic blood pressure is the minimum pressure exerted in between heart contractions. The ideal blood pressure varies depending on factors like the risk of heart disease and other medical conditions (e.g., diabetes), but the target blood pressure for most people is a systolic pressure of ≤ 140 mm Hg and a diastolic pressure of ≤ 90 mm Hg (i.e. below 140/90 mm Hg).

WHAT IS ORTHOSTATIC HYPOTENSION?

Orthostatic hypotension (OH) is defined as the decrease in systolic blood pressure by ≥ 20 mm Hg or diastolic BP of ≥ 10 mm Hg after moving from a sitting or kneeling position to a standing position. OH occurs due to an inability to compensate and stabilize the reduction in blood pressure after assuming a standing position. The clinical features include weakness, fatigue, light-head-

IF INDIVIDUALS THINK THEY MAY HAVE OH OR ARE DIAGNOSED WITH OH, IT IS IMPORTANT FOR THEM TO TAKE AN ACTIVE ROLE IN DISCUSSING THEIR CONDITION WITH HEALTHCARE PROFESSIONALS. THE INITIAL STEP INVOLVES LEARNING ABOUT OH, INCLUDING WHAT SIGNS AND SYMPTOMS IT MAY BRING, AND WHAT MIGHT BE THE CAUSE OF OH. edness, dizziness, blurred vision, and loss of consciousness. Patients may also present with confusion, orthostatic dyspnea (shortness of breath), neck and shoulder pain, headaches, or chest pain. Since most patients with OH do not experience symptoms or present with few non-specific symptoms, it has a high rate of underdiagnosis. Risk factors for OH include volume depletion due to fluid loss like vomiting, disorders affecting the autonomic nervous system such as Parkinson’s disease and autonomic neuropathies (nerve damage that affects autonomic bodily function), adrenal insufficiency (an inability of adrenal glands to produce steroid hormones), and advanced age. OH is a risk factor for falls and subsequent reductions in quality of life, especially for the elderly population where an estimated 30–70 per cent of older adults are affected by OH. In addition, OH is associated with an increased risk of all-cause mortality and adverse cardiovascular and cerebrovascular events like heart failure and stroke.

DRUG-INDUCED ORTHOSTATIC HYPOTENSION

OH is also a common side effect associated with numerous medications, with over 250 drugs (https://doi.org/10.1371/ journal.pmed.1003821) be-

ing known to contribute to its occurrence. Among these medications are those prescribed for conditions like diabetes, depression, and enlarged prostates. Some drug classes, such as beta blockers (e.g., atenolol, metoprolol) and tricyclic antidepressants (e.g., amitriptyline, nortriptyline), are strongly associated with a six- to seven-fold increased risk of OH. Medications causing OH typically operate through mechanisms that induce a drop in blood pressure upon standing. For example: • Alpha blockers, which are commonly used for enlarged prostates, dilate peripheral blood vessels. • Beta blockers, which are typically prescribed for high blood pressure and heart conditions, interfere with the baroreceptor reflex, a vital mechanism in blood pressure regulation. • Diuretics, mostly used for managing heart failure and high blood pressure, cause reduced blood return to the heart or dehydration and electrolyte imbalance, which can then affect the blood volume. • Tricyclic antidepressants can delay orthostatic reflexes that are crucial for maintaining blood pressure when standing.

CONSIDERATIONS OF SAFE MEDICATION USE

Effective management strategies for OH encompass medication ad-

justments, gradual position changes, increased fluid intake, and the use of compression stockings. Adjusting the dosage of a blood pressure medication, or other medications causing OH, can mitigate blood vessel dilation effects. Slow position changes (for instance, advising patients to rise gradually) will allow the body’s autonomic mechanisms to respond more effectively. Encouraging increased fluid intake helps maintain adequate blood volume, while the use of compression stockings reduces venous pooling by applying external pressure to the legs, enhancing venous return.

WHAT CAN PATIENTS DO?

