Hospital News June 2021 Edition

Special: Canadian Society of Hospital Pharmacists Inside: From the CEO’s Desk | Evidence Matters | Safe Medication

June 2021 Edition

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Seniors need more.

For decades, Ontario’s nurses have been warning about dangerous, chronic problems in long-term care. Two new official reports confirm what we’ve been saying.

Here’s what needs to happen: • Ensure every resident receives four hours of direct care every day.

• Of those four hours, 20% should be provided by RNs, 25% by RPNs, and 55% by PSWs - and must be enshrined in the Long-Term Care Homes Act. • There should be one Nurse Practitioner for every 120 residents.

• Create more full-time positions to ensure staffing levels that meet residents’ needs.

The pandemic has made it abundantly clear: our seniors deserve better.

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Contents June 2021 Edition

IN THIS ISSUE:

Dispatches from the front line: UHN’s Pandemic Response

14

▲ Cover story: Imagining health leadership after the pandemic

16

▲ Canadian Society of Hospital Pharmacists

18

▲ Vaccinating in a COVID-19 Hotspot: The challenges and rewards

COLUMNS Editor’s Note ....................4 In brief .............................7

12

Safe medication ............32 Evidence matters ...........33

▲ Telerehabilitation is here to stay – are you optimizing your delivery?

13

Ethics .............................34 From the CEO’s desk .....35

▲ The CABHI Summit 2021

37

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JUNE 2021 HOSPITAL NEWS 3

Window of opportunity for feds to address healthcare deficits

By Sarah Watts-Rynard eadlines across Canada and around the world continue to be filled with news of shutdowns, widespread economic chaos and the race to vaccinate. Where we once defaulted to small talk about the weather, conversation has turned to daily case counts, ICU beds and vaccination statistics. Health has become a national obsession, with all signs suggesting it will remain so until the pandemic fades into memory.

That’s why now is the right time to talk about – and invest in – the future of Canada’s healthcare system.

For many years, investing in healthcare was a matter of boosting federal transfers to the provinces. Not terribly exciting in terms of advancing national policies or programs but, rather, a way to buy short-term peace within the federation. The COVID-19 pandemic has opened the door to something more.

Lessons from the pandemic point to two structural issues that are well within the federal government’s capacity to address: Canada’s system of long-term care and challenges within the healthcare talent pipeline. The current environment opens a window to fresh policy action and a renewed federal/provincial partnership on healthcare.

First, the pandemic has laid bare the fault lines in Canada’s long-term care system. Staffing was inadequate to meet the needs of seniors in care when family access was restricted. By all accounts, personal protective equipment was insufficient and the need for it poorly understood. As a result, those with compromised immune sys-

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tems and pre-existing health conditions – the very group long-term care is designed to support – died at alarming rates.

With a Canadian population that is living longer, eldercare is a reality with which the federal government must grapple. Now is the time to activate and empower the Minister of Seniors to set national standards of care and employee training for senior living facilities. These actions would be appropriate and well-timed, not to mention welcomed by countless families who were denied the ability to visit, advocate for or support their loved ones over the past year.

If there were a federal will, there is no shortage of capacity. Polytechnic institutions, for example, have dedicated applied research expertise in eldercare and healthy aging. They are also the foremost education providers for a workforce that is well-trained and certified, rather than ad hoc and under-prepared.

While a number of the issues surrounding eldercare relate to training standards, the government needs to think bigger. Frontline workers across all health fields have been pushed to their limit for more than a year, with each subsequent wave of the pandemic accompanied by a host of new challenges.

Part of the solution lies in a much greater emphasis on professional development and upskilling. While the same can be said across sectors, the healthcare field is a critical case in point. At Polytechnics Canada, we are hearing about micro-credentials to activate a vaccination workforce and upskilling for critical care nurses.

Continued on page 6

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Monthly Focus: Cardiovascular Care/Respirology/Diabetes/ Complementary Health:Developments in the prevention and treatment of vascular disease, including cardiac surgery, diagnostic and interventional procedures. Advances in treatment for various respiratory disorders, including asthma and allergies. Prevention, treatment and long-term management of diabetes and other endocrine disorders. Examination of complementary treatment approaches to various illnesses.

Monthly Focus: Paediatrics/Ambulatory Care/Neurology/ Hospital-based Social Work: Paediatric programs and developments in the treatment of paediatric disorders including autism. Specialized programs offered on an outpatient basis. Developments in the treatment of neurodegenerative disorders (Alzheimer’s, Parkinson’s etc.), traumatic brain injury and tumours. Social work programs helping patients and families address the impact of illness.

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NEWS

First-in-Canada trauma recovery clinic opens at Sunnybrook

By Sybil MIllar fter years of planning and months of renovations, a new clinic that aims to improve long-term outcomes for trauma patients has opened its doors at Sunnybrook Health Sciences Centre.

The Jennifer Tory Trauma Recovery Clinic, the first clinic of its kind in Canada, will provide an innovative model of follow-up care for trauma patients navigating a new reality that can often include a combination of physical disability, pain, mental illness and impaired cognitive function.

“For many of our trauma patients, leaving the hospital is just the beginning of a long and challenging recovery process. Centralizing their follow-up care in the Jennifer Tory Trauma Recovery Clinic will help better prepare them for life outside the hospital,” says Dr. Avery Nathens, Medical Director of Trauma and Surgeon-in-Chief at Sunnybrook who also led the development of the clinic alongside his colleagues in the Tory Trauma Program.

Until now, a trauma patient who had been discharged but still required

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follow-up with multiple care providers would have needed to visit several different areas of the hospital.

The Jennifer Tory Trauma Recovery Clinic will instead bring those care providers to the patients in a purpose-built space consisting of five exam rooms, a dedicated registration and waiting area, staff workstations and equipment areas, and a meeting room that can support virtual appointments if needed.

Accessible features have also been incorporated into the clinic, such as doorways wide enough to accommodate wheelchairs and stretchers.

“Having this dedicated space will help us ensure patients are getting the support they need during their recov-

ery and follow-up process,” says Corey Freedman, Manager of Trauma Services at Sunnybrook.

Dr. Nathens says the interprofessional nature of the clinic means that staff from across the hospital will be working with patients in the new space, including care providers from physiotherapy, occupational therapy, social work, physiatry, psychology, clinical psychiatry and pain services.

“As an example, surgeons might not know what to do if a patient has post-traumatic stress disorder after their injury or is asking for more opioids to help with their pain. Having access to all of that expertise in the clinic will be helpful for both the care providers and the patients,” he says.

The clinic will be managed by Grace Walter, who is also the patient care manager of Sunnybrook’s trauma unit, to ensure a smooth transition from inpatient to outpatient care.

“We will follow trauma patients for a year after they are discharged from Sunnybrook, with the ultimate goal of helping patients transition back to their home community for ongoing support,” says Walter.

The clinic was made possible thanks to a leadership gift by Jennifer Tory, which has since inspired other donors to provide support.

Jennifer’s support for trauma recovery follows her family’s long history of involvement with Sunnybrook, and in particular the Tory Trauma Program, Canada’s first and largest trauma centre. Her parents, John and Liz, are benefactors of the John A. Tory Family Regional Trauma Centre at Sunnybrook and other critical programs.

Jennifer’s own dedication to Sunnybrook began at an early age, when she was a candy striper. She is a passionate leadership volunteer and a long-time member of the Sunnybrook FoundaH tion Board of Directors. ■

Sybil Millar works in communications at Sunnybrook Health Sciences Centre

Thank you from Nursing Hero winner Ordia Kelly I would like to thank you all for your kind words and I am humbled by such a nomination and award.

To be acknowledged as a Nursing Hero leaves me overwhelmed and in shock but I remain grateful and full of appreciation for this honour and for such a moment as this.

I always aim to do my best because I love being a Nurse. I accept this honour on behalf of everyone on our team because I could not have done it without the support of my coworkers. www.hospitalnews.com

I am appreciative of a workplace that allows me to aim for excellence in my daily duties as a nurse and the opportunity I was given to lead a team with many outstanding professionals.

Most of all I want to thank God for giving me the strength, courage and guidance to do what I do best.

H To God be the Glory! ■ With sincere thanks and gratitude, Ordia Kelly RN

JUNE 2021 HOSPITAL NEWS 5

NEWS

Reducing healthcare-related PPE and medical single-use plastic waste THE COALITION AND OUR COLLABORATORS WILL CONDUCT IMPORTANT FIRST-PERSON I RESEARCH THAT CAN INFORM THE SECTOR n order to keep Canada’s health care workers safe and provide care in hospitals during the COVID-19 pandemic, the use of personal protective equipment (PPE) and medical single use plastics (mSUPs) increased significantly. At the same time, numerous challenges emerged during the pandemic which reduced access to PPE, mSUPs and other medical products.

A newly launched project, of the Canadian Coalition for Green Health Care (Coalition), Reducing Health Care-Related PPE and Medical Single Use Plastic Waste Through Circular Economy Principles, will demonstrate that hospital-generated PPE and mSUP materials can be successfully managed by applying the principles of a circular economy: reduce, reuse and recycle as much as possible before the materials are disposed. The project will demonstrate

ON BEST PRACTICES FOR PPE WASTE MANAGEMENT.

that waste PPE can be collected, stored and transported to a designated recycling facility operated by an industry partner. In addition, PPE and selected mSUPs reuse and reduction opportunities will be identified which will complement and further enable resource conservation.

“The Coalition and our collaborators will conduct important first-person research that can inform the sector on best practices for PPE waste management. It will also help develop operational expertise among the various stakeholders engaged in the

Healthcare deficits Continued from page 4 Investments in upskilling and reskilling must be viewed as much a health issue as a workforce training priority. It isn’t enough for the courses to exist – Canadian workers need to be encouraged, supported and navigated to high-quality continuing education.

Another important way to support the current healthcare system is to enable the efficient entry of new graduates.

While late-stage students in many vital health fields made an accelerated entry into the healthcare workforce last spring, the learners behind them have struggled to find the practicums and placements critical to earning their professional designations. Work-integrated learning opportunities didn’t dry up for lack of work, but because of an overwhelmed system without the resources to offer hands-on experience to students.

Polytechnic institutions found creative ways to continue hands-on and applied learning in a largely remote environment, but investments in post-secondary digital infrastructure – simulators, augmented and virtual reality, high-tech labs and smart classrooms – will go a long way to ensuring new entrants are work-ready in high demand fields. In addition to providing teaching and learning solutions in the time of a pandemic, such investments lay the groundwork for a future that includes digital and remote healthcare.

While most Canadians will be grateful when the pandemic is over and behind us, we shouldn’t lose sight of the opportunities to address deficiencies identified in the last year. Without a doubt, one of the most important is a reimagined federal/provincial partnership for the H health and welfare of Canadians. ■

Sarah Watts-Rynard is CEO of Polytechnics Canada.

6 HOSPITAL NEWS JUNE 2021

acquisition, use/re-use, recycling and disposal of PPEs and selected mSUPs,” says Coalition Executive Director Neil Ritchie. “Ultimately, we hope to demonstrate that applying a circular economy lens to purchasing decisions in hospitals can both save money and our planet.”

Hospital partners include GreenCare, managed by British Columbia’s Energy and Environmental Sustainability team, a shared service supporting BC’s Lower Mainland health organizations and a leader in considering circular economy applications in health care, and Toronto’s University Health Network (UHN), both of which have award-winning environmental sustainability programs and have demonstrated leadership in these areas.

To learn more about the Coalition’s new PPE/mSUP initiative, please visit the website at: https://greenhealthH care.ca/ppe-msup ■

Dialysis patients do not develop adequate antibodies with one dose of SARS-CoV-2 vaccine ew research in CMAJ (Canadian Medical Association Journal) shows that most hemodialysis patients do not develop adequate antibodies after their first dose of SARSCoV-2 vaccine.

“We advise that the second dose of the BNT162b2 [Pfizer] vaccine be administered to patients receiving hemodialysis at the recommended threeweek time interval, and that rigorous SARS-CoV-2 infection prevention and control measures be continued in hemodialysis units until vaccine efficacy is known,” writes Dr. Rita Suri, a nephrologist at the Research Institute of the McGill University Health Centre, Montreal, Quebec, with coauthors.

Patients receiving hemodialysis are especially vulnerable to COVID-19 as they must leave their homes three times a week for dialysis at a health care facility, and case fatality rates are 20-30 per cent, which is 10 times higher than in the general population.

The study included 154 patients receiving hemodialysis in Quebec (135 without and 19 with prior SARSCoV-2 infection), 40 healthy volunteers (20 without and 20 with prior

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SARS-CoV2 infection) and convalescent plasma from 16 dialysis patients who survived COVID-19. Researchers measured antibody levels in the participants and found dialysis patients who were never previously exposed to COVID-19 had lower antibody levels than participants in the two control groups, even up to eight weeks later.

Antibodies were undetectable in 57 per cent of patients receiving hemodialysis. Of the 154 patients receiving dialysis, four developed COVID-19 after vaccination.

“Patients receiving hemodialysis who did not respond at four weeks remained non-responders at eight weeks, which is an argument against the possibility of a delayed response in these individuals.

Older patients and those on immunosuppression had even lower seroconversion rates, but even younger patients not on immunosuppression had a significantly lower seropositivity rate than controls,” write the authors. How well dialysis patients respond to the second dose of vaccine is being studied.

“Short-term antibody response after 1 dose of BNT162b2 vaccine in patients receiving hemodialysis” was H published May 12, 2021. ■ www.hospitalnews.com

IN BRIEF

Physicians must be aware of potential VITT after SARS-CoV-2 adenoviral vector vaccines ll doctors should consider vaccine-induced immune thrombotic thrombocytopenia (VITT) in a patient who develops blood clots and low platelets after receiving a first dose of the ChAdOx1 nCOV-19 (Oxford-AstraZeneca) vaccine, physicians write in a case study in CMAJ (Canadian Medical Association Journal).

The authors describe the case of a 63-year-old man who developed VITT after receiving his first dose of the ChAdOx1 nCoV-19 vaccine. His symptoms began 20 days after receiving it. He presented to an emergency department with thrombocytopenia (low blood platelets) and extensive thrombosis (blood clots) in his leg and lungs. The patient required emergency vascular surgery.

“We suspected vaccine-induced immune thrombotic thrombocytopenia (VITT) based on ongoing postoperative bleeding, new digital thrombosis

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VITT CAN OCCUR IN MEN AND WOMEN OF ANY AGE, RATHER THAN ONLY IN YOUNGER WOMEN, AS THOUGHT INITIALLY. and thrombocytopenia,” writes Dr. Paul Petrasek, a vascular surgeon at the Peter Lougheed Centre and the Cumming School of Medicine, University of Calgary, with coauthors.

The case report summarizes the latest approach to the diagnosis and treatment of VITT and explains the current understanding of how VITT can cause life- or limb-threatening thrombosis. It adds to a growing body of literature recognizing that VITT can occur in men and women of any age, rather than only in younger women, as thought initially. The authors indicate that most cases of VITT have been described in patients who received the ChAdOx1 nCoV-19 vaccine, but a smaller number have been reported

in patients who received the Ad26 CoV2.S (Johnson & Johnson-Janssen) vaccine.

A related commentary provides additional guidance on how to detect and treat VITT, and emphasizes vigilance, the importance of treating as soon as the presumptive diagnosis of VITT is made and the need for clinicians to be aware of which confirmatory tests to order. The authors indicate that the current best estimate of the frequency of VITT after the first dose of the ChAdOx1 nCoV-19 vaccine is between 1 in 26,000 and 1 in 127,000. No case of VITT has been reported after receiving an mRNA vaccine.

