Hospital News June 2022 Edition by Hospital News

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

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Canada’s first

fully robotic

esophagectomy Page 10

June 2022 Edition

The future of nursing It’s a painful irony that the dedication of nurses and health-care professionals has led some to undervalue us and take us for granted. Now, devastating staff shortages have eroded the quality of patient care in this province. We’ve been ﬁghting hard to prevent this situation, which was fully avoidable. It’s discouraging that our voices have been ignored, but it hasn’t stopped us, because no matter how tough things are, nurses and health-care professionals know we can always count on each other. We’re standing together for our patients and our profession - and we won’t back down.

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Contents June 2022 Edition

IN THIS ISSUE:

New cardiac defibrillator is found to be safer for patients

▲ Cover story: Canada’s first fully robotic esophagectomy

▲ Special Focus: Canadian Society of Hospital Pharmacists

▲ Nurse serves up fundraisers for people facing food insecurity

COLUMNS Editor’s Note ....................4 In brief .............................6

Evidence matters ...........16 From the CEO’s desk .....28

▲ Omicron triples Canada’s COVID-19 infection count, study shows

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▲ Local researchers using artificial intelligence to lead the way in bedside lung imaging

Preventing pediatric COVID-19 vaccine errors

JUNE 2022 HOSPITAL NEWS 3

Canadians are concerned about the

mental health of health workers – they should be By Ivy Lynn Bourgeault

f the health workforce was a patient, it would be in critical condition. The public seems to get it. New results of a nation-wide survey by the University of Ottawa, conducted among members of the Angus Reid Forum (March 4-8, 2022) paint a troubling picture of how we feel about health workers. Overall, nine out of 10 Canadians (87 per cent) say they are concerned about the mental health of health care workers. This level of concern is even higher than ratings of our own worsening mental and physical health. When asked how things have changed since March 2020, 54 per cent of Canadians say their own mental health has worsened, and 53 per cent say their overall physical health and well-being has worsened. After two years of pandemic stress, we are much more likely to express concern about the mental health of health workers than to say we’ve experienced a worsening of our own health. People are not only concerned about how health workers are doing; they also express concern about what this means for their access to, and quality of, health care. Overall, four out of five Canadians (79 per cent) say they are concerned about being able to access health care services because of the shortage of health workers. Slightly more (84 per cent) say they are concerned about the quality of health care services.

Women are significantly more likely than men to express concern about the mental health of health workers, health access and quality of care. Perhaps this is because the health system is primarily a women’s workforce, with 82 per cent identifying as women, and growing, each year. Regionally, half of those in Atlantic Canada (53 per cent) expressed strong agreement that they are concerned about being able to access health care services because of labor shortages – by far the highest rate in the country. Perhaps the importance of health care to provincial elections is most salient in this region. If the public gets it, why doesn’t it seem to be the case for our politicians? The recent federal budget was like crickets about these growing concerns. The pandemic has caused remarkable increases in rates of burnout and other mental health concerns, already prevalent among nurses and doctors before the pandemic, due to health and safety concerns and unsustainable workloads. Health workers have faced 16+ hour days, cancelled vacations and forced redeployment. And then there is the violence. We were warned pre-pandemic of the increasing violence nurses experience in health care, caused by understaffing, inadequate security and increased patient numbers, and how even in medicine, women faced incivility, bullying and harassment. 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.

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NEWS

Omicron triples Canada’s COVID-19 infection count, study shows By Jennifer Stranges early 30 per cent of Canadian adults – nine million people – were infected during the Omicron variant wave early in 2022, compared with just 10 per cent who had been infected in the previous four waves, according to a new study led by Toronto researchers. Despite the high numbers of infections, the study also revealed that every dose of vaccine and previous infection boosted immune responses. Canadian adults with three vaccine doses and a past infection from COVID-19 had the highest protection. The findings, published in a letter to the editor in The New England Journal of Medicine, fill a gap in understanding the scale of COVID-19’s spread during the fifth wave, as well as Canadians’ immunity to the virus, either through vaccination or natural infection. Provinces scaled back COVID-19 molecular diagnostic testing in December 2021, leaving policymakers and the public without reliable data to inform pandemic responses and to gauge community risk. “The incidence of Omicron variants, which rose worldwide from December 2021 even among vaccinated people, is poorly understood. This study quantifies SARS-CoV-2 incidence during the initial Omicron wave among Canadian adults, and the contribution of prior infection and vaccination to age-specific active immunity,” said Dr. Prabhat Jha, principal investigator of the Action to Beat Coronavirus (AbC) study and director of the Centre for Global Health Research at St. Michael’s Hospital of Unity Health Toronto. Dr. Jha is also a professor of epidemiology at the University of Toronto’s Dalla Lana School of Public Health (DLSPH). The study analyzed more than 5,000 blood samples representative of Canadian adults – members of the Angus Reid Forum, a public polling cohort – from January 15 to March 15, 2022. From those results, the researchers de-