If individuals think they may have OH or are diagnosed with OH, it is important for them to take an active role in discussing their condition with healthcare professionals. The initial step involves learning about OH, including what signs and symptoms it may bring, and what might be the cause of OH. Maintaining a symptom diary that details when symptoms occur, their duration, and potential triggers will help articulate symptoms to healthcare providers. Effective communication is crucial for informed clinical assessments and decision-making. Regular blood pressure monitoring and thorough medication reviews with healthcare providers (e.g., pharmacists) are essential. Regular blood pressure monitoring can assist in detecting and addressing changes, especially after medication adjustments. Open communication with pharmacists is strongly encouraged. The “5 Questions to Ask About Your Medications” (https://www.ismp-canada.org/medrec/5questions.htm) is a handy resource that help facilitate a dialogue between patients and caregivers with their health care providers H about medications. n

Huy Pham and Samir Kanji are PharmD Students at the Leslie Dan Faculty of Pharmacy, University of Toronto; and Certina Ho is an Assistant Professor at the Department of Psychiatry and Leslie Dan Faculty of Pharmacy, University of Toronto. 30 HOSPITAL NEWS FEBRUARY 2024

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NEWS Continued from page 19

Quality care

Prior to SCOPE, PCPs in Humber’s catchment area struggled to access certain care pathways and supports, which ultimately increased avoidable visits as patients sought timely services through the ED. Now, more patient needs can be addressed through SCOPE. The program also takes a holistic approach to educating and informing patients so that future ED visits can be avoided. By coordinating alternative care pathways for patients, SCOPE facilitates heightened awareness of available health resources, amplifies access to specific services like essential tests, imaging, or referrals, and even helps patients navigate different healthcare processes.

INCREASING ACCESS TO EQUITABLE CARE

The informative approach and care facilitated by SCOPE increases access to equitable, team-based care and spe-

cialists. This is particularly important as Humber serves an equity-deserving community that continues to experience a lack of access to primary care and social support services. By supporting PCPs, SCOPE ensures that patients continue to get the care they need, when and where they need it. In response to these needs, SCOPE enhanced its Mental Health Pathway to include patient access to Mental Health Social Workers to provide short-term service navigation and information on available resources.

FOSTERING COLLABORATION IN HEALTHCARE

The positive impact of the program on PCPs and patients within our community is a result of collaboration among healthcare experts and would not be possible without Humber’s dedicated SCOPE team.

Beatrise Edelstein, Vice President of Post-Acute Care and Health System Partnerships at Humber led the implementation, and evaluation of SCOPE, and provides ongoing strategic leadership, advocacy, and stakeholder engagement to ensure its continued success. The program also benefits from the thoughtful and strategic management of Kathleen Kirk, and PCPs registered in SCOPE are supported by the expertise of our Nurse Navigators, Mehwish Ali and Kris-Ann Simpson. The insight and direction of Dr. Patrick Safieh, Primary care SCOPE Lead and Dr. Andrew Duncan, General Internal Medicine SCOPE Lead, is imperative to the growth of the program. Dr. Safieh and Dr. Duncan integrate their personal experiences as physicians to ensure we are aligning the trajectory of SCOPE to the most pressing needs of physicians. Together with the program’s governance inputs, including an Advisory

Committee and the continual assessment and feedback of additional staff and physicians, Humber’s SCOPE team is making a profound difference in the lives of both PCPs and patients. This collaborative approach encourages interdisciplinary teams to actively participate in shaping patient care strategies, share insights, and contribute to continuous improvement. This engagement ensures that SCOPE remains a dynamic and evolving force in Humber’s care approach, fostering a culture of innovation and excellence. In the realm of healthcare, the power to expedite care is transformative, especially when it offers answers to patients during their most vulnerable moments. SCOPE is a testament to the power of collaboration in healthcare, and it’s helping Humber deliver innovative, safe, and equitable healthH care to every patient, every time. n

Shahana Gaur is a communications specialist at Humber River Health.

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