“Given the serious clinical consequences of VITT, clinicians must

maintain a high index of suspicion for VITT in patients presenting with symptoms suggestive of thrombosis in any vessel within 30 days of administration of an adenoviral vector SARSCoV-2 vaccine, despite its low incidence,” writes Dr. Michelle Sholzberg, a hematologist at St. Michael’s Hospital, Unity Health Toronto, and the University of Toronto, with coauthors.

Symptoms of VITT can include severe and persistent headache; blurred or double vision; weakness on one side or change in sensation; chest, abdominal, leg or back pain; leg swelling; and shortness of breath.

“Early diagnosis is more likely if clinicians inquire about the type and timing of SARS-CoV-2 vaccination as part of standard history taking. Clinicians should seek expert consultation early and consider transfer to a centre that can provide critical care and specialized immunohematology care,” the H authors write. ■

JUNE 2021 HOSPITAL NEWS 7

NEWS

Researchers team up with Diagnostics Biochem Canada to study COVID-19 esearchers at Lawson Health Research Institute (Lawson) and Western University have teamed up with local biotech company, Diagnostics Biochem Canada Inc. (DBC), to help us better understand COVID-19 and the body’s immune response to the infection.

A recently published study followed 28 critically ill patients at London Health Sciences Centre (LHSC); 14 who tested positive for COVID-19

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and 14 who tested negative. They also followed 14 mildly ill non-hospitalized patients with COVID-19 and 14 healthy controls. The researchers tracked their body’s immune responses and found that all COVID-19 positive patients had a robust antibody response to the infection, even those with poorer outcomes.

“Our previous research showed that in severe cases of COVID-19, the body produces what’s called a cytokine

storm, or an intense, initial immune response. However, in this new study, we observed that after a few days and weeks in critical care, the body produced a later, humoral antibody response that is equivalent to what we would expect with any similar infection,” explains Dr. Douglas Fraser, lead researcher and Critical Care Physician at LHSC. Patients with COVID-19 reacted to the infection and produced ample

More than 400 people helped show UHN we

Give a Shift

ore than 400 people and 40 teams participated in Give a Shift this past weekend to honour UHN’s healthcare heroes in an incredible first-of-itskind virtual fundraising event.

Over three days, participants spent 12 hours completing tasks and challenges to give them a glimpse into the life of a healthcare worker – all in support of UHN. The event raised more than $250,000 coming from more than 1,200 donations.

VIRTUAL FUNDRAISING EVENT RAISES MORE THAN $250,000 FROM MORE THAN 1,200 DONATIONS TO SUPPORT FRONTLINE HEALTHCARE WORKERS BATTLING COVID-19.

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Funds raised through Give a Shift will directly support frontline workers as they battle the third wave of COVID-19, providing them with meal vouchers and mental health support, among other things, so they can care for themselves while caring for others.

We’d like to thank everyone who participated in this event, who demonstrated their gratitude for UHN’s healthcare heroes, and made a lasting impact on the lives of patients. You ensure we can continue our mission to H build a healthier world for all. ■

This article was submitted by UHN News.

Photo credit UHN foundation

8 HOSPITAL NEWS JUNE 2021

anti-SARS-CoV-2 antibodies, including those who passed away. This finding suggests that blunted immune responses – when there is a lack of antibody production – did not contribute to mortality. Dr. Fraser says that based on their data, the focus of treatment should shift to combatting the viral load a person receives, and the body’s more immediate reaction to the infection.

THE RESEARCHERS TRACKED THEIR BODY’S IMMUNE RESPONSES AND FOUND THAT ALL COVID-19 POSITIVE PATIENTS HAD A ROBUST ANTIBODY RESPONSE TO THE INFECTION, EVEN THOSE WITH POORER OUTCOMES. This research was made possible through a collaboration between Lawson, Western and DBC, with DBC providing the serological testing kits.

“DBC was the first Canadian company to launch Health Canada-authorized serological tests for COVID-19 and we are happy that our scientists have been working with Lawson on this important study. We look forward to continuing this collaboration and supplying Canadian labs with much needed serological tests,” says Manon Hogue, CEO at DBC. Analyzing serum antibody levels using a blood test could help improve patient outcomes by allowing early identification of who may require certain treatments, and guide decisions around patient cohorting. In addition, serological testing allows for viral surveillance and its immunity in the community.

The study, “Critically Ill COVID-19 Patients Exhibit Anti-SARS-CoV-2 Serological Responses,” is published H in the journal Pathophysiology. ■ www.hospitalnews.com

NEWS

Rapid access to world class surgical care for patients requiring orthopaedic care

By Michelle Lee Hoy touffville Hospital (MSH) has enhanced its capabilities to provide orthopaedic care at both its Markham and Uxbridge sites, bringing the very best in surgical care to these communities and their residents.

MSH has been able to maintain close to full surgical volumes, operating at 85-90 per cent capacity over the past year thanks to advanced, careful planning and infection control considerations to ensure that patients receive the treatment they need without further delays brought on by the pandemic. Part of this planning included resourcing additional physical space and staff to ensure all pandemic protocols could be followed while at the same time continuing to deliver care to patients with minimal disruptions to operations. This led to the expansion of the Orthopaedic Joint Assessment Centre (OJAC) at the Markham site and the opening of a satellite surgical clinic at the Uxbridge site.

“Thanks to the generosity of our donors, we were able to expand and refresh our OJAC space to increase our capacity to care for patients in a timelier manner,” says Erin Landry, patient care director of surgical services, Markham Stouffville Hospital.

“More space means we can bring in additional staff to provide a wider range of services in one space as needed, thereby reducing patient wait times and giving them the answers, treatment and relief they so desperately need as soon as possible and as conveniently as possible.”

At the Markham site, seven months were spent redeveloping OJAC to include additional existing square footage from another working space, adding another 11 clinic rooms for dedicated orthopaedic care and consultations. This new OJAC space allows for a more holistic offering for orthopaedic patients, including: rapid access to see an advance practice phys-

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MSH IS THE FIRST HOSPITAL IN ONTARIO TO PROVIDE ORTHOPAEDIC CARE UNDER THE MINISTRY OF HEALTH’S RAC MODEL TO PEOPLE WITH HIP AND KNEE, LOWER BACK/SPINE, SHOULDER AND FOOT AND ANKLE JOINT ISSUES. iotherapist and orthopaedic surgeon as needed; diagnostic services; access to wellness nurses; and post-surgical support – all in one place at one time.

This means our patients will be able to receive all the care they need in a timelier and more efficient manner, allowing for faster recovery from joint pain and returning to a quality of life they can enjoy.

At the Uxbridge site, a satellite surgical clinic officially opened earlier

this year, offering more services to the residents of Uxbridge, closer to home.

Physicians will now be accompanied by advance practice physiotherapists to see patients, without having to redirect them to Markham for additional consultations.

“Having a satellite clinic operating under the same rapid access clinic (RAC) model as OJAC at our Uxbridge site means our patients can receive the care they need, closer to home,” says

Sandi Lofgren, patient care director for Uxbridge Site and Seniors Care Transitions, Markham Stouffville Hospital.

“Our patients can receive assessment and treatment plans at one site, without having to travel to Markham for further care, which is especially appreciated by our elderly patients.”

OJAC provides patients with fast access to an interdisciplinary team.

MSH is the first hospital in Ontario to provide orthopaedic care under the Ministry of Health’s RAC model to people with hip and knee, lower back/spine, shoulder and foot and ankle joint issues. The expansion of the OJAC, as part of the Canadians of Pakistani Origin Orthopaedic Centre, was funded by the generosity of our donors and the important work of the H MSH Foundation. ■

Michelle Lee Hoy is a Senior Communications Specialist at Markham Stouffville Hospital.

10 HOSPITAL NEWS JUNE 2021

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SPONSORED CONTENT

We are people before we are patients

The case for more humanity in Canadian healthcare

By Steven Wilson, CEO/Managing Director, Tegria Canada

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are empowering people to holistically manage their health, that they are indeed able to do so. This includes bridging the digital divide and delivering health literacy and educational programs that are accessible to all.

We need to design solutions around what people and communities really need.

This is where we, as healthcare business and technology innovators, have the opportunity to do more. While modernizing our healthcare infrastructure and the delivery of services, it is imperative that we recognize where, who and how our tools are accessed to ensure barriers to services no longer exist.

As we contemplate the future of healthcare, we embrace our past.

Tegria’s foundation is descended from Quebec’s Sisters of Providence whose founder, Sister Emilie Gamelin said, “...we are steadfast in serving all, especially those who are poor and vulnerable.” This past year has shown us the vulnerabilities, now is the time to be steadfast in our humanity.

anadian governments are currently making several decisions about how healthcare will evolve into

the future.

We are on the cusp of a major digital revolution; COVID-19 has emerged as the ultimate technology disruptor, illustrated by the speed of transition from physical to virtual health consultations.

Technologies such as artificial intelligence, automation, augmenting technologies, digital-twinning, and wearables, which were all emerging pre-COVID, are now primed for exponential growth, fuelled in part by the same global healthcare realities that propelled vaccines swiftly through the usual red tape.

As we seek to improve the overall health of our population, decisions will be made to improve our patient experience, to create better efficiencies and reduced costs.

But, will we go far enough? Will we achieve our ultimate goals of improving the health of our communities, transforming the business of healthcare to one that supports the true diversity of our society?

To do so, our healthcare must evolve by embracing a greater humanity.

We must not define healthcare just through consumerism or the narrow lens of being a patient. A patient is a temporary situation. We are people first and healthcare should be what assists us in living our best lives.

As we navigate a complex world of unintended consequences, what choices should we make as we move toward a more data-driven, human-centric, public-private partnership to drive needed changes?

What decisions should we make as we move toward greater healthcare interoperability? What directives are needed as we build out a more connected, integrated health ecosystem

ABOUT TEGRIA CANADA

Steven Wilson that is humane and leaves no one behind?

COVID-19 has also exacerbated the wide-spread inequities in our society, exposing the fragilities of our system. Now, more than ever, we need to address the social determinants of health – those circumstances outside of healthcare which either nurture or impair our population.

We need to ensure that the voices of remote, racialized, and other marginalized communities are represented and heard. The future must be approached with a more empathetic, humanistic, inclusive, and equitable mindset.

We need to think holistically about our health, shifting our focus from cure

to prevention and early intervention, and develop a new healthcare ecosystem, one which is truly connected to all aspects of our behavioural health (mental, sexual, and physical) across our lifespan.

We need to stop treating aging as a clinical problem and re-examine how we support our aging population; allowing them to live, and die, in their own homes rather than in long-term care facilities.

We need to shift our focus from cost reduction economics and redirect it to strategic investments in healthcare that, if made correctly, will pay dividends down the road for everyone.

We need to make sure that if we

Tegria Canada helps healthcare organizations of all sizes accelerate technological, clinical, and operational advances that enable people to live their healthiest lives through a unique patient-centered care approach that is evidence-based, informed by data, powered by technology, and rooted in healthcare.

With locations in Vancouver and Toronto and teams throughout Canada and the United States, Tegria has more than 3,000 strategists, technologists, healthcare service providers, and scientists dedicated to delivering value for healthcare providers and their clients. Founded by Providence, Tegria is committed to creating health for a better world. To learn H more, visit tegria.ca. Q

Steven Wilson is the CEO and Managing Director of Tegria Canada. Wilson has held leadership roles at TELUS, Canada Life, Info-Tech Research Group, and Holland Bloorview Kids Rehabilitation Hospital. He brings a strong track record of success in business and technology strategy across a broad range of industries that include pharmaceutical, banking, insurance, and the public sector. www.hospitalnews.com

JUNE 2021 HOSPITAL NEWS 11

NEWS

Vaccinating in a COVID-19 Hotspot: The challenges and rewards hese last four months have been a whirlwind for Humber River Hospital. Establishing a vaccine clinic in North Western Toronto, a COVID-19 “hot-spot,” has had its challenges yet is replete with rewards.

“Meeting the vaccination needs of our Northwest Toronto community has been a massive team effort requiring dedication for our staff and physicians, our Ontario Health Partners and our colleagues from other Toronto hospitals,” says Barb Collins, President & CEO of Humber River Hospital.

Intense initial planning “We began planning our vaccine clinic December 14th and opened our doors on December 23rd,” says Sudha Kutty, Vice President, Strategy and External Relations at Humber. “Planning was intense during those first nine days. At the time, there were already two early clinics in Ontario, at University Health Network (UHN) and in Ottawa, and we used their top-level planning to help guide us.”

The Humber River Hospital vaccine clinic was first opened in the thirdfloor auditorium of the Hospital. As volumes increased, additional space was added on the main floor to support flow and for better accessibility.

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MOBILIZING STAFF FOR THE CLINIC While hospitals have run flu clinics, running a COVID-19 vaccination clinic was a whole other level of complexity. “Along with planning the physical space, we had to mobilize staff and volunteers,” indicates Kutty.

“Two nurses, Jane Cornelius and Jane Sanders, came out of retirement from Humber on January 4 to co-manage the clinic.”

“When we came on board, Humber had already established a framework for the clinic and were targeting staff to get vaccinated,” explains Cornelius. “Our jobs were to streamline the clinic and improve operations and efficiency.”

“The clinic was still in its infancy, and we were vaccinating staff who had highest priority, who were facing patients,” says Sanders. “And then we 12 HOSPITAL NEWS JUNE 2021

Humber River Hospital vaccination clinic at Downsview Arena. started vaccinating essential caregivers at long-term care homes. Later, the roll out evolved with the patients’ age groups.”

COMMUNITY OUTREACH

Humber River Hospital serves a large geography that has been hit hard

by COVID-19. Once the clinic began vaccinating the general public, the hospital decided to work with its partners to further reach the community.

In addition to the in-hospital vaccine clinic, it supported vaccination clinics at its Ontario Health Team (OHT) partners – Runnymede and West Park Healthcare Centre and Black Creek Community Health Centre – as well as mobile clinics at congregate settings in the Jane and Finch corridor working with Lumacare and LOFT. “We have also focused on faith communities, including churches and a local mosque,” says Ruben Rodriguez, the lead for vaccine outreach at Humber.

“We have been using the leadership in these communities to support engagement,” adds Rodriguez. “By doing this, we helped educate seniors in the community before their vacci-

nation dates so that uptake was higher. Our presence in faith communities also enabled seniors to be in familiar surroundings so they could feel more comfortable with the vaccine.”

USING NURSING STUDENTS

One challenge with running the in-hospital and outreach clinics was having enough staff to administer the vaccines.

“We partnered with fourth year nursing students at Ryerson University to fulfill many of the aspects of vaccination, and in turn provided them the opportunity to learn good clinical skills,” says Sanders.

MOVE TO DO WNSVIEW ARENA

With the in-hospital vaccine clinic, some issues arose with foot traffic on the main floor, since both vaccine recipients and non-vaccination hospital patients were coming through the same areas. As a result, the clinic was recently moved out of the hospital entirely – to Downsview Arena.

“This decision was made quickly and executed smoothly,” says Kutty.

“It was two weeks from the date of our first site visit to Downsview Arena to

opening our doors. We took all of the lessons we had learned since the middle of December, what worked well and what the challenges were, and applied these lessons to our new Downsview Arena clinic.”

HIGHLIGHTS

“We are grateful to be able to offer the community many options for vaccination and thank the many leaders in the community who have provided advice and ambassadorship in this endeavor,” says Collins.