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termined that an estimated nine million of 29.7 million Canadian adults were newly infected during the Omicron wave. Of those infections, one million were among the country’s 2.3 million unvaccinated adult population – representing 40 per cent of all unvaccinated adults. The Ab-C study is a collaboration among Unity Health Toronto, DLSPH, the Angus Reid Institute, and the Lunenfeld-Tanenbaum Research Institute at Sinai Health. It is funded by the Government of Canada through its COVID-19 Immunity Task Force (CITF). Ab-C has been tracking the pandemic in Canada with periodic polling about lived experience and blood sample collection since May 2020, and will continue as long as the COVID-19 pandemic continues to evolve. “Canada has kept natural infection levels generally low – perhaps less than 10 per cent of the adult population prior to Omicron – in contrast to many parts of the United States and England. So Canada must rely on vaccination – especially three doses for the older population. However, the proportion of adults vaccinated with third doses is still lower than

ideal,” added lead author Dr. Patrick Brown, a biostatistician at the Centre for Global Health Research and the University of Toronto. “If we take into account the fact that pediatric surveys have estimated that the proportion of infections

among children was as high or higher than it was among adults and that new subvariants of Omicron continue to infect Canadians in the ongoing sixth wave, there are now millions more infections to add to the Ab-C study’s total,” states Catherine Hankins, CoChair of the COVID-19 Immunity Task Force. “In short, a substantial portion of the Canadian population now has hybrid immunity – defined as a combination of a past COVID-19 infection along with between one and three doses of a COVID-19 vaccine.” The Ab-C study has started surveying approximately 1,300 adults who were not infected from the initial Omicron variant (called BA.1/1.1) to determine whether they were infected by the latest Omicron variant (called BA.2) from March to June 2022. “We owe a great debt of gratitude to the thousands of Canadians, drawn from every region who took the time to share specimens of their blood and complete related surveys. Their participation made this study possible,” said Dr. Angus Reid, chairman of the H Angus Reid Institute. ■

Jennifer Stranges is a senior communications advisor, Unity Health Toronto. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.

JUNE 2022 HOSPITAL NEWS 5

IN BRIEF

Deep crisis in nursing demands urgent action by government, employers, educators and associations ew survey results shared in a pivotal report released Thursday by the Registered Nurses’ Association of Ontario (RNAO) highlight instability in the nursing profession that, left unchecked, will have profound impacts on the profession, the effective functioning of the health system and the quality of care Ontarians receive. The results are detailed in the report Nursing Through Crisis: A Comparative Perspective. RNAO carried out a detailed survey from May to July 2021, during the height of Ontario’s third wave. Responses from 5,200 Canadian nurses, most of them from Ontario, were analyzed and compared with the association’s earlier Work and Wellbeing Survey Results report, as well as with similarly focused national and international surveys that examined the

MORE THAN 75 PER CENT OF CANADIAN NURSES WHO RESPONDED TO THE SURVEY WERE CLASSIFIED AS BURNT OUT, WITH HIGHER PERCENTAGES AMONG HOSPITAL AND FRONT-LINE WORKERS. struggles of nurses working throughout the pandemic. RNAO CEO Dr. Doris Grinspun says “the numbers are both sobering and alarming and represent a call to action for the government, health employers, educators, and nursing associations.” More than 75 per cent of Canadian nurses who responded to the survey were classified as burnt out, with higher percentages among hospital and front-line workers. Sixty-nine per cent of nurses said they planned to leave their position with-

Continued from page 4

Mental health of health workers In its 2019 report, Violence Facing Health Care Workers in Canada, the House of Commons Standing Committee on Health noted that health care workers are four times as likely to face workplace violence than any other profession, yet most goes unreported due to a culture of acceptance. Few of the critical recommendations from the report have ever been implemented. We are still waiting for the recommended public awareness campaign about the violence faced by health care workers or the pan-Canadian prevention framework. We are also still waiting for the much-needed update to the Pan-Canadian Health Human Resources Strategy to address staffing shortages and reflect the well-being of health care providers. While health care workers care for us, they have not received the support and care they need from our governments through supportive public policy.