Running the vaccine clinic has been “one of the fastest initiatives we’ve been involved with at Humber River Hospital,” says Sanders. “We had a great senior team who made everything happen quickly, who took barriers out of the way to get organized and move people through. The expectations were challenging, and Humber staff were committed to the response.”

“Many of the seniors we’ve encountered have been fulfilling the public health directives, wearing masks, washing hands, and not going out,” says Sanders. “And to see their smiles, and their relief that hope is on the horizon, is very rewarding. We’re all H getting through this together.” ■ www.hospitalnews.com

NEWS

Telerehabilitation is here to stay – are you optimizing your delivery?

By Ellen Rosenberg irtual care may have flourished from necessity, but its potential to deliver quality rehabilitation after injury or illness means it’s here to stay.

And a team at Toronto Rehab is sharing their robust, homegrown, Telerehabilitation Toolkit for Outpatient Rehabilitation Programs to ensure more rehabilitation centres can optimize their own delivery of virtual care.

While most ideal for centres that have started to provide virtual rehab and are now looking to expand their program, the toolkit takes teams through the entire virtual care process, from how to form an implementation team to evaluating and monitoring progress.

“The Toolkit reflects our heartfelt intention to remove as many barriers as possible, to delivering safe, efficient, and patient-centred rehabilitation,” says Dr. McKyla McIntyre, Physiatrist at Toronto Rehab-UHN and member of the development team.

Read how it can be accessed at no cost.

When the first wave of COVID was building in Ontario, the team within Toronto Rehab’s Brain Program realized they needed to pivot from in-person to a virtual care as quickly as possible.

“Our patients have time-sensitive windows to maximize their recovery after injury or illness,” says Dr. McIntyre. “We knew if their therapy was delayed, it could lead to long-term loss of function.”

sources we needed, to ensure we were covering our bases,” she recalls.

“The toolkit is a perfect reflection of the rehab community’s willingness to collaborate in ways we never have before, to meet the needs of patients and each other.”

V

THE URGENT NEED FOR VIRTUAL EXCELLENCE As Canada’s largest rehabilitation sciences centre, the team harnessed the expertise of staff trained in implementation sciences and quality improvement, and the experience of colleagues in the Telerehab Centre for Acquired Brain Injury (ABI), to

‘THE POTENTIAL FOR GLOBAL, CROSS-CENTRE COMMUNICATION AND LEARNING’

immediately launch a virtual program that currently supports 60 per cent of their outpatient population.

They were also empowered by a leadership team committed to reimagining care, and enabling patients, families and teams through digital platforms.

“We know that in our connected future, technology will support outstanding patient experiences,” says Dr. Mark Bayley, Physiatrist-In-Chief and Program Medical Director, Toronto Rehab.

“But we needed to fast-track our approach. This meant allocating resources, and ensuring teams felt safe and supported during this innovative process.”

Recognizing that many other centres can’t leverage the same in-house resources, the team has translated their work into a toolkit that can be scalable across the broader rehabilitation community.

Chapters include the following topics: • Getting started: How to form a team, establish a vision, and identify enablers and barriers to changing care pathways.

• Preparing patients and caregivers for outpatient telerehab: Determining

who virtual care is appropriate for, setting goals and expectations, and preparing patients for meaningful participation.

• Implementing telerehab: Tools to support a safe and successful treatment session, including a safety checklist, medical event protocol, and tips for preparing the environment.

• Evaluating and monitoring: Establishing an evaluation framework While the toolkit isn’t the only one of its kind, what sets it apart from most is its hands-on resources, including gap analysis templates, a medical event protocol, pre-and post-telerehab safety checklists, and patient and provider experience surveys.

Denise Taylor is the Physiotherapy Practice Lead for St. Joseph’s Care Group, in Thunder Bay. She says the toolkit was essential in helping their teams fill the gap, as they transitioned and expanded their existing virtual program from hospital-to-hospital, to hospital-to-home.

“From consent forms to the adverse medical event decision-making guide, we were able to lift and adapt the re-

Since its launch in the fall of 2020, the toolkit has been requested more than 400 times, in Canada and beyond.

The team is encouraging feedback to help build future versions.

“The potential for global, cross-centre communication and learning is really exciting,” says Dr. McIntyre.

The team also looks forward to increasingly harnessing homegrown innovations to support patient safety.

For example, computer vision and wearable technology being developed at UHN’s KITE Research Institute include artificial intelligence (AI) algorithms that will be able to detect a patient’s heart rate and monitor exercise performance and engagement in real-time.

They also hope that greater uptake will help address health inequities that a growing reliance on virtual care are creating for older patients, ethnic minorities, and those with lower income.

“The more people who are participating in virtual care, the more advocacy we can bring to solutions such as more widely accessible internet, more dedicated staff to support digital health literacy, and programs to fund equipment and loaner devices,” says Dr. McIntyre.

These changes are hard to make in small groups, she says, but when the same issue is brought to light again and again, it makes the team hopeful that system-wide changes H are possible. ■

Ellen Rosenberg is a Senior Public Affairs Advisor at University Health Network www.hospitalnews.com

JUNE 2021 HOSPITAL NEWS 13

NEWS

Dispatches from the front line:

UHN’s Pandemic Response r. Erin O’Connor has already put in a full day’s work when she arrives at the Toronto Western Hospital (TWH) Emergency Department (ED) for her 4 p.m. shift.

On this day, there were virtual committee meetings, and the planning and administrative duties that come with also being the ED Deputy Medical Director. Plus, there was sharing oversight of her five-year-old’s online schooling with her husband, while the nanny helped with the couple’s threeyear-old and meals.

Now, and until early the next morning, Dr. O’Connor’s focus is broken hips, overdose, breaking the news to a patient they have cancer, and COVID-19. Always COVID-19.

“One day last week, of the 19 patients that were here, nine were COVID positive and the other 10 were pending their tests,” she explains.

“Almost everyone had something that could have been a symptom.”

“We’re really feeling the pressure on the system more in the third wave than we did in the first or second. I think we knew it was coming. I don’t think we knew it was going to be quite this bad.”

By 6:15 p.m., Dr. O’Connor has examined five patients, performed a bedside ultrasound to rule out internal bleeding with one patient, and ordered a multitude of diagnostics. There’s bloodwork. Herpes swab. CT scans of neck, head, and shoulder. Hip X-rays.

And in addition, all patients get two automatic COVID tests upon entry to the ED. One rapid, one NP – nasopharyngeal.

Dr. O’Connor suspects two elderly patients have broken hips. One after a fall at home, the other after being hit by a car. The results will take up to a few hours. With families restricted from access during COVID, she phones both patient’s families to inform them of the status of their loved one, and promises to call back once a diagnosis is confirmed. Then, it’s on to the next new admission.

Dr. O’Connor is thankful this third wave has finally plateaued and weekly

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14 HOSPITAL NEWS JUNE 2021

case counts are slowly declining. But she knows the impact on the hospital system will be felt for a long time by patients.

“Patient care has been stretched, surgeries and procedures have been delayed, and at what cost to morbidity and mortality for patients?” observes Dr. O’Connor.

And then there is the cost to healthcare workers.

“What we see is a system that was strained before the pandemic, that had no stretch capacity and has somehow found the stretch capacity, but really at the cost of those of us working in care,” she says. “Where that stretch has come from is our personal and physical wellness, our resilience, that stretch has come from us.”

“What’s stretched in the system is the human factor – those of us who work, and those we serve.”

Dr. O’Connor pauses, choosing her words, then adding for emphasis.

“We’re like ‘okay, it’s a crisis and we’ll use all of our reserves’...there’s been no relief, it’s been constant… there’s no more stretch, there’s no more left.”

Back on the ED, Dr. O’Connor is examining a patient in his early 40s.

He arrived by ambulance with decreased consciousness. A suspected opioid overdose. He’s been given Narcan to reverse the overdose. He now seems alert, and asks for a sandwich.

Good signs.

Dr. O’Connor’s plan is to try and hold onto him for at least four hours to ensure the Narcan has done it’s work.

Next up, another elderly patient who has fallen, discovered on the floor of her room at a care home. Suspicion is she fell out of bed. The patient has dementia. She utters sounds and yells, but there are no words. After the ritual of donning personal protective equipment, Dr. O’Connor enters the patient’s space, pulling a thick and faded heavy cotton blue patterned curtain closed for privacy.

From the other side of the exam room, a cheery greeting from Dr. O’Connor is heard: “My dear, your nails are so lovely!”

Dr. Erin O’Connor on the phone with a patient’s family to inform them about their loved one’s condition in the TWH Emergency Department. (Photo: UHN) It is a striking moment of humanity amidst the unrelenting strain of this pandemic. Borne of an innate desire to care for her patients and their well-being. A quality Dr. O’Connor is vigilant – and concerned – about retaining.

“Sometimes I wonder if my fuse is a bit shorter or I’m less patient,” she says. “And you worry about ‘compassion-fatigue.’ It’s well documented and well researched as part of burnout that you kind of lose that ability to feel – partially because you’re shielding yourself against it, and partially just because you have no capacity.”

Amongst her colleagues, Dr. O’Connor sees clear signs of burnout.

Short fuses. Easily triggered about things that they wouldn’t have reacted to in the past.

“Some are reaching out for help,” says Dr. O’Connor. “Some, I think, don’t really recognize in themselves what is actually happening. For some people, depending on our relationship, I will ask what can be done to help and if they need anything.”

She’s seen a few already leave the profession. Others have confided to her they will retire once the pandemic ends. There is no desire to go through this again.

Just after 8 p.m., diagnostics start coming back. The patient with the

lovely nails has a slight fracture in one shoulder. The best course of action to healing is keep the shoulder immobile and put the arm in a sling.

Unfortunately, both of the suspected broken hips are confirmed. Dr. O’Connor knows a fractured hip is associated with an increased mortality rate in the elderly. Both require emergency surgery. Dr. O’Connor pages the orthopedic resident to come assess the patients for surgery, and starts the process for both to be admitted. Then, there’s the calls to the families.

At 8:40 p.m., Dr. O’Connor sees a small window of opportunity for dinner. She lets her colleagues know, then heads down a long corridor to the TWH ED change room. It is quiet here, away from the constant cacophony of intercom pages and announcements, capsules being sucked up the pneumatic tube system, and ringing phones. Although, it’s certainly not what you’d call a sanctuary.

The room is cramped. There are rows of lockers lining the walls around the room. On top of the lockers, sit knapsacks and shoes. On the floor, around the edge of the room, are more knapsacks and shoes. In the middle of the room is a small two-seater couch and low-rise table laden with alcohol wipes, hand sanitizer, and a box of grawww.hospitalnews.com

NEWS nola bars brought in by a colleague. To one side, there’s a small table with a computer, and most curious, in a corner to the left of the computer stands an old portable folding three-panel wooden screen divider. Behind this screen, is the privacy afforded every ED doctor of all sexes to change in and out of scrubs.

Who says ED life is glamorous.

Dr. O’Connor chats with a few colleagues as she nibbles on dinner – a cheese stick, pepperoni stick, and water. All three people try to stay physically distanced in this claustrophobic space. Dinner complete, Dr. O’Connor continues the conversation while reaching into her pocket. Out come a few small pieces of her five-year-old’s LEGO. She rolls them in her fingers and smiles. Then, she just holds them.

They appear to bring a small measure of comfort.

After the 15-minute dinner break, Dr. O’Connor is back in the middle of the ED. Sitting at a computer amidst the bustle and sound of the Acute/Sub Acute Nursing Station. She’s running down the status of each of her patients.

Reading diagnostic assessments.

She is asked how she is doing.

“I mean, certainly there’s definitely fatigue, and it ebbs and flows right? And it depends on the day… and what’s happened,” explains Dr. O’Connor. She stops. Her eyes are tearing. Clearly, it has been one of those days where something happened. She composes herself.

“Sorry, that’s going to happen...but it’s actually not that bad.”

Another pause, more composing.

“One of the things that’s been really helpful is colleagues. There are a few of the people in the department who

are friends you can call at any time and just talk it out. To know someone else is feeling that burden, it’s a huge difference. And then, trying to carve out time where you get a little more sleep.

And, try as much as possible when I can to really just focus on kids and family.”

A nurse arrives to tell Dr. O’Connor the overdose patient wants to leave. It’s been close to four hours.

She hustles over for one last examination to ensure it is safe for him to be discharged.

Another patient arrives. Another elderly woman has fallen. The diagnostics will come back all clear.

Thankfully, all that’s required is a few stitches over one eye.

For all the strain of the pandemic, Dr. O’Connor is quick to point out there are positives that will have a lasting benefit to patients.

“Virtual models of care will benefit patients with disabilities and elderly patients in the future,” she says. “Not needing to leave their homes for follow-up or simple medical appointments hopefully will allow for more equitable access to care.

“And, maybe, just maybe, the pandemic will be the start in a shift back toward trust in expert opinion. There has been a movement in popular culture in the past few years away from trust in experts and education, maybe this will help people to change their minds. Though the anti-maskers and anti-vaxxers are still loud!”

By 12:30 a.m., Dr. O’Connor is delivering a brief handover to her colleague in charge of the overnight shift.

Of all the patients in her care this past evening, the majority have been discharged or been admitted. There’s just

Dr. Erin O’Connor stitches up a patient in the TWH Emergency Department. (Photo: UHN)

the lady with the stitches awaiting her discharge paper work. And one of the broken hip patients is awaiting orthopedics admission.

“At the end of the day, I love my job,” she says. “I’m so lucky that I get to do this…

I have the best job in the world and I love where I work and I love the people I work with.

I’ve been so very privileged to be able to be their leader and have their faith and their confidence. And, I am so immenseH ly privileged that I get to do this job.” ■

This article was submitted by University Health Network.

www.hospitalnews.com

JUNE 2021 HOSPITAL NEWS 15

COVER

Photo courtesy of Kelly Spence

Queensway Carleton Hospital community donning their “QCH Strong” toques. (L-R) Darien Backstrom, QCH Screener, Nicholas Lomonossoff, Volunteer, Dr. Andrew Falconer, President & CEO, Judy Gula, Special Care Nursery RN, Jaason Geerts (CCHL), Taryn Neil, Pharmacy Techntician.

Imagining health leadership

after the pandemic

By Jaason Geerts e’re at mile marker 35 (of 26.2) in the marathon of COVID-19 response and the finish line continues to find furtive ways of eluding us. Those racing on fumes are nervous that if the sixty seconds of Kipling’s “unforgiving minute” extend much longer, the physical and the mental toll of this distance run will become dire.

As the timelines for international herd immunity lengthen and experts warn of the endemic potential of COVID-19, it seems unlikely that we’ll see a quick and definite end to this crisis in the conceivable future.

And yet, imagining a post-pandemic world (the Resolution Stage) can perhaps provide the focus and motivation that is desperately needed during this phase. After all we have been through together; having exposed the deplor-

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16 HOSPITAL NEWS JUNE 2021

able gaps in the system, its failures and the losses - along with having realized the very best of humanity - our collective resilience and resolve, our collaborative successes, our breakthrough innovations, our unwavering partnerships - it is hard to imagine a scenario without an unrepenting global expectation that things must be better - that we must apply lessons learned and make sure that things are better – as we move forward.

“Better” means improved global health and healthcare, as well as unequivocal advancements in the parallel priorities of Long-Term Care (LTC), equity, diversity, and inclusion (EDI), and climate change. The more vivid the picture we have of the landscape and life in the Resolution Stage, the more efficacious that picture can be as a North Star to guide our current

work, even without an official End of the Pandemic Day! At all costs, we must avoid drifting into the Waiting it Out (until it’s over) syndrome and limiting our weary sights on the immediate priorities, at the expense of a future-looking strategic mindset. As the gradual progression toward crisis resolution rumbles on, central to health leadership in 2021 is maintaining organizational stamina, capacity, and confidence that, as trying as it is, envisioning and co-creating the path to Resolution will make things markedly better for staff, patients, families, and communities.

IMAGINING THE FUTURE OF HEALTH LEADERSHIP To prepare this article, we contacted nearly 100 CEO’s and senior leaders of Canadian hospitals, provincial

and regional health authorities, and national health organizations, asking them the following questions: 1) What imperatives or priorities will be most important for leaders after the pandemic? 2) What leadership capabilities will be most important to enable leaders to implement those imperatives priorities/address those priorities?

3) Any further insights into effective leadership after the pandemic? These questions form the structure of what follows.

LEADERSHIP PRIORITIES AFTER THE PANDEMIC

Celebrating people. The Queensway Carleton Hospital’s “QCH strong” t-shirts and toques (see photo) attest to the fundamental importance of acknowledging the remarkable contributions and dedication of staff www.hospitalnews.com

COVER at all levels, since they are bricoleurs entrusted with advancing the path toward resolution.

Recovery for people. This includes providing psychologically and culturally safe environments, compassion, care, and support for the mental, physical, spiritual, and emotional wellbeing of staff. Particular concern should be extended to those who have undergone chronic stress and traumatic experiences. Health human resources (HR) is a related urgent priority in terms of retention and recruitment, since vacancies are high and many are leaving healthcare, while the demand for staff is soaring (Cameron Love, CEO, The Ottawa Hospital (TOH)).

Leaders need support too, given the weight of the burden they have borne throughout the pandemic (Karen Biggs, CEO of Menno Place). No progress can be made in collapse.

Recovery of care. The operational task of tackling the backlog of paused services, screening, diagnostics, and care, as well as other unintended harm caused by the pandemic, needs to be orchestrated within the limits of available beds, resources, staffing, and financial constraints. Though wrought with harrowing tradeoffs at times, this is an opportunity to reconsider how to most effectively and efficiently move forward.

Actioning and resourcing lessons learned. Synthesizing the lessons learned at the individual, team, organizational, and system levels, as well as actioning and resourcing them, provides the foundation for system transformation and for future pandemic preparedness (Alain Doucet, CEO, Canadian College of Health Leaders (CCHL)). This includes discussing how to sustain improvements and create pathways for higher quality and innovation in non-crisis environments (Brenda Lammi, Vice President, CCHL).

Clarifying the heart of the matter.

Shifting sights to the future begins with collectively re-examining the “reason to be” and quintessential relevance of the organization (Suzanne McGurn, CEO of Canadian Agency for Drugs and Technologies in Health (CADTH)), along with “the highest value of our work,” while ruthlessly

clarifying what is non-essential (Frank Vassallo, CEO of Kemptville District Hospital). Next is revisiting strategic priorities to ensure that they reflect the renewed focus (Jo-Ann Marr, CHE, CEO of Markham Stouffville Hospital).

Addressing gaps and inequities in the system and enhancing integrated care. This begins with isolating the root causes of cracks in the system, identifying priority populations and opportunities for greater access and EDI, and implementing sustainable reforms (Dr. Tim Rutledge, CEO, Unity Health Toronto). A system-wide perspective is needed to critically examine how to best integrate care among hospitals, Primary Care, Home Care, LTC, Community Care, etc. and to decrease reliance on hospitals significantly. This requires advocating for changes in legislation and policy (Caroline Lidstone-Jones, CHE, CEO of the Indigenous Primary Health Care Council (IMPACC)) and a commitment of bona fide leadership and political will to see this through, not one-off initiatives (Dr. Andy Smith, CEO of Sunnybrook Health Sciences Centre).

OPTIMIZING WORK AND CARE

It is important to discuss how teams, organizations, and systems can optimize work and care delivery models, including by upskilling staff and maintaining key strategic and operational partnerships (Hélène Sabourin, co-chair of Organizations for Health Action (HEAL) and CEO of the Canadian Association of Occupational Therapists (CAOT)). The organizational carbon footprint should also be considered.

In addition to providing focus and direction, these processes can be precursors to another key priority, which is to “revitalize, reenergize, and inspire leadership” across the system (Marianne Walker, CHE, CEO of Guelph General Hospital). Similarly, Julia Hanigsberg, CEO of Holland Bloorview Kids Rehabilitation Hospital, suggests that the pivotal question is, “What will remind people why they love working in healthcare and help to re-find that joy in work?”

Three questions for reflection are: 1) What immediate priorities and tasks are most essential, given the heart of the matter for the organization? 2) What in the immediate priorities and tasks should not be? 3) What approaches to the most essential immediate priorities and tasks could lead us to a better, more equitable future?

KEY CAPABILITIES

To address these priorities successfully, thirty-one different capabilities were proposed. The most common were resilience, transparent communication, empathy, and build relationships.

Leadership in the Resolution Stage will require the tenacity to get the hard stuff done, including making bold and, at times, unpopular decisions (Dr. Andy Smith). Uniting many of these key capabilities, Col. Scott Malcolm, MD (Deputy Surgeon General, Canadian Armed Forces), suggests that essential to effective communication is understanding one’s people so that one can create the narratives that are most likely to resonate with each of them.

KEYS TO SUCCESS

Four overarching themes emerged as keys to success in the responses to the final question of our study.

• Restoration will be needed: people are exhausted and many have struggled more so than we might realize (Dr. Verna Yiu, CEO, Alberta Health Services). We must moderate expectations and strike a balance between system priorities and staff health, wellness, and capacity (Patrick Gaskin, CHE, CEO, Cambridge Memorial Hospital; Ray Racette, CHE, CEO, Lake of the Woods District Hospital). One CEO concluded, “We have to look after each other.” including leader self-care, and reclaim a healthier work/life balance than many have been sustaining for over a year.

• This is the time to bring desperately needed transformational changes to our healthcare systems. If this pandemic isn’t enough to ignite a passionate commitment to fundamental improvements, it is hard to imagine what would. One CEO summarized

the imperative: “we absolutely cannot go back.”

• There are calls for a major shift away from silos within organizations and from treating health care organizations as independent providers toward a community-based approach across the spectrum of care involving complementary services, including health promotion and prevention. This must include Long-Term Care, EDI, and climate change as cardinal components of the healthcare system, all of which have been largely treated as externalities until now. It is essential that governments and organizational boards appreciate the importance of this approach.

• Identifying proven and emerging leaders, particularly those with high Emotional Intelligence, and providing them with further opportunities and training to continue to succeed is key (Sandy Jensen, CEO, Tillsonburg District Memorial Hospital).

This involves developing leadership in equity populations and ensuring that they have the tools and resources they need (Caroline Lidstone-Jones).

To conclude, Dr. Jackie Schleifer Taylor, interim President and CEO of London Health Sciences Centre (LHSC), explains, “You might not know when [the marathon] ends and you may not be familiar with the path, but the leader’s job is to ensure that you know that the path is going to be wonderful at the end and that we will come out richer in our understanding of how our health systems have to change for the better.”

If we hold a vivid picture of Resolution in our collective imagination, we may just find the invigoration and fuel that is most likely to sustain us through the remaining miles of this unforgiving distance run and to make the awaiting landscape and life more richly ours… for us all. *This article is the second in a series on health leadership during the pandemic and is informed by more than a year of international research projects by the Canadian College of Health Leaders (CCHL), funded in part by Healthcare H Excellence Canada (HEC)). ■

Jaason Geerts, PhD is the Director of Research and Leadership Development at the Canadian College of Health Leaders. www.hospitalnews.com

JUNE 2021 HOSPITAL NEWS 17

CANADIAN SOCIETY OF HOSPITAL PHARMACISTS

Virtual platform

brings increased accessibility to hospital pharmacy conference n March 2021, the Canadian Society of Hospital Pharmacists (CSHP) reimagined what it meant to gather as a community. The COVID-19 pandemic introduced radical changes to the professional association’s longstanding national conference as it moved to a virtual platform.

Though this change was born out of necessity, it ushered in welcome innovations – namely, increased accessibility.

Moving the event online meant a departure from over 50 years of tradition, as CSHP has typically held its annual Professional Practice Conference in Toronto, with hundreds of hospital pharmacy professionals in attendance.

This year’s event was the Society’s first-ever virtual conference. Rather than gathering in a hotel, attendees participated from wherever they’d spent the lockdowns, on their couches, at their kitchen tables and even from workplaces, all across Canada.

I

THE COMBINATION OF ACCESSIBILITY, FLEXIBILITY, AND QUALITY PROGRAMMING DREW AN ENTHUSIASTIC RESPONSE FROM CONFERENCE ATTENDEES. ported and connected, the way they normally would at one of our events.”

The conference ultimately drew over 800 attendees, the highest registration numbers CSHP’s national conference had seen in a decade. “The response exceeded what we thought was possible,” says Christina Adams, Chief Pharmacy Officer of CSHP. “It goes to show that during this crisis, there was a huge need for us to gather and support one another however we could.”

That response is also a clear sign that virtual events have substantial benefits to offer, even beyond their utility during the pandemic. CSHP’s CEO Jody Ciufo reflects, “We learned

THE CONFERENCE ULTIMATELY DREW OVER 800 ATTENDEES, THE HIGHEST REGISTRATION NUMBERS CSHP’S NATIONAL CONFERENCE HAD SEEN IN A DECADE. Despite the miles physically separating attendees, CSHP titled the event Together: Canada’s Hospital Pharmacy Conference. “‘Togetherness’ is really what professional associations like us are all about,” says Zack Dumont, President of CSHP. “Even though we were innovating the conference format, we wanted attendees to feel sup18 HOSPITAL NEWS JUNE 2021

this year that virtual conferences are powerful tools to reimagine and to democratize the conference experience.”

Organizers and participants agree that increased accessibility was a major benefit of the Together Conference.

Eliminating the need to travel across the country, let alone leave home, results in both financial savings and

greater flexibility for attendees. With the highest rates of attendance by province com- ing from both Ontario and Alberta, the Together Conference attracted a more representative national audience than an in-person conference might, given the prohibitive cost of cross-country travel.

From an ecological perspective, too, gathering without flying is a boon: Air travel is a major contributor to carbon emissions. With the climate crisis becoming an increasingly urgent consideration, virtual or hybrid models of conferences will likely be a valuable option in the future. As we emerge from this pandemic, climate change will continue to pose its own public health threat, and as healthcare professionals, our sector has a responsibility to conduct our work in a sustainable manner.

Tailoring a conference to the needs of frontline workers during a pandemic introduced its own challenges and opportunities, as flexible scheduling was an important consideration for hospital pharmacy professionals working long hours. By recording the conference sessions and making them available on-demand, attendees could access a wide array of educational content at

their convenience. Some attendees tuned in from hospital breakrooms, while others watched recorded keynotes at home. On-demand sessions maximized the value of the conference while minimizing disruption to attendees’ work.

With school closures in many provinces, studies have shown that on average, women are disproportionately carrying the increased demands of childcare that the pandemic has introduced. By offering greater flexibility in conference participation, virtual formats might be one way of addressing structural and systemic barriers that prevent caregivers – and certain groups of caregivers in particular –from accessing career opportunities like educational sessions and networking. Even after the pandemic, the flexibility of virtual platforms could lessen barriers to conference attendance, not only from the perspective of cost but also taking into account factors such as family, gender, and equity.

The combination of accessibility, flexibility, and quality programming drew an enthusiastic response from conference attendees. “This was one of the best conferences I’ve attended, and I didn’t even have to leave my house!” said one anonymous survey respondent. The Together Conference offers a model for other professional associations to replicate as we continue to reckon with the pandemic and to strive for greater equity and sustainability in our professions.

CSHP will be hosting another virtual conference in 2022, and members receive discounted conference rates. To join or renew your membership with H CSHP, visit our website! ■ www.hospitalnews.com

CANADIAN SOCIETY OF HOSPITAL PHARMACISTS

Welcome to the annual CSHP special n this special section of Hospital News, the Canadian Society of Hospital Pharmacists (CSHP) presents stories of pharmacy innovation. As CSHP’s CEO, I’m constantly inspired by the groundbreaking ways hospital pharmacy professionals advance patient care to make new and vital contributions to the healthcare system. You’ll see from these stories that the spirit of innovation and discovery in pharmacy is strong!

In reading these, I’m struck by the deeply collaborative nature of our members’ work. Pharmacy excellence often takes the form of exceptional teamwork. Our professional association exists to support, facilitate, and celebrate those connections, because we know that we’re better together.

CSHP is proud to share these inno-

I

vative projects with you, to give you a glimpse into the varied, exciting world of hospital pharmacy.

CSHP represents pharmacy professionals working in hospitals and other collaborative health care settings who seek excellence in patient care through the advancement of safe and effective medication use. We offer our 3,000+ members education, national advocacy, information sharing, promotion of best practices, conferences, facilitation of research, and recognition of excellence. We also publish the Canadian Journal of Hospital Pharmacy, conduct the Hospital Pharmacy in Canada Survey and accredit pharmacy residency programs H across Canada. ■ Sincerely, Jody Ciufo, CEO Canadian Society of Hospital Pharmacists

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t the onset of the global pandemic, healthcare systems were overwhelmed with the global shortage

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Health all issued recommendations to facilitate optimal PPE availability and to reduce in-hospital spread of COVID-19. These guidelines advised minimizing the number of times healthcare workers need to enter a patient’s room. One strategy to achieve this is to bundle or cluster healthcare activities.

Trillium Health Partners (THP) is one of the largest health systems in Canada. It is situated in the Peel Region of Ontario, which has seen a large proportion of COVID-19 and patients under investigation (PUI) admits since March 2020. For patients admitted with infectious diseases and requiring isolation, standard practice at our hospital did not include having medications reviewed specifically for medication bundling. With the guidelines for minimizing spread and optimizing PPE in mind, the pharmacy department identified a need to focus on bundling medication management at our organization. Through this initiative, we aimed to optimize the safety of healthcare workers (primarily nurses) by decreasing unnecessary exposure. We also intended to enhance the safety of patients through improved traffic control, thus reducing the risk of in-hospital transmissions and conserving hospital PPE supply.

Medication bundling is a pharmacist-led initiative at THP which includes holding non-essential medications and reducing the dosing frequency of medications by considering extended-release products. We also synchronize medication administration with procedures or meals, in consultation with the patient’s nurse, and we reassess the frequency of blood work required for therapeutic drug monitoring. Pharmacists review all requests for drug levels and prioritize them based on urgency. We recommend drawing level at the same time the nurse would be entering the room for other bloodwork or care. Clinical pharmacists at THP are able to perform these duties under a pharmacist clinical scope of practice policy our organization recently implemented. (See “Pharmacists’ clinical scope of practice.”) This initiative has been well received by both nursing staff and pharmacy staff.

Like other frontline healthcare workers, during the pandemic pharmacists have had to find ways to rapidly respond to the needs of their patients and their colleagues. Despite the added workload, these innovations gave pharmacists a deep level of satisfaction, knowing they were actively contributing to the safety and well-being of their patients and fellow health care H providers. ■

Anjana Sengar and Trupti Kulkarni are Resource Pharmacists at Trillium Health Partners. www.hospitalnews.com

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CANADIAN SOCIETY OF HOSPITAL PHARMACISTS

Innovative education:

A pharmacy student perspective on learning during a pandemic

By Caitlin Chew hen I first began pharmacy school, I never would have imagined finishing my degree during a global pandemic. From online practicums to virtual hospital pharmacy residency interviews, this year challenged me – and its given me opportunities to think about my education more creatively. As I approach my graduation, I’ve been reflecting on the opportunities the pandemic presented to learn in innovative ways.