As more than 65 health care organizations and 300 health workforce experts and organizational leaders stated in an open Call to Action last year, the time is now for the federal government to take the lead in supporting provinces, territories, regions, hospitals, health authorities and training programs with an investment in better health workforce data and decision-making tools. Canada needs to make informed staffing decisions, optimize contributions of the available workforce and enable safer workplaces. Right now, we are working in the dark. There is both a sound economic argument for such an investment – with the health workforce making up eight per cent of Canada’s GDP, or over $175 billion in 2019 – and a sound humanistic argument in support of health workers. The status quo must be seen for what it is – the most expensive and H least tenable option going forward. ■

Dr. Ivy Lynn Bourgeault is a Professor of Sociological and Anthropological Studies at the University of Ottawa and the Lead of the Canadian Health Workforce Network. 6 HOSPITAL NEWS JUNE 2022

in five years. And, among those who indicated they wanted to leave their position, 42 per cent said they were planning to leave the profession altogether and seek opportunities elsewhere or retire. Among other major findings from the survey: • 73 per cent of nurses reported that their workloads increased moderately or significantly during the pandemic • 60 per cent of nurses were moderately or extremely concerned about staffing levels • 53 per cent were moderately or extremely concerned about workloads • 54 per cent were moderately or extremely concerned about skill mix • Only 35 per cent of nurses said they had adequate support services to spend time with patients/clients • Nurses struggled in all sectors and domains of practice during the pandemic with hospital and front-line nurses reporting higher levels of depression, anxiety, stress and burnout RNAO says the results are even more stark when you consider that Ontario went into the pandemic with a shortfall of 22,000 registered nurses (RN) on a per-capita basis compared to the rest of Canada. Grinspun says the survey echoes what RNAO has been saying all along: “Without a detailed health human resources plan that is laser-focused on retaining nurses in the profession and building Ontario’s RN workforce, people’s health and the system’s ability to operate effectively are in danger.” The report’s recommendations include: • Repeal Bill 124 – Ontario’s wage restraint legislation – and refrain from extending or imposing any further wage restraint measures • Immediately increase the RN workforce by expediting applications and

finding pathways for 26,000 internationally educated nurses (IEN) living in Ontario that are eager to join the province’s workforce • Increase enrolments and funding for baccalaureate nursing programs, including second entry and compressed programs by 10 per cent for seven years and compress the RPNto-BScN bridging program to two years • Develop and fund a Return to Nursing Now program to attract RNs back to Ontario’s nursing workforce • Support nurses throughout their careers by expanding the Nursing Graduate Guarantee, reinstating the Late Career Nurse Initiative and bringing back retired RNs to serve as mentors to new graduates and IENs • Establish a nursing task force to make recommendations on matters related to the retention and recruitment of RNs In addition to sharing its recommendations, RNAO announced its launch of four programs that will address nurses’ needs for better workplace supports, more professional development opportunities and more control over their working lives. These initiatives include: the Advanced Clinical Practice Fellowship program, the Leadership and Management for Nurses program, the Mentorship for Nurses program, and the Nursing Student Preceptor for Long-Term Care program. “Nurses play a central role in the lives of Ontarians, in health and in illness. That’s why we need to ensure that all nurses feel valued. And, we must pay unique attention to RNs – who are the ones exiting the profession en masse. We know nurses are committed and have vital expertise, compassion and skills to share. What we need is sustained effort to retain the nurses we have, and ensure welcoming workplaces for new graduates and others who join the profession,” says Hoffarth, adding that “the silver lining is that there is a 35 per cent increase in applications to baccalaureate nursing programs across the province.” Join the conversation on social meH dia using #NursingThroughCrisis. ■ www.hospitalnews.com

IN BRIEF

Residents of Ontario retirement home residences have higher rates of hospital care than residents of long-term care homes etirement homes are generally privately run, for-profit residences to support independent living for older people thought to have fewer care needs than residents of long-term care homes. “These older adults purchase some services from their retirement home to support independent living, but they still use a lot of publicly funded hospital-based care and have surprisingly low rates of primary care use,” says Dr. Andrew Costa, St. Joseph’s Health System Centre for Integrated Care, ICES, and McMaster University, Hamilton. “Our findings suggest that we should be thinking about how to better organize integrated primary and supportive care services to avoid a great deal of hospital care use.” In 2018 in Ontario, there were 757 licensed retirement residences. Researchers included 54 733 residents (72% of licensed beds) with a mean age of 86.7 years of whom 69% (37 768) were female. Common health conditions included hypertension (86%), osteoarthritis (68%), mood disorders (64%) and dementia (38%). Compared with LTC home residents, residents of retirement homes had more than double the rate of emergency department visits and hospital admissions and about 50% more alternate level of care (ALC) days in which a patient occupies a hospital bed because they cannot be safely discharged. However, they had lower rates of primary care visits and specialist visits than LTC residents. “We found that residents of retirement homes had the highest rates of ALC days, which suggests that the needs of some residents may exceed their capacity to procure, publicly or privately, the level and scope of care needed in their retirement home,” write the authors. “Some of these residents may not be able to afford additional care from

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their retirement home, as rates for heavy care in Ontario can exceed $6000 per month.” As almost half the retirement home residents lived in middle- and low-income neighbourhoods, the costs of additional care may be too high for many people. “This underscores the need for equitable policies that reduce barriers to housing and health care for this population to curtail the incidence of ALC patient days that strain hospital resources,” write the authors. The study contributes to the literature as there is a lack of Canadian evidence on health care use and char-

acteristics of residents of retirement homes. “We have been largely in the dark on understanding who lives in retirement homes, and how they compare with those who live in long-term care homes,” says Dr. Derek Manis, postdoctoral fellow at McMaster University and ICES. “This has been the case despite the growth in the number of older people choosing to live in retirement homes.” “The growth and availability of beds in these homes outpaces that of long-term care homes, and this growth is likely attributed to fewer supply and regulatory requirements

than in long-term care homes that encourage capital growth in response to real demand. The increased supply of retirement homes may suggest that some of these retirement homes are a growing substitute for a longterm care home. As an important link in the continuum of care settings for older adults, our data suggest retirement homes should be subject to oversight in keeping with the vulnerability of their residents,” the authors conclude. “Rates of health services use among residents of retirement homes in Ontario: a population-based cohort H study” was published May 30, 2022. ■

Physicians, nurses offer solutions to immediately address health human resource crisis or more than two years, health care providers have worked tirelessly to keep the Canadian health system from buckling under the strain of a global pandemic, massive surgical backlogs, and a depleted workforce. Unfortunately, the health system was struggling before COVID-19. Today, with more health workers burning out and leaving their professions, the system has reached a point where immediate action is needed to prevent total collapse. In response, the Canadian Medical Association (CMA), in partnership with the Canadian Nurses Association (CNA) and the College of Family Physicians of Canada (CFPC), have collaborated to develop health human resources solutions designed to rebuild Canada’s health care workforce in a proactive and sustainable way. The plan offers immediate, medium and long-term policy recommendations for the federal government to adopt and collaborate with its provincial/territorial counterparts.

IMMEDIATE ACTION PLAN (NEXT SIX MONTHS):

1. Create retention incentives for health care workers, especially in areas of greatest need. 2. Address issues that prevent health care workers from spending more time caring for patients by creating administrative and mental health supports in primary and secondary care settings. 3. Scale up collaborative, interprofessional primary care so that more Canadians can access timely care provided by family doctors together with other primary care practitioners in a team-based model.

MEDIUM-TERM PLAN (7-12 MONTHS):

1. Build on existing virtual care models to increase access and remove barriers to appropriate care in a safe, secure virtual space. 2. Invest in new training and education infrastructure to increase the supply of physicians, nurses and nurse practitioners.

3. Support internationally trained physicians, nurses and nurse practitioners in getting licensed and into the workforce.