In September 2020, I completed a pharmacy practice research rotation with Interior Health in Kelowna, BC. As part of my pharmacy training, in my fourth year, I have the opportunity to partake in three rotations in different areas of pharmacy practice. Given the travel restrictions at the time, my practice educator and I opted to pivot my

W

rotation to a virtual one instead. We came up with a research idea that I would be able to execute online. Unlike any other practicum, I completed my 8-week rotation from the comfort of my own home. Over the next two months, I conducted a scoping review of existing literature that characterizes the types of clinical pharmacy services that are provided at small hospitals.

In total, I screened over 4400 studies, completed a full-text review of over 500 papers, and included a total of 51 studies in our review. Thanks to Zoom, I was able to meet my preceptor on a daily basis to share my progress. We even organized a virtual presentation with the Interior Health Pharmacy Services team, where I was able to present my findings and generate discussion with clinical pharmacists surrounding the types of clinical pharmacy services that should be prioritized in a small hospital setting. The

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virtual nature of this practicum challenged me to take accountability and ownership of this project, as I managed my own time and reached out to the necessary resources. It also allowed me to share my research and engage with a larger reach of clinicians.

In December, I had the privilege of taking part in the Canadian hospital pharmacy residency matching process. A hospital pharmacy residency is a one-year, post-graduate training program where pharmacists learn the skills necessary to practice as a clinical pharmacist and a member of the interprofessional healthcare team. Because of the pandemic, these interviews took place online for the first time. Initially, I was nervous about preparing for the novelties of virtual interviews; I worried about making meaningful connections and presenting myself through a webcam as opposed to in-person. In the end, the virtual nature of these interviews surpassed my expectations.

Screensharing and timekeeping functionalities increased interview accessibility, and technology allowed for seamless transitions from interview to interview. I’m grateful that the pandemic didn’t stop us from being able to complete the residency matching process. Thanks to this year’s innovative processes, I’ll be starting my hospital pharmacy residency at BC Children’s and Women’s Hospital this summer, and I’m beyond excited to get started.

More recently, in January, I completed my 8-week hospital pharmacy

rotation at Royal Columbian Hospital (RCH) in BC, where I had the opportunity to learn and practice within the Emergency Department. Practising in the Emergency Department was a novel experience for me, let alone practising during a global pandemic.

I learned how to take the appropriate safety measures when caring for newly admitted patients. I spent my days providing patient care, working up patient cases, counselling patients on new medications and fielding COVID-19-related questions. While at RCH I also had the opportunity to attend numerous online case presentations, journals clubs, and education sessions hosted through the pharmacy department. The virtual nature of these presentations increased their accessibility, allowing more individuals, including students like me, to participate. With the novelty of the COVID-19 vaccines at the time, it was helpful to join discussions surrounding the efficacy and safety profiles of these novel vaccines.

This year was filled with challenges, both mentally and academically – but it allowed me to grow as a learner and a future clinician. Despite the circumstances, I wanted to make my last year of pharmacy school as memorable as possible, filled with clinical and academic opportunities. With a little creativity, I was able to do so. I hope to bring this sense of adaptability and innovation into my future practice as a H clinical pharmacist. ■

Caitlin Chew is a 2021 UBC PharmD graduate and will be starting her hospital pharmacy residency with Lower Mainland Pharmacy Services in BC this July. www.hospitalnews.com

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CPDN thanks all front line workers for making a difference during the pandemic

You keep essential medicines in stock for patients in need.

24 HOSPITAL NEWS JUNE 2021

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Niagara Health identified the trannsition of care at patient discharge as an n opportunity to enhance patient care. e.

To address this, a team participated in the Medication Safety at Care Transitions – Safety Improvement Project led by the Canadian Patient Safety Institute (Healthcare Excellence Canada) with subject matter expertise support from ISMP Canada.

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atients discharged from a hospital may have mixed feelings: on the one hand, grateful to go home, but on the other hand, stressed and confused. Healthcare providers sometimes forget that patients are receiving a large volume of information at once, including new, changed, or discontinued medications. In fact, patients’ lack of understanding of their medication changes is a common cause of preventable adverse drug events. A recent study by Weir showed that patients did not accurately follow 25 per cent of all hospital medication changes after being discharged from the hospital. At the same time, system issues

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to patient discharge, the pharmacist harmacist compared the discharge prescription i ti with the patient’s best possible medication history (BPMH) from admission and resolved any discrepancies with the prescriber in order to prevent medication errors. The pharmacist also counselled patients on opioid safety, and on any new changes to their medications.

This intervention had a significant impact. In July 2019, only 22 per cent of vascular surgical patients were receiving medication reconciliation on discharge. By the end of the intervention, that number changed to over 90 per cent. The team saw first-hand the effects this had on patient safety. For instance, one patient experiencing post-procedure diabetic ketoacidosis had changes made to their insulin regimen while in hospital. Upon discharge, the patient received instructions to go back on their home insulin regimen.

However, their home regimen did not match the insulin regimen that the patient was currently receiving in hospital. This could have caused a repeat adverse drug event, re-admission, or potential harm to the patient. Thanks to this intervention, a pharmacist caught this “near miss” during the MedRec at discharge. They counselled the patient to ensure they understood the changes to their insulin regimen, and the patient went home safely.

Along with patients, healthcare providers also found this new practice tremendously valuable. One prescriber at Niagara Health shared: “A multitude of surgical patients are seen for

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differentt reasons by diff b generall internal i t l medicine. Prescriptions can change dramatically from home and the surgeons are unfamiliar with many of the changes and meds. I am feeling 100 per cent more comfortable with the prescriptions being sent home after the pharmacy review.”

Even when the COVID-19 pandemic hit, the team at Niagara Health was determined to continue conducting MedRec and patient counselling on discharge. They showed their creativity with some innovative methods of reaching patients, like using phone interviews to connect with personal care providers at home. With COVID-19 restricting hospital visitors, patients often did not have their loved ones with them at the time of discharge to help retain critical information about medication changes. To make sure that the key information made it home, a Niagara Health pharmacist completed patient counselling with the patient and their personal care provider in a drive-thru lane outdoors prior to the patient going home – a true example of curbside service!

MedRec on discharge and patient medication discharge counselling is an integral component of the care process. In addition to the vascular patients, the team observed collateral benefits across the entire surgical program. The team at Niagara Health plans to build a long-term sustainability plan with additional pharmacy support at discharge. www.hospitalnews.com

RESOURCES USED IN THIS INTERVENTION

During both admission and discharge, the team drew on the 5 Questions to Ask About Your Medications.

Available in 30 languages, this tool was co-designed with patients to provide a springboard for conversations about medications, particularly at transitions of care.

When counselling opioid-naive patients after surgery, the team also used a patient handout called ‘Opioids for pain after surgery: Your questions answered’. These resources support patients and families to be informed, empowered, and active participants in the care process.

For more information, please contact Haidy Tawfik at Haidy.Tawfik@ niagarahealth.on.ca or Alice Watt at Ht Alice.Watt@ismpcanada.ca. ■

Left to right: Calvin Poon, Haidy Tawfik, Anna Boric

This article was written by Haidy Tawfik, Andrea Forgione, Anna Boric, Lanny Tran, Laura Guirguis, and Calvin Poon (Niagara Health) in collaboration with Alice Watt (Institute for Safe Medication Practices Canada (ISMP Canada))

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CANADIAN SOCIETY OF HOSPITAL PHARMACISTS

Circling back to move forward: The pharmacists’ circle of care

By Ashley Walus day in the life of a hospital pharmacist is fastpaced and ever changing.

Pharmacists are called to be medication experts and provide many different types of care for their patients. Our responsibilities include selecting the best medications for the patient based on their health needs and health goals, and reviewing medications when patients are admitted to hospital, transferred within the hospital, or discharged. We also modify medication doses based on laboratory results. A large part of our job involves communication: we teach patients and families about their medications so that they can use them safely when at home, and we share drug information with the rest of the healthcare team. Pharmacists need to be nim-

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THIS INNOVATIVE TOOL EMPOWERS FRONTLINE PHARMACISTS TO PRIORITIZE THEIR ACTIVITIES, ALLOWING THEM TO MAXIMIZE THEIR IMPACT ON PATIENT OUTCOMES, WHILE BALANCING THE DEMANDS OF A FLUID PRACTICE ENVIRONMENT. ble throughout the day to match the changing needs of their patients on the units that we serve.

The Winnipeg Regional Health Authority (WRHA) is in a period of health system transformation. With this in mind, WRHA Pharmacy Program saw an opportunity to modernize our approach to communicating practice expectations to pharmacists who work on medicine units. Historically, our practice expectations were shared in the format of a task list. However, this proved to be too rigid of a model:

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it did not account for the realities of modern hospital pharmacy practice.

The WRHA Pharmacy Program decided to develop a new model: the Pharmacists’ Circle of Care (PCC).

The PCC is designed to allow for decision-making autonomy, while still providing guidance and direction related to WRHA Pharmacy Program priorities. This model transforms the task list of practice expectations into a circle, with a built-in triage filter. Mandatory activities such as drug allergy and medication order review are must-dos for pharmacists, so they are outside of the circle. Once those tasks have been addressed, the pharmacist moves into the circle, which depicts 10 different activities or functions that a clinical pharmacist could focus on, each of which could be considered equally important. These activities include: • providing patient education, medication management and care planning • teaching and mentoring students • providing drug information to the patient and healthcare team • performing medication reviews at transitions in care • performing therapeutic drug monitoring • answering direct consults from other healthcare providers • performing targeted pharmacy services and team-oriented activities (e.g. attending interprofessional case rounds) • improving the quality of care provided to patients It was important to us to create a model that supported pharmacists to be nimble and efficient, given the fact that our work is so fluid. As the day progress-

es, patients change, scenarios change, and what was our top priority an hour ago may have moved down to the bottom of your to-do list. To capture this reality of clinical pharmacy practice, the PCC includes a triage filter, supporting pharmacists to prioritize tasks based on their ability to prevent imminent harm to the patient, promote patient flow, prevent re-admission to hospital, and provide value-added service. This triage filter is what makes this model novel: unlike other models, the PCC explicitly incorporates the expectation of applying professional judgement to revaluate patient priorities on an ongoing basis throughout the day.

In a trial, we launched the PCC in three hospitals with a facilitated training session for each pharmacy team.

We then performed a research survey to determine pharmacists’ perceptions of the utility of the PCC. The survey confirmed that the PCC accurately reflects clinical pharmacist practice and how pharmacists actually prioritize their work. Pharmacists indicate that they use the PCC as a training tool for new staff, pharmacy residents, and pharmacy students, as well as to assist in prioritizing their own work. Every single survey respondent indicated that the PCC was useful. Survey results also showed that pharmacists are meeting the needs of their patients by re-prioritizing their work throughout the day.

This innovative tool empowers frontline pharmacists to prioritize their activities, allowing them to maximize their impact on patient outcomes, while balancing the demands of a fluid practice environment. We have since rolled out this tool across the WRHA Pharmacy Program for pharmacists in all practice areas to use. Communicating practice expectations through models that accurately reflect the realities of the workplace environment could be empowering not only for pharmacists, but for other healthcare H workers’ decision making, too. ■

Ashley Walus BScPharm, ACPR, MBA, is a Regional Pharmacy Manager with the WRHA Pharmacy Program. She has no conflicts of interest to disclose. www.hospitalnews.com

CANADIAN SOCIETY OF HOSPITAL PHARMACISTS

Reimagining communication processes to improve patient safety

By Shelby Pflanzner, Crystal Richter, Barb Evans, Erin Yakiwchuk, and Meagan Rieger ransitions of care points are a critical time for patient safety, and communication is of the utmost importance. In fact, studies have shown that poor communication of medical information at transition points accounts for up to 50 per cent of all medical errors in hospital and up to 20 per cent of adverse drug events.

Our team set out to address this pressing issue by considering ways to standardize communication processes, and to make them more effective. We honed in on a process called transfer medication reconciliation (TMR).

TMR is an Accreditation Canada Required Organizational Practice which involves comparing the patient’s medications used prior to admission to those used at the time of transfer. The goal is to identify and resolve medica-

T

tion discrepancies. We realized that a formalized process for TMR did not exist in our area, but we felt introducing it could provide a new way to improve patient safety through enhanced communication.

We decided to conduct a pilot study to develop and trial a standardized electronic form and process for medication reconciliation when a patient is transferred between acute care facilities. We built an electronic TMR form, and pharmacists, physicians, and nurses at sending and receiving sites collaborated to complete the forms during patient transfer.

During the study period, we learned many lessons about what makes a standardized form successful and what presents opportunities for improvement. We’ll be taking these lessons into account as we work to implement

this form at a broader level, but these lessons are also useful for any healthcare team looking to standardize processes to improve communication and patient safety.

When patients are transferred, clinicians often receive inaccurate or incomplete information about medications. This means healthcare teams spend a significant amount of time identifying which medications a patient should be taking. Communicating accurate and complete medication information during care transitions is vital, and a standardized process can help facilitate this. In our study, sending sites provided key communication pieces on transfer that improved the transfer process. For example, we found it was helpful to include documented comments outlining rationale for medication changes in hospital,

with notes on the indication and duration of new medications, such as antibiotics, that had been initiated. Attaching the most recent insulin order sets supported accuracy and continuity of insulin doses.

Our study also highlighted for us the benefits of electronic forms. Research has shown that electronic tools improve form completion rates, save time, and reduce errors. In our case, having active and held medications auto-populate on the TMR form helped reduce transcription errors and ensure review of these medications. Discrepancies that did occur were a result of omissions in areas of the form that required transcription; more discrepancies occurred when capturing medications used prior to admission that had been stopped during hospitalization.

Continued on page 31

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Hospital care in the comfort of your own home

By Dr. Sean P Spina & Dr. Curtis K Harder he Hospital at Home model of care is putting a new twist on the old adage “there’s no place like home.” Research shows that the best place for many patients to receive care is at home. Hospital at Home (HaH) is an innovative model of care that uses a suite of health technologies to provide safe, effective hospital-level care and services to people in their own home.

Through a combination of in-person and virtual visits, patients are “admitted” to the hospital, and remain under the care of a hospital physician, nurse, dietician, clinical pharmacists and other healthcare providers. Island Health has implemented a one-program, twosite prototype at the Victoria General Hospital and Royal Jubilee Hospital in Victoria, BC. While similar programs have been implemented successfully in other countries, it’s a novel concept in Canada. This is also the first program with dedicated hospital clinical pharmacists embedded in the care team.

The HaH model leverages the specific benefits pharmacists provide in the inpatient care model. Pharmacists have become widely recognized as patient advocates and knowledge translators. In their role as patient advocate, pharmacists are particularly attuned to the potential risk involved in transitions in care, and they are able to navigate the complexity of medication systems to ensure patients stay safe.

Clear communication with patients, caregivers, and the healthcare team is critical in the acute care context, and this is further heightened when care is delivered at a distance. Pharmacists have always had to be skilled in adapting their communication style to specific patient needs. HaH has now introduced a new context and new communication modalities (e.g.,

T

THROUGH A COMBINATION OF IN-PERSON AND VIRTUAL VISITS, PATIENTS ARE “ADMITTED” TO THE HOSPITAL, AND REMAIN UNDER THE CARE OF A HOSPITAL PHYSICIAN, NURSE, DIETICIAN, CLINICAL PHARMACISTS AND OTHER HEALTHCARE PROVIDERS. virtual care). With their longstanding experience in presenting complex information in understandable terms, pharmacists are particularly well suited to ensuring that patients and their families understand what they need to know about their medication regimens, especially at a point in care when changes (e.g., dose increases or decreases) are often essential.

When HaH was proposed as a model of care for implementation in Victoria, BC, our first questions were: “How are we going to evaluate impact of the program? How do we know that pharmacists are making a meaningful contribution?” A pharmacy-led Island Health research

team, in collaboration with an Island Health internal evaluations team, are studying whether the program prototype is safe and convenient for patients and clinicians, and whether HaH is an effective and sustainable alternative to hospital-based care.

We are developing a research study titled “INvestigation of the impact of a Pharmacist in a Hospital At Home Care Team” (IN PHACT) to specifically assess the impact of the pharmacist role on the HaH. At the outset, we needed to ensure that in building the program in a Canadian context, we were meeting the needs of all stakeholders, including patients, family caregivers, health system

decision makers, and clinical staff. We engaged patients and family caregivers as partners in the development of both the program and the evaluation framework, and we implemented a broad public engagement strategy consisting of a public survey and key informant interviews to hear from people across the health service spectrum that would be impacted by Hospital at Home.

As a direct result of feedback from these partners, we implemented a virtual call bell, enabling patients to reach a member of their care team remotely at any time, at the push of a button. We also implemented a comprehensive communication platform to ensure that patients and family caregivers are easily able to contact their care team for support. Even small changes, such as increasing the font size on instruction sheets and sanitizing hands in front of patients, are improving the experience of patients and family caregivers in the program. We have also been able to develop an evaluation framework grounded in patient and family caregiver priorities; we’re ensuring that we measure and report on outcomes and experiences that matter to them, in addition to the outcomes that are important to clinicians and decision-makers.

A less tangible but no less critical impact has been an incremental shift in organizational culture. By inviting patients and families to the table and valuing their input, there has been a shift toward collaboration, inclusivity and respect, and a greater understanding of the value that patient and family caregiver partners bring as experts on their own experiences.

For more information please follow our journey on our Island Health HaH webpage or Dr. Spina’s webpage or email H us at HaHEvaluation@VIHA.ca. ■

Dr. Sean P Spina is the Principal Investigator for ATHOME, Co-Lead – HaH Evaluation, the Clinical Coordinator – Pharmacy Services, Royal Jubilee Hospital, Victoria, BC, an Adjunct Assistant Professor – University of Victoria, Health Information Sciences, and a Clinical Associate Professor, Faculty of Pharmaceutical Sciences, University of British Columbia Dr. Curtis K Harder is Clinical Coordinator, Pharmacy Services, Victoria General Hospital and Clinical Assistant Professor, Faculty of Pharmaceutical Sciences, University of British Columbia.

28 HOSPITAL NEWS JUNE 2021

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CANADIAN SOCIETY OF HOSPITAL PHARMACISTS

Pharmacists’ clinical scope of practice Trupti Kulkarni and Anjana Sengar ospital pharmacists are uniquely positioned to improve medication safety and efficacy. In order to have the most impact, pharmacists should work to the fullest capacity within their scope of practice. Unlike community pharmacy practice, the professional practice scope of hospital pharmacists is not solely determined by the Pharmacy Act. Rather, scope must be approved by each individual hospital’s Medical Advisory Committee. This means that different Ontario hospital organizations have variances in pharmacist scope of practice based on organization-specific policies, protocols and/or medical directives.

Our team worked together to create a policy for pharmacists’ clinical scope of practice at Trillium Health Partners (THP) in Mississauga, Ontario with an aim to enhance efficacy, safety, timeliness, and cost-effectiveness of patient care. The Pharmacists’ Clinical Scope of Practice Policy allows pharmacists the ability to independently adapt or modify prescriptions if it is in the patient’s best interest, and if the pharmacist has the knowledge, skills and judgement to do so (excluding narcotics, controlled drugs, or targeted substances). Pharmacists can reorder home medications and hold or discontinue medications, if deemed appropriate. Pharmacists are also able to independently order laboratory tests if required to optimize medication therapy management.

Prior to the development and implementation of our Pharmacists’ Clinical Scope of Practice Policy, we knew that we needed a focused strategy to gather feedback from all relevant stakeholders, and to ensure a smooth and sustainable implementation process. We conducted a survey within the pharmacy department to gather opinions on the perceived benefits, drawbacks, facilitators, and barriers of this prac-

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tice change. In our survey results, we saw that pharmacists expressed readiness for the practice change, and they provided insights into potential barriers to implementation. A review of existing clinical scope policies, protocols, and medical directives from other hospital organizations further informed the development of a policy draft with a practice scope and processes unique to the needs of THP. In developing the policy, we sought feedback from physicians, nurses, and pharmacists, which we then used to revise our drafts. For example, we removed the ordering of diagnostic imaging from the draft, to prevent potential liability risks of incidental clinical findings associated with diagnostic imaging results. Input from our colleagues also guided the decision to rename the policy from “Expanded Scope” to “Clinical Scope,” to reflect the idea that the interventions mentioned in the policy already lie within the scope of essential services that pharmacists have the knowledge and skills to provide.

The policy was presented to the THP Pharmacy and Therapeutics Committee (P&T), Clinical Policies and Procedures Committee, and Quality and Patient Safety Committee, with final approval granted by the Medical Advisory Committee.

Education and communication were central to implementing the policy.

We held pharmacist education sessions to outline the purpose, scope, restrictions, and practical applications of the policy. Pharmacists raised awareness of the policy through mandatory communication at clinical huddles and meetings attended by nursing, allied health, and physician staff. An official communication notice was also sent to all staff to inform them of the policy.

Post-implementation, processes were put in place to ensure appropriate use of the policy. We wanted to ensure that any questions or concerns regarding the practice change were promptly addressed. In team huddles, we encouraged individuals to share their experiences with the policy, and we

created an FAQ document available to all hospital staff. Furthermore, the policy is reviewed with all new pharmacist hires during orientation.

After the rollout of the policy, the pharmacy department assessed the impact and appropriateness of pharmacy scope of practice interventions. We collected and reviewed pharmacist orders during first 30 days of the policy’s implementation, to determine what kinds of interventions pharmacists were making.

We found that the majority of interventions included adaptations, medication discontinuation, and prescribing. Our assessment found that pharmacists adhered to the policy and their interventions contributed to increased patient safety, optimized therapy, and improved efficacy of drug therapy.

This carefully planned policy implementation resulted in a successful change in scope of clinical practice for pharmacists at THP. This innovation empowers pharmacists to use their knowledge and skills to the fullest to H optimize patient care. ■

Anjana Sengar and Trupti Kulkarni are Resource Pharmacists at Trillium Health Partners.

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CANADIAN SOCIETY OF HOSPITAL PHARMACISTS

An innovative student-led screening program

By Carole Goodine n a recent blog, Simon Sinek shared a formula for innovation: Innovation = lack of time + lack of resources + optimism. This describes the situation at our local hospital, and I suspect at many others. There is no extra money in healthcare, so if we want to innovate pharmacy care, we need to think outside the box and design creative solutions. I believe pharmacy students can help.

I’d like all patients admitted to a family practice unit at our hospital to have access to a pharmacist. Today, our family practice pharmacists see about 20 per cent of admitted patients.

There is good evidence that proactive pharmacist care improves patient health and economic outcomes, reduces medication adverse events, and reduces morbidity and mortality.

Proactive pharmacist care consists of an intervention bundle: obtaining a medication history on admission, reconciling admission medications, participating in interprofessional patient care rounds, developing and initiating a pharmaceutical care plan, resolving drug therapy problems, educating patients during their hospital stay and at discharge, and reconciling medications at transfer and discharge.

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Clearly, there are good reasons to expand pharmacists’ reach, and the influx of students expected from entry-level Pharm D programs may be an opportunity to grow our program. Yes, precepting students requires time and commitment. It also provides preceptors with a chance to re-evaluate their current practice using a different lens.

Students bring a fresh enthusiasm to the workplace. They are eager to learn and share their knowledge, they see things differently, and their wages are significantly less than a staff pharmacist. Entry-level Pharm D programs will increase demand for clinical pharmacy practice placements. To reduce preceptor burden, we want to design programs that will allow students to make meaningful contributions to patient care without adding workload to hospital pharmacists.

With this vision in mind, our team reflected on ways pharmacy students could contribute to patient care. We considered our challenges and factors that prevented pharmacists from seeing patients. Then we identified activities that fell within the scope of students’ abilities and considered our workflow. We realized that students could screen patients through a chart review. Pharmacists were spending an hour or more each morning reviewing electronic records to identify patients

they would like to target for a pharmacotherapy assessment. When pharmacists arrived on the family practice unit, priorities quickly changed as nurses and physicians started to ask questions and other drug-related issues were identified. Pharmacists were frustrated with a lack of control over workflow; they felt that much of the care they were providing was reactive and that they were missing opportunities to be proactive. Pharmacists wanted to work with patients to prevent drug-related problems, rather than putting out fires.

As a result, in 2019 we designed a site-specific Pharmacy Patient Screening Tool (PPST) with the goal of piloting a pharmacy student-led patient screening program. With training and orientation, we felt that a pharmacy student could review patient charts and collect information to help unitbased pharmacists identify patients at risk for drug-related problems. They could then prioritize patient care activities based on perceived need.

Once we secured a grant from the Dalhousie Pharmacy Endowment Fund, we hired a pharmacy student and were on our way discovering new ways of providing patient care! First, we oriented the student to the unit and filled in any knowledge gaps. The student learned about high-risk medi-

cations and common disease states encountered on the family practice unit.

They also received training on how to locate information in electronic and paper charts. A clinical manager worked with the student to screen patients until they were deemed capable of working independently. In less than three weeks, the student was screening independently and supporting the unit-based pharmacists’ activities.

In our study, we found that the student-to-pharmacist discrepancy rate was only 1%. The student’s work brought tremendous benefits.

The hands-on learning opportunity increased the student’s therapeutic knowledge, communication, and data collection skills. Meanwhile, pharmacists felt that the student utilizing the PPST helped their workflow and patient prioritization.

It certainly helped that the student who conducted this project was a highly motivated hard worker who was eager to learn and had great communication skills. These attributes are common to many pharmacy students, and we believe that structured activities combined with self-directed learning are the cornerstones to successful student rotations. When both the preceptor and the learner work together to meet the patient’s needs, everyone H wins. ■

Carole Goodine is a Pharmacy Clinical Manager at Dr Everett Chalmers Regional Hospital, Horizon Health Network, New Brunswick.

Reimagining communication processes Continued from page 27 If these medications could also be auto-populated, discrepancies would be eliminated altogether.

We also found it was crucial to have a standardized process for form completion to clearly define the responsibilities of the sending and receiving sites. During the study, several sending site practitioners inadvertently completed the section of the form designated for the receiving site, and this caused errors and confusion. During the pilot, some sending

sites faxed the transferring patient’s documents to the receiving site prior to patient transfer to facilitate timely generation of admission orders.

Sending the form before the patient was physically transferred introduced the potential for discrepancies if new medication orders were written prior to patient transfer. Therefore, teams using the TMR form will need to determine an optimal time to send the form to facilitate its use as admission orders at receiving sites. Healthcare

teams must also develop a process to facilitate use of the TMR form as admission orders if no physician is present at the receiving site at the time of patient transfer.

With respect to training, providing TMR form users with standard education is imperative for successful implementation. In our study, we saw that increased uptake of education was correlated with fewer discrepancies when using the forms. To ensure consistency at all acute care sites, physicians, nurs-

es, and pharmacists will need to understand and complete the TMR form following the standardized process.

Medication reconciliation at transfer is necessary to ensure clear communication and improve patient safety. Our study supports a structured, collaborative, and electronic TMR process that will reduce medication discrepancies at transfer, enhance efficiencies, and improve communication of medication information across the H province. ■

Shelby Pflanzner, Crystal Richter, Barb Evans, Erin Yakiwchuk, and Meagan Rieger all work on the pharmacy team at Saskatchewan Health Authority. www.hospitalnews.com

JUNE 2021 HOSPITAL NEWS 31

SAFE MEDICATION

When COVID-19 meets allergy season

By Annie Yao, Peter Zhang, and Certina Ho ack could not help feeling self-conscious as he removed his face mask to wipe his nose. He had been sneezing and sniffling on his entire walk to work.

Although it was a beautiful day to be outdoors, he could not enjoy the weather, as he had been becoming increasingly unsettled by how other passersby were warily looking at him. He knew they were probably concerned that he had contracted COVID-19, and Jack was slightly worried about the similarities between his symptoms and those experienced by COVID-19 patients. However, Jack did not panic as he knew there was another possibility that could explain his symptoms: Seasonal Allergies.

After a long year of lockdown measures, many are hoping to be outdoors as summer arrives. However, for those experiencing seasonal allergies, they may find themselves wondering whether their sniffles are typical of allergies or something more insidious.

In the context of the COVID-19 pandemic, differentiating between the two respiratory conditions can be challenging. However, there are marked differences between the signs and symptoms of seasonal allergies and COVID-19 that could help guide your next steps.

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SYMPTOMS: COVID-19 VS. SEASONAL ALLERGIES Symptoms of seasonal allergies that may overlap with those of COVID-19 include cough, shortness of breath, difficulty breathing, fatigue, headache, sore throat, congestion, and runny nose. However, symptoms that are common markers of seasonal allergies include sneezing, itchy eyes, and watery eyes. In contrast, COVID-19 could result in fever and chills, muscle aches, nausea, vomiting, loss of smell or taste, and/or diarrhea, which are usually absent in patients experiencing seasonal allergies. Saskatchewan Health Authority has created a one-pager infographic “COVID-19 Symptoms in Comparison to Seasonal

Allergies” where you can refer to for further information www.saskhealthauthority.ca

TESTING: COVID-19

If you are in doubt of what you are experiencing or if you have not encountered seasonal allergies in the past, take an online self-assessment.

Health Canada offers a COVID-19 Self-Assessment Tool (at https:// ca.thrive.health/covid19/en) and provinces/territories have also established province/territory-specific online self-assessment tool, where patients can use for self-assessment and accessing province/territory-specific COVID-19 information and resources. The self-assessment tool will recommend next steps, including whether one may need further COVID-19 diagnostic test (or not). The molecular or polymerase chain reaction (PCR) lab testing is the gold standard for diagnosis of COVID-19, but rapid test devices, such as point-of-care and self-testing devices are emerging

and becoming more accessible in the community. Despite the fact that these rapid tests have a lower sensitivity for detecting the COVID-19 virus when compared to the gold-standard PCR lab tests, they do play a role in supplementing diagnostic testing, for example, in high-risk populations and/or geographical regions. Further information related to point-of-care and self-testing devices is available at the Government of Canada website at www.canada.ca

MANAGEMENT: SEASONAL ALLERGIES

If you have experienced seasonal allergies in the past and are familiar with the symptoms, an array of options can help manage the condition.