LONG-TERM PLAN (13-18 MONTHS):

1. Initiate a long-term, sustainable pan-Canadian mental health plan for health care workers. 2. Improve workforce data collection across health systems to support creating a health human resource plan for Canada. The CMA, CNA and CFPC recently presented these recommendations to the House of Commons’ Standing Committee on Health and the federal/provincial/territorial Committee on Health Workforce. The complete presentation with further details on the recommendations can be found online. Our organizations are calling on immediate action to begin implementing these critical policy measures. We are prepared to work in collaboration with governments and other stakeholders to support and grow the health workH force needed to care for Canadians. ■ JUNE 2022 HOSPITAL NEWS 7

NEWS

Virtual gourmet cooking experience blends fundraising with a dash of star power By Michelle Rowe-Jardine ike most hospital foundations, West Park Foundation plans a busy calendar of popular annual fundraising events including galas, golf tournaments, and their signature celebrity basketball event, Tournament of Stars. And like the rest of the world, they were forced to pivot in 2020 as the COVID-19 pandemic took hold. All in-person events were put on pause and the Foundation had to start from scratch. They tried to imagine one of their fun, elegant cocktail reception-style events, and how they would go about providing a similarly special experience without attendees ever being in the same room together. “One concept we were looking at even before COVID was that we wanted to have a bit more focus on the food and we wanted to involve chefs,” says Ashleigh Manzon, West Park Foundation’s Director of Annual Programs and Planned Giving. They decided to plan out a virtual cooking experience, where a skilled chef would lead people at home through a culinary experience, teaching participants tips and tricks along the way, and together they would enjoy a homecooked meal. The first iteration took place in June, 2020, and involved a collaboration with the restaurant George. For the second event, they wanted to step it up and felt a celebrity chef might be a bit of a draw for people, so Manzon says they began talking about renowned chefs they liked and a reoccurring name was Chef Lynn Crawford, the famous TV personality from Food Network programs including Pitchin’ In and Restaurant Makeover, and the author of several cookbooks. They managed to get the esteemed Canadian chef on board and test their theory with their second virtual event in October, 2020, called UNCORK UNTAP UNWIND, which had more than 300 participants. “You can go out to a restaurant or order food to your door, but the whole idea is ‘what are we offering beyond

Chef Lynn Crawford

“YOU CAN GO OUT TO A RESTAURANT OR ORDER FOOD TO YOUR DOOR, BUT THE WHOLE IDEA IS ‘WHAT ARE WE OFFERING BEYOND JUST THAT? IT’S NOT THAT WE’RE GIVING YOU A MEAL TO JUST REHEAT AT HOME, SO IT HAS TO BE MORE ABOUT THE FACT THAT YOU ARE COOKING WITH CHEF LYNN, AND IT’S ABOUT COOKING TOGETHER SO THERE’S THAT SENSE OF COMMUNITY,” just that? It’s not that we’re giving you a meal to just reheat at home, so it has to be more about the fact that you are cooking with Chef Lynn, and it’s about cooking together so there’s that sense of community,” Manzon says. On top of the opportunity to cook an amazing meal alongside a famous chef, the event involves musical en-

tertainment – most recently Divine Brown – patient speakers, and has even involved a silent auction. Pippa Cossette and Bernie McGarva had previously attended several West Park events in person, and when the Foundation pivoted to an online event during the pandemic, Cossette says she was thrilled. “I thought this was

such a great opportunity for us to feel connected again to people, and it felt a bit like having a dinner party with friends.” For McGarva, who was treated at West Park in 2014 following an amputation, he felt even though the format was online, the spirit of the in-person events was very much still there. “One of the nice things about the West Park events is they always have one of their recent patients as a guest and a speaker, and that becomes the central part of the presentation portion of the evening,” McGarva says. “They tell their story and it’s a moving story, and everybody comes away with a greater understanding of what West Park does because of the stories that are told at those events.” Cossette adds that another reason virtual events like this have value, even post-pandemic, is because it helps more people to be involved. “Some people who want to participate may have their own disabilities to deal with and so the challenge of getting somewhere for these events is then mitigated by the fact that you can do this in your own home.” The Foundation has held six of these virtual events, and as they look ahead to October, Manzon says depending on restrictions, they may try a hybrid-model event where some participants can cook from home and a smaller group can be in a professional kitchen with Chef Lynn. “I’m so enthusiastic about the virtual events that I’ve written Joanne Cole [West Park Foundation’s CEO] several e-mails about it saying whatever happens, even if we all get together again for big shindigs, I think there’s a lot of value in these wonderful, gourmet, in-home experiences,” Cossette says. “An experience like this, I mean you’re actually part of the show as opposed to just attending as a guest and watching someone else do everything – you’re doing things too,” McGarva H adds. ■

Michelle Rowe-Jardine is the Communications Coordinator at West Park Healthcare Centre. 8 HOSPITAL NEWS JUNE 2022

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NEWS

Canada’s first fully

robotic esophagectomy By Elaine Mitropoulos ith a new, fully robotic approach, thoracic surgeons at St. Joe’s have changed the way that esophageal cancer surgeries are performed. It’s the most significant advancement in surgery for esophageal cancer in Canada in more than two decades. “While esophageal cancer rarely makes headlines, it has the second highest mortality rate of all cancers,” says Dr. Waël Hanna, a thoracic surgeon at St. Joe’s and the head of research within the Hospital’s Boris Family Centre for Robotic Surgery. “It’s so deadly because the esophagus is deep in the throat and thorax and has historically been difficult to operate on using traditional surgical methods.” The complication rate for those undergoing a traditional esophagectomy (a procedure to remove the cancerous portion of the esophagus while pulling the stomach up in the chest cavity to reattach it) is as high as 60 per cent. This is due to the procedure’s handsized incision, the trauma caused to the patient’s chest cavity, and the lengthy recovery stay required post-surgery in the ICU that often results in struggles with pneumonia, infections and heart complications. No one knows that better than Georgetown, Ont., resident Jackie Dean-Rowley. Her daughter Rachel Chuvalo was diagnosed with esophageal cancer in 2011 when she was just 29 years old. At that time, traditional surgery was the only option. “She stood five-foot-two, was fit and trim,” says her mom, Jackie. “It’s hard for me, even now, to think of her small beautiful body experiencing such trauma. But Rachel was a fighter.” Rachel experienced complications after her surgery and eventually succumbed to her disease in 2013. It was eight years after Rachel received care at St. Joe’s that Jackie learned about the promise robotic surgery was showing in treating patients with various forms of cancer. She met

with Dr. Hanna and learned he was researching how to perform a new procedure to help people living with esophageal cancer. Jackie knew she had found a way to honour Rachel’s memory and make a difference in the lives of those living with the same disease that claimed her daughter. Jackie made a $10,000 gift to help Dr. Hanna and his thoracic surgery colleagues to receive special training on how to use a surgical robot to perform procedures on the esophagus. On March 30, 2022, that training was put to use as Dr. Hanna and Dr. John Agzarian performed the first fully robotic esophagectomy in Canada on a 74-yearold Burlington, Ont., man named David Paterson who was diagnosed with esophageal cancer in October 2021. “The surgery took approximately eight hours to complete and was performed through a number of small incisions ranging in size from eight to 12 mm in the patient’s abdomen and chest,” Dr. Hanna says. He walked out of the Hospital eight days later. From our perspective, everything went very, very well.

But what matters most to us, is how our patients are feeling after surgery, and whether we were able to achieve the cancer operation that we intended.” Just over three weeks out of hospital, David is at home and says he is in remission. “With Dr. Hanna’s care and support, I’m happy I made the decision to receive the first fully robotic surgery for this type of cancer in Canada. It was daunting at first, to know that you’re the first person they have operated on this way. But once Dr. Hanna explained how the robot could pinpoint removing only the cancerous portion of my esophagus, while also making it easier for me to recover, it seemed like the right decision. I don’t know what traditional surgery would have felt like, but from what I have heard, it would have been much more painful and hard on my body. I definitely feel fortunate to have had this opportunity. Hopefully, it means other patients like me will have a better quality of life post-surgery.” In addition to the robotic surgery training Drs. Hanna and Agzarian re-

ceived, St. Joe’s sought approval from its ethics board as well as Health Canada before embarking on the procedure. The surgery was also proctored by Dr. Daniel Oh from the University of Southern California, a centre of excellence in robotics. Robotic surgery is not yet funded by OHIP and is only made possible through the generosity of donors in our community and funding from the Hospital as St. Joe’s believes robotic surgery has the power to speed up healing, be more cost-effective, and ease pressures on the healthcare system. “Here at St. Joe’s, we’re not just using a robot because it’s new or flashy. We’re using it to advance patient care. To change the way procedures are performed. To develop new procedures to help those whose cancers were previously thought to be inoperable,” says Dr. Anthony Adili, Chief of Surgery at St. Joe’s. “We’re changing and improving care for patients like Rachel and David, and those who will follow in the future. We’re grateful to all of the donors who have made it possible for us to deliver H this kind of care to our community.” ■

Elaine Mitropoulos is a Communications Officer at St. Joseph’s Healthcare Foundation. 10 HOSPITAL NEWS JUNE 2022

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NEWS

New cardiac defibrillator is found to be safer for patients By Ellie Stutsman amilton researchers have found that the newer type of cardiac defibrillator which gets implanted under the skin reduces patient complications by more than 90 percent. An implanted cardiac defibrillator is a small device that will detect an abnormal heartbeat and send an electric shock to the heart to restore a normal heart rhythm. They are used in patients who have an irregular heart beat that can be life-threatening and are at a high-risk of going into cardiac arrest. The traditional implanted defibrillator has a wire that is inserted into a vein in the chest that travels to the heart. This device can cause damage to the heart or lungs as well as blood clotting in the veins. Whereas the newer device, called a subcutaneous defibrillator, is implanted under the skin just below the armpit with a wire that runs under the skin alongside the

breastbone. Since the wire isn’t inserted into the veins it doesn’t cause blood clotting or risk damaging the heart. “The subcutaneous defibrillator greatly reduces complications without significantly compromising performance,” says study lead Dr. Jeff Healey, electrophysiologist at HHS, senior scientist at PHRI, and professor of cardiology at McMaster University. “This makes it an attractive alternative to the traditional defibrillators, particularly in patients with increased risk for complications.” The study, conducted out of the Population Health Research Institute (PHRI) – a joint facility of Hamilton Health Sciences (HHS) and McMaster University, followed 544 patients from 14 clinical centres across Canada for an average of two and a half years. Half of the patients were randomly selected to have the newer subcutaneous defibrillator and the other half, the traditional defibrillator. Patients were between the age of 18 to 60 years old

who had a genetic heart condition or were at high risk for complications. “Younger patients are usually under-represented in trials with implanted cardiac defibrillators,” says Healey. “However, since Canada has a strong history of clinical trials in this area,

plus registries of patients with inherited heart rhythm disorders, we were able to include the younger demographic.” Healey presented the study results at the Heart Rhythm 2022 conference on April 30, 2022 and hopes it can evenH tually result in a change of practice. ■

Ellie Stutsman works in communications at Hamilton Health Sciences Centre.

Infoway Insights: An Interactive Data and Analytics Hub Access research findings collected by Infoway and our partners on topics such as virtual care, remote patient monitoring (RPM), e-prescribing, e-mental health, digital health literacy and more. Get started: insights.infoway-inforoute.ca

12 HOSPITAL NEWS JUNE 2022

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We need healthy change to prevent a quantum crisis By Dr. Peter Vaughan and Dr. Michele Mosca s the saying goes, an ounce of prevention is worth a pound of cure. This is true in health care, where preventive medicine seeks to anticipate and prevent disease before it happens, and it is true in computing, where we try to predict and proactively anticipate issues related to computing function and cybersecurity. One such example is quantum safe computing: quantum computers have the potential to upend how we protect health information. We must act now to ensure that we can safeguard our health systems – and our systems’ health. Our health data – like other sensitive information on the internet – is protected through encryption. The encryption we use today is too complex for conventional computers to reverse quickly. They could eventually decrypt the data, but it might take hundreds, thousands or even millions of years. Quantum computers work on a fundamentally different level. Where a conventional computer might need a few centuries to decrypt data, in the future a quantum computer will be able do so in seconds. What makes health data an attractive target for quantum computer decryption? It lasts a very long time. You cannot change your biochemistry, your medical history or your biomarkers (fingerprints, iris scans, etc.