Over-the-counter products, such as oral antihistamines can reduce sneezing and itching. Oral decongestants or temporary use of nasal decongestants can provide quick relief for a stuffy nose. However, consulting a healthcare professional, such as a physician

or a pharmacist, before self-selecting a medication off the shelf is always important and highly recommended. For instance, some oral antihistamines, such as diphenhydramine, may cause more drowsiness than antihistamines in a different generation, such as desloratadine. While drowsiness may alleviate certain bothersome seasonal allergy symptoms, it could be disruptive when it occurs during working hours or potentially dangerous if you need to operate a car or machinery that requires attention and alertness.

In addition, if you are taking other medications, seeking advice from a healthcare professional prior to self-selecting over-the-counter medications can help prevent potential drug-drug interactions. Special considerations also exist for children, pregnant or breastfeeding women, older adults, and people with chronic or immunocompromised conditions, impaired liver or kidney functions, etc.

Besides medications, preventative measures also have an important role in management. Irritants such as tobacco smoke and insect sprays may aggravate allergy symptoms. If you know the cause of your seasonal allergies, the best strategy is to reduce your exposure to the allergen(s). Since avoidance may not always be possible, there are self-management options that may be helpful. For example, try to decrease outdoor activities during the spring/allergy season, especially on windy days. Showering and washing your clothes after returning home can prevent allergens from remaining indoors and prolonging your exposure to the irritants. Lastly, wearing a face mask during your outdoor activities may also help prevent you from seasonal allergies. HealthLinkBC “Hay Fever and Other Seasonal Allergies” is an online resource where you can find further information on symptoms, prevention, and management of seasonal allergies (https://www.healthlinkbc.ca/ H health-topics/tv6577). ■

Annie Yao and Peter Zhang are combined PharmD/MBA students at the Leslie Dan Faculty of Pharmacy and the Rotman School of Management, University of Toronto; Certina Ho is an Assistant Professor in the Department of Psychiatry and the Leslie Dan Faculty of Pharmacy, University of Toronto.

32 HOSPITAL NEWS JUNE 2021

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EVIDENCE MATTERS

Is more information always better?

Considerations for integrating pharmacogenomics into health care

By Barbara Greenwood Dufour medication isn’t necessarily going to work for everyone.

In fact, it may be effective in only 30 per cent to 60 per cent of patients. Each person’s genetic makeup will affect how they respond a medication. This is where pharmacogenomic (PGx) testing can help.

Pharmacogenomics is a rapidly expanding area of study into how our genetic differences make us respond differently to pharmaceutical treatments. PGx testing can help predict how well a drug will work for a patient and how likely they’ll have an adverse effect from it. So, it can help clinicians pick the right treatment without “experimenting” with medications until one works and without the additional health care interventions and hospital admissions caused by serious side effects.

What do patients and clinicians think of PGx testing? How could their experiences inform how pharmacogenomics is implemented into practice?

To answer these questions, CADTH looked for published literature on PGx testing, specifically qualitative studies or studies on the perspectives and experiences of patients and health care providers. CADTH is an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures.

CADTH found 13 qualitative studies on PGx testing in a variety of health care settings. According to these stud-

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ies, patients and health care providers do think that PGx testing is beneficial.

To some, more information is always better, regardless of how it’s used. But, for many the value is specifically in avoiding the pain, suffering, and time lost trying medications that provide poor results. These studies, however, also shed light on related issues health care planners and providers should prepare for.

MAKE SURE TESTING DOESN’T LIMIT CHOICE

Clinicians may approach PGx testing as just one tool for narrowing down potential treatments rather than determining a specific one. However, patients may need assurances that the tests will be used this way. Patients sometimes have unique perspectives or prior experiences with drug treatments that they would want clinicians to also consider. For example, the “best” medication according to a PGx test assumes the patient will accept an average level of risk to achieve a benefit. But individuals who have a higher-than-average tolerance for side effects might prefer a medication with more severe ones in order to get more clinical benefit.

Patients also want to be assured that a medication ruled out by a PGx test taken today won’t be ruled out later on.

This is of particular concern to people with chronic conditions who sometimes need to be treated with different medications over the course of their lives –

in the future, they might benefit from a medication that was once rejected on the basis of a PGx test.

MAKE SURE PRIVACY IS PROTECTED

Concern about the confidentiality and privacy of personal health data isn’t unique to the field of pharmacogenomics. But it has been raised in the context of PGx test results. Some patients worry that the information could get in the hands of others and misused, for example by insurers to discriminate against them in terms of eligibility and coverage.

PROVIDE GUIDANCE ON WHEN TO TEST AND HOW TO USE THE RESULTS

Some clinicians aren’t likely to order a PGx test because they aren’t sure how to interpret and use the results. But they may be more likely to use them if given educational materials to help guide them as they discuss test results with their patients. Even clinicians who are familiar with and comfortable using PGx tests may need guidance, such as clear direction on when to use the tests –at the beginning of treatment or after a patient isn’t responding well to a treatment.

CONSIDER AND PLAN FOR SECONDARY FINDINGS

It’s also important for clinicians to know how to address the ramifi-

cations of PGx test results for a patient’s family. If a test reveals that a patient has an increased risk of a disease, current and future family members could be at this increased risk as well. Guidance on if and how these findings should be communicated to patients, and who should do it (i.e., the clinician who ordered the test or a genetic counsellor), would be useful, especially when there’s no action that can be taken to reduce disease risk.

Most patients and clinicians acknowledge the potential of PGx testing to improve health care, helping patients access effective treatments more quickly and saving clinicians time and effort. Although PGx testing is not currently widely used, its use is expanding. Policies and resources will be needed to support the clinicians who order, interpret, and use PGx tests. And patients must be assured that PGx testing won’t restrict the medications offered to them and that their information is kept safe.

You can access the full report –Pharmacogenomic Testing for Medication Selection: A Rapid Qualitative Review – on the CADTH website. If you’d like to learn more about CADTH, visit cadth.ca, follow us on Twitter @ CADTH_ACMTS, or speak to a Liaison Officer in your region: cadth.

H ca/Liaison-Officers. ■

Barbara Greenwood Dufour is a knowledge mobilization officer at CADTH. www.hospitalnews.com

JUNE 2021 HOSPITAL NEWS 33

ETHICS

Compassionate use:

Access to experimental or unapproved medical interventions

By Sarah Abu-Jazar he terms “compassionate use” and “expanded access” are used to describe scenarios in which individuals with serious, rare, emergency, and/ or life-threatening conditions are given the opportunity to access drugs or other medical interventions that have not yet been approved for conventional use or sale. These interventions may still be under clinical study, pending approval by relevant regulatory bodies (e.g., Health Canada), or they may be unavailable for use. The purpose of obtaining access to an unapproved or experimental drug or medical intervention is typically that it may provide individuals with some therapeutic benefit when all other options have been exhausted (i.e., available treatments have not been effective or are unsuitable) and/or if they are ineligible to participate in a clinical trial.

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the name of Julie was diagnosed with a rare type of sarcoma (i.e., a type of cancer). Julie has undergone various treatments, including surgeries, chemotherapy, and radiation. Although these treatments have resulted in temporary improvements, her condition remains present and she is unlikely to receive any long-term relief. Through doing some research about alternate treatments, Julie learns that there is a drug available in another country that has shown evidence of tumor regression in patients with her type of cancer. However, this drug is not approved for use in her country. Julie asks her physician to access to the drug through a compassionate use program.

The Special Access Programme (SAP) is the regulatory body in Canada that allows clinicians to request medical interventions for their patients under the umbrella of “compassionate use”. When applying for access through this program, evidence

THE SPECIAL ACCESS PROGRAMME (SAP) IS THE REGULATORY BODY IN CANADA THAT ALLOWS CLINICIANS TO REQUEST MEDICAL INTERVENTIONS FOR THEIR PATIENTS UNDER THE UMBRELLA OF “COMPASSIONATE USE”.

For instance, suppose that an eightyear-old old child is diagnosed with a rare congenital condition that causes developmental delays and that there are no approved medical treatments.

However, a clinical trial is testing a drug that has shown promise in controlling the biological pathways that contribute to the condition. The clinical trial only includes children over the age of twelve, but the child’s parents want them to gain access to the drug through a compassionate use program because the trial will end by the time their child becomes eligible.

To consider another hypothetical example: Suppose that someone by

of efficacy from scientific literature and from the manufacturer must be presented, and clinicians are responsible for informing their patients about the risks and benefits of the medical intervention. If approval is obtained from the SAP, then the manufacturer of the drug or medical device may choose to sell it to the physician’s institution for the requested use.

Compassionate use approval does not guarantee that the manufacturer will authorize use of the drug or medical device outside of the clinical trial and/or be willing to ship it to another country. The process of seeking compassionate use approval, manufactur-

IT IS IMPORTANT FOR CLINICIANS TO SUPPORT THE DECISION-MAKING PROCESS

BY ENSURING THAT THEIR PATIENTS FULLY UNDERSTAND THE PROS AND CONS OF EXPANDED ACCESS BASED ON THEIR CONDITION AND GOALS OF CARE. er approval, and gaining access can take a significant amount of time.

It is important to keep in mind that the practice of compassionate use does not come without risk; this is especially the case when it comes to medical interventions that are still under clinical trial. By virtue of the drug or medical intervention being studied, its efficacy in providing therapeutic benefit is not guaranteed, and any risks or potential harms have not been confirmed. As such, it is possible that the individual seeking access may not experience any benefit and/or may experience substantial harm. It may also be the case that their condition could worsen. It is also important to note that new information about the experimental intervention may arise at any point during trial, including serious side effects. This may be the case even if it has been approved in other parts of the world since different health regulatory bodies have different standards for safety and efficacy.

A number of ethical considerations and concerns exist when thinking about compassionate use programs.

One of these concerns involves patient autonomy and decision-making capacity. Since patients who seek compassionate use have exhausted all other treatment options, and since their condition is rare, life-threatening and/ or debilitating, it is possible that they may be unable to accurately evaluate the risks and benefits of the drug or intervention; the sense of urgency to get better, in addition to any corresponding vulnerabilities, may influence their

decision-making capacity. SAP regulations emphasize that it is important for clinicians to support the decision-making process by ensuring that their patients fully understand the pros and cons of expanded access based on their condition and goals of care.

Another concern about compassionate use involves the possible lack of patient oversight, where individuals who access experimental or unapproved medical interventions may not receive the same level of oversight and protection as clinical trial participants.

Nonetheless, compassionate use programs (such as the SAP) do systematically review individual applications and previous uses of the intervention.

They also collect mandatory reports from clinicians on the outcomes of the interventions used through the program. Another obstacle that patients may encounter when trying to access an experimental or unapproved treatment through compassionate use is that its cost is not covered by the manufacturer – it may need to be purchased by the physician, the medical institution, and/or the patient.

In short, there are many ethical considerations to take into account when it comes to compassionate use, such as weighing potential benefits versus potential (and sometimes unknown) harms and upholding patient autonomy. Ultimately, it is worth considering strategies that can be put in place to minimize harm to patients, support their right to make autonomous decisions even if risks are present, and to facilitate compassionH ate use access if approval is granted. ■

Sarah Abu-Jazar, MHSc, is currently a Research Compliance Specialist at Khalifa University’s College of Medicine and Health Sciences.

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FROM THE CEO’S DESK

With them, not for them: Putting lived expertise centre stage

By Dr. Joanne Bezzubetz t The Royal, we’re re-imagining our role and how we deliver care… a future where the clients and families who have lived expertise can move in lock-step with us to co-create the future of care, research and education.

By working shoulder to shoulder with clients and families, we know we are carving a path towards a brighter and meaningful future. And, new research into this shift in mentality, philosophy and approach, where we build partnerships with clients and families, shows that when we meaningfully engage clients and families in the provision of care, we see higher engagement, better outcomes and high-quality care experiences at all levels.

At The Royal’s Research Institute, lived expertise already drives research.

Clients, families and peers work alongside scientists in a collaborative process that is opening up new possibilities when it comes to understanding the brain and paving the way for cutting-edge research into novel treatments for people with mental health and addiction issues.

Like every other health care institution, The Royal undertakes a strategic plan every five years. This plan acts as a roadmap: where do we want to go and how do we get there?

As The Royal’s new CEO, I wanted to reimagine The Royal of the future. But I knew that we couldn’t, and shouldn’t, design our future alone. We need the insights of clients, families, staff, partners and the wider community in order to build the organization that we need to be. We need their lessons and insights if we are to aspire to a recovery model of care.

The lessons and insights that come from their journey of recovery is vital to the delivery of modern mental health care. This change from traditional top-down care models to having clients as active members of their own

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care teams and families as crucial partners in the care of their loved ones is turning the tide in mental health.

And so, what began as a typical strategic planning exercise quickly evolved into a mission to transform and co-create mental health care with clients and families as partners. Their voices have helped to shape our new strategic plan, entitled Co-creating Access, Hope and New Possibilities.

This new plan embodies the principle and value of lived expertise. In so doing, it highlights The Royal’s position of the need to elevate the voices of clients and families; to give them credence as integral and valuable members of the care team.

The Royal is a leading academic health science centre in Ontario. As such, we embrace the opportunity to co-create the design, planning, delivery and evaluation of care with clients and families. Doing so goes far beyond the necessity of measuring and tracking our clinical performance and outcomes using quality indicators, which are standardized, evidence-based measures of health care quality. Working in partnership and collaboratively with clients and families will help us provide evidence-based treatments that enable the very clients we serve to live their best lives.

As we look to improve our organization and the mental health and addictions system, the expertise of clients and families is what will help drive innovation and success… to co-create the future of care, research and education at The Royal.

At the launch of our strategy, Glenda O’Hara, chair of The Royal’s Client Advisory Council, shared that “as a client with lived expertise, my experience in the development of the strategy with staff, the senior leadership team, Board members and community partners made me feel heard and hopeful for the future of mental health and addictions services in our

Dr. Joanne Bezzubetz community. I can already see a culture change that is happening from the top down in the codesign of initiatives and inclusion of clients in everything that is [being] undertaken.”

Ms. O’Hara also opened our minds to the value and importance in embracing lived expertise in our new strategy. Her quote from Maya Angelou best captures the essence of The Royal’s visionary new strategic plan: “People will forget what you said, peo-

ple will forget what you did, but people will never forget how you made them feel.”

Working shoulder to shoulder with clients and families, we know we are on the path towards a brighter and meaningful future. By putting lived expertise centre stage, The Royal is becoming a hospital without walls – a hospital where mental health care is delivered where people need it the H most, close to home. ■

Dr. Joanne Bezzubetz is the President & CEO, The Royal. www.hospitalnews.com

JUNE 2021 HOSPITAL NEWS 35

LONG-TERM CARE NEWS

AgeTech solutions:

New technologies will make a difference in long-term care

By Alex Mihailidis

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s we start to imagine life after this global pandemic, we must not lose momentum in searching for

lessons.

There is an important and essential national conversation underway about how to do better for residents of longterm care and to give more support for dedicated staff who have endured extraordinary stresses.

As challenging as the pandemic has been, it is important to understand that many of the stresses are not new.

Addressing the challenges is a complex matter requiring a multifaceted response, but we do have some readily available tools that can make a difference: the burgeoning AgeTech sector is offering up an array of technologies that can help to transform long-term care.

While there is no substitute for the human touch, new and emerging technologies can help to ease the burden on staff, allowing them more time to devote to caring for residents. Technology can also improve safety for all.

Think about the daily challenge of moving residents with mobility difficulties. Shifting someone from a bed to a gurney or a wheelchair often requires several people, with the constant risk of injury for the staff. A Toronto startup called Able Innovations has developed a compact device called the Delta Platform, which allows a single caregiver to safely transfer an individual to and from a bed, without contact and while preserving the person’s dignity.

Infection prevention and control are long-standing issues that predate COVID-19. A Nova Scotia company called Tenera Care is now testing a wearable device that can help trace, reduce and prevent the spread of infectious diseases like COVID-19 by providing a readout of everyone who has been in contact with an infected visitor, resident or care worker. The

system can also “see” people moving around and alert staff if a resident falls or goes into the wrong room.

Nighttime can be particularly challenging for staff spread thinner.

A Vancouver-area startup called Tochtech Technologies has developed a non-wearable health tracking device that is placed under the leg or frame of a bed and allows staff to monitor residents as they sleep. It could make work easier and more effective for hardpressed workers on the overnight shifts, alerting them when a resident is experiencing heart or breathing problems.

The isolation felt by older people in long-term care has been heartbreaking to witness during pandemic lockdowns. While nothing can replace face-to-face contact with loved ones, a Canadian-designed app called FamliNet helps fill the gap, with an easyto-use communications platform that allows older adults with little or no computer experience to connect with family and friends.

And there are new technologies that can help to increase cognitive and physical stimulation for residents in long-term care. The list goes on.

TECHNOLOGY AS PART OF A NEW NATIONAL STANDARD FOR LONGTERM CARE

For all it can deliver, technology is one of the topics that will inform a new national standard for long-term care homes in Canada. You may have heard about this proposed standard, which will provide requirements for safe operating practices and for infection prevention and control in longterm care. I am honoured to be leading its development for the Canadian Standards Association (CSA Group).

Along with technology, topics including cleaning and disinfecting processes, waste removal, HVAC, plumbing

and medical gas systems will be referenced or inform the standard.

I am pleased to be working closely with Dr. Samir Sinha, who is leading the development for Health Standards Organization (HSO) of a national standard for long-term care services to ensure that long-term care residents receive the quality of care they deserve.

The two standards will be complementary and developed in parallel. We want to hear from as many Canadians as possible. We will be working with stakeholders, experts and people with lived experience to develop standards that address challenges in long-term

care, and take into account lessons learned from the COVID-19 pandemic. Broad-based consultations will ensure that the new standards are informed by the wisdom and experience of people on the front lines, including caregivers and residents.

When it comes to technology, we will certainly be looking at the many possibilities it offers to improve safety and quality of life in long-term care, and ease stresses on staff.

Dedicated human beings will always form the core of care but let us call upon the brilliance of Canada’s emerging AgeTech innovators to help us do H better for all. ■

Alex Mihailidis is Scientific Director and CEO of AGE-WELL, a federally-funded Network of Centres of Excellence. AGE-WELL brings together researchers, older adults, caregivers, partner organizations and future leaders to accelerate the delivery of technology-based solutions for healthy aging. Dr. Mihailidis is also Associate Vice-President, International Partnerships and a professor at the University of Toronto, and a senior scientist at the KITE Research Institute at Toronto Rehab-UHN. 36 HOSPITAL NEWS JUNE 2021

www.hospitalnews.com

LONG-TERM CARE NEWS

The CABHI Summit 2021

highlights cutting-edge trends in healthcare technology

By Arielle Ricketts he Centre for Aging + Brain Health Innovation (CABHI), powered by Baycrest, held their annual conference on March 24th and 25th.

The CABHI Summit 2021 featured more than 800 attendees from all over the world, including 90 speakers, 85 exhibitors, and over 11 hours of dedicated programming.

T

This year’s theme was “Accelerating Innovation + Amplifying Impact.”

The Summit connected a broad and inclusive global community of the world’s top thought-leaders, innovators, investors, researchers, older adults, and care partners – the people who make up the aging and longevity sector today.

Here are some of the Summit’s highlights:

THE LEAP FORWARD: LAUNCHING A GLOBAL INNOVATION COMMUNITY OF OLDER ADULTS

The first day of programming was targeted to older adults and their care partners and CABHI’s launch of their new global community plat-

form, Leap. Leap is a new collaborative learning, engagement, and innovation acceleration platform for a welcoming and diverse community of older adults, both online and, when circumstances allow, in-person.

Continued on page 38

What is Home Care?

Home care is about trust. It is feeling comfortable with a provider ĐŽŵŝŶŐ ŝŶƚŽ LJŽƵƌ ŚŽŵĞ ĂŶĚ͕ ƉŽƐƐŝďůLJ͕ ĂƐƐŝƐƟŶŐ LJŽƵ ǁŝƚŚ ƚŚĞ ŵŽƐƚ ŝŶƟŵĂƚĞ ĐĂƌĞ͘ Bayshore’s home care services are extensive and varied, depending on your needs. They ƌĂŶŐĞ ĨƌŽŵ ŵĞĂů ƉƌĞƉĂƌĂƟŽŶ͕ ŵĞĚŝĐĂƟŽŶ ƌĞŵŝŶĚĞƌƐ͕ ĐŽŵƉĂŶŝŽŶƐŚŝƉ Žƌ ĂƐƐŝƐƟŶŐ ǁŝƚŚ errands to nursing, respite care, wound care, ƐĞƌŝŽƵƐ ŝŶũƵƌLJ ĐĂƌĞ͕ Žƌ ƉĂůůŝĂƟǀĞ ĐĂƌĞ͘

Caregivers wear PPE

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Home care is personalized for you, so you can experience the best in your day-to-day living – in your own home.

Support is just a phone call away.

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bayshore.ca www.hospitalnews.com

JUNE 2021 HOSPITAL NEWS 37

LONG-TERM CARE NEWS

Supporting cancer patients during a health crisis

By Margaret Valois OVID-19 triggered a new and unexpected health crisis for cancer patients.

Cancelled surgeries, treatments and diagnostics, limited access to health professionals, and increased isolation have all served to heighten the already considerable mental and emotional toll on cancer patients and have significantly increased their need for supportive care.

Wellspring, a Canada-wide network of nine community-based

C

centres, has provided supportive care for cancer patients for the past 29 years. Wellspring’s professionally-led emotional, psychosocial, physical and practical supportive care programs and services are for individuals with any type or stage of cancer, and their caregivers, at no charge and without a referral.

Wellspring has ensured that access to these fundamentally critical supports remained a priority despite the pandemic crisis’s challenges.

MOVING TO THE DIGITAL SPACE

To ensure the uninterrupted availability of supportive care programs for cancer patients, Wellspring immediately transformed 94 per cent of its programs, from in-centre and in-person, to an online capacity. Since introducing online programs, 96 per cent of those participating indicated through a mission delivery survey that they would recommend them to other cancer patients.

A year earlier, Wellspring had tiptoed into virtual programming in response to requests to provide supports to Canadians who did not have access to a physical centre. “In speaking with our constituents,” said Judi Perry Brinkert, Chief Mission Officer with Wellspring, “there was a worry that we would lose something fundamental to the Wellspring experience, the hallmarks of which are the warmth and connection of the interactions with our members. We had a modest plan

CABHI Summit 2021 Continued from page 37 Day one sessions shone a light on how innovation can improve older adults’ and their care partners’ daily lives, homes, health, and well-being, and kicked off with keynote Ashton Applewhite, TED Talk Speaker and author of the book, This Chair Rocks: A Manifesto Against Ageism.

Applewhite began her talk by asking: What would the pandemic have looked like, and how would it have unfolded differently, had we not operated by an ageist belief that it would “only” affect older people? Probably very different.

Wednesday’s sessions also illustrated how older adult perspectives must be at the forefront of innovation development. Redesigning the places in which older adults live and approaches to their care was central to our concluding keynote, Moira Welsh, Investigative Reporter, The Toronto Star, and author of the new book, Happily Ever Older: Revolutionary Approaches to Long-Term Care, in her presentation and fireside chat with Dr. William Reichman, President & CEO, Baycrest.

Wednesday panels showcased older adults’ active participation, such as on “Inclusive Innovation: Bringing the End User to the Virtual Table,” “Discovery, Access and Lifelong Learning: Digital Immigrants Talk to Digital

Natives,” and the demo of “How End Users Inform Innovation.” That last session featured some of CABHI’s own Seniors Advisory Panel members assessing solutions that select healthtech and agetech innovators presented.

ENOUGH ABOUT ME: FROM THE CAREGIVER’S PERSPECTIVE

A centrepiece of the Summit was the keynote panel named for Journalist and News Anchor, MSNBC and NBC, Richard Lui’s new book, Enough About Me: The Unexpected Power of Selflessness, which draws upon his experience caring for his father.

Lui joined in a candid, heartfelt conversation with two other high-profile caregivers who have cared for their husbands with early-onset dementia: Jill Daum, mom, actor, playwright, and caregiver to her husband, John Mann, beloved singer-songwriter of the band, Spirit of the West; and the Honourable Lisa Raitt, Vice-Chair of Global Investment Banking, CIBC, and caregiver to her husband Bruce, who, like Daum’s, was also diagnosed with a form of early-onset dementia.

For all three caregivers, overcoming the stigma associated with dementia led them to embrace their own vulnerability and open up about their experiences.

THE BUSINESS OF AGING WELL

Thursday’s sessions were about strategies for connecting innovators with investors, to better grow and scale their solutions.

The day began with an insightful keynote from André Picard, Health Columnist, The Globe and Mail, and author of the new Canadian bestseller, Neglected No More: The Urgent Need to Improve the Lives of Canada’s Elders in the Wake of a Pandemic. Picard outlined in broad terms the scale of the problems facing older adults in long-term care and articulated several viable solutions to improve older adults’ lives.

THE LONGEVITY SECTOR’S LARGEST COMBINED PITCH COMPETITION

The combined pitch competition represented the longevity sector’s largest, with a pool of $1.5 million for the best and brightest agetech, healthtech, and neurotech companies. The combined pitch competition was made possible by a collaborative partnership funded

by CABHI, the Ontario Brain Institute (OBI), and Innovacorp, with lead sponsorship from our event’s Presenting Sponsor, SOMPO Digital Lab Inc. The People’s Choice Award winner for OBI’s Pitch Competition was Ling-

go, a novel augmentative and alternative communication (AAC) mobile application system that improves communication for individuals with limited-to-no speech, such as people living with dementia, post-stroke aphasia, an acquired brain injury, autism, or other developmental disabilities.

Linggo has also received early-stage funding from CABHI’s Spark program, which supports the development of emerging innovations from point-ofcare staff.

CABHI’s People’s Choice Award winner was a tie between Steadiwear Inc., a device supporting the stabilization of hand tremors, and Welbi, empowering senior living community programming tools.

The combined pitch competition and sessions at the CABHI Summit 2021 revealed how vibrant the aging and longevity sector is. Whether it’s improved patient transfer systems, better retinal and brain scans, caregiver mental health support apps, or VR-based screening-experiences for dementia patients, the companies at this year’s Summit and Pitch Competitions, like the thought leaders who spoke at the Summit, suggests a much brighter future emerging on the horizon.

Visit cabhi.com to learn more about H our upcoming Summits ■

Arielle Ricketts is the Marketing & Communications Content Specialist at the Centre for Aging + Brain Health Innovation (CABHI) 38 HOSPITAL NEWS JUNE 2021

www.hospitalnews.com

CAREERS to grow this part of our services strategically. We didn’t know what was going to happen.”

Today, all Wellspring programs are provided either as interactive virtual groups, real-time webinars, self-paced videos, or audio or telephone-based programs and are available through a new website named Well on the Web (www.wellspring.ca/online-programs).

The variety of types of access purposefully accommodates the wide range of comfort levels of the participants.

Since launching the new platform in March, Wellspring has accommodated 50,200 visits from members, 45 per cent of which were visits to programs to address emotional needs, 35 per cent to participate in physical/ functional programs such as exercise, fatigue and Brain Fog, and 57 per cent were for real-time, virtual groups and webinars.

Interactive group sessions are limited to 20 participants, whereas the webinars can accommodate up to 500. Well on the Web now sees more than 6,000 program visits monthly, with participants joining from every Canadian province and two of the three territories and beyond.

“We anticipated a significant learning curve,” said Perry-Brinkert.

“Instead, we’ve been surprised and delighted with how quickly and readily our members have adopted online programming.” One Wellspring participant shared, “This comes at a time when we are all struggling with a wide range of emotions as we try to make sense of the world today. I think this new way of providing help is beneficial for those of us living with cancer and who already feel overly isolated.”

Today Wellspring offers complex programs online, such as Cancer Exercise and the Children’s and Parents’ program, in addition to a variety of support groups and coping strategy programs such as Healing Journey, Relaxation and Visualization, Yoga, Chi Life, and Peer Support. In February, a new stream of programming was launched to address the unique challenges posed by a chronic cancer diagnosis, and a new partnership with Myeloma Canada recently added a specialized stream of peer support for those experiencing myeloma. All are gaining new and larger audiences rapidly.

Wellspring strives to create as seamless an online experience as possible. ‘Zoom Buddies’ are availwww.hospitalnews.com

able to assist participants in learning how to register for programs and to build their sense of comfort in using the zoom platform. In addition to the professional program leader, each session has a virtual host who is available to assist with any technical concerns arising and answer questions from participants. Leaders stay online post session to connect with participants who have extra questions or to provide time for informal conversation between participants.

Wellspring employs all the software’s security features to create a safe environment for the participants.

BENEFITS

A recent member survey indicated great appreciation for having access to such help from the safety and security of home. Those not feeling well can participate from the comfort of their beds, those with hearing loss can change the volume of the discussions to suit their needs, and those uncomfortable with changes in their physical appearance can participate with their cameras off.

Members also indicated that online programming helped with energy-levels, with many members reflecting on how much energy it took to get dressed, to travel to a physical site, participate in a program and then return home afterwards. Many indicated that being able to join a group from home left them with the energy they needed to manage the rest of their day.

Many of the informational program sessions are recorded and posted afterwards as opportunities for self-paced learning. With now more than 50 videos making up the online resource library and views of the recordings surpassing 1,100/ month, this too has proved a highly popular option for those either unable or uncomfortable participating in real-time group discussions or those who need a ‘refresher’ of the content provided. Said one patient, “Being able to participate in the programs online has been amazing for my mental health and my soul. I am very thankful and happy that Wellspring exists and offers all this help online!”

According to the recent mission survey: • 90 per cent of responding Wellspring members indicated they “have gained valuable information to help them cope with their cancer experience.

ming shared nationally through Well on the Web. It has also improved opportunities to collaborate and partner with national cancer organizations such as Pancreatic Cancer Canada, Bladder Cancer Canada and Myeloma Canada to extend reach across the country and provide access to more specialized program offerings.

• 87 per cent said they are “coping better because of participation in Wellspring programs” • 81 per cent indicated they “feel less isolated” • 80 per cent indicated that they feel “able to access the types of support they need through Well on the Web” • 76 per cent said they “felt a connection to other participants”, and • 87 per cent “plan to continue to access some programming virtually post-pandemic.

As a network of affiliated centres across Ontario and Alberta, each Wellspring centre continues to focus on their respective communities’ unique needs and opportunities. The changes brought about by the pandemic have resulted in stronger connections between Wellspring affiliated centres and collaboration on program-

THE FUTURE

So, where does Wellspring go from here? Of course, Wellspring welcomes the days when the centres can reopen to cancer patients, family members, and caregivers. However, Well on the Web and online programming will continue as an integral part of the Wellspring brand available to cancer patients across Canada. Every new program developed will include considerations for online adaptation and facilitation. For H more information visit Wellspring.ca ■

Margaret Valois, Director, Communications, at Wellspring.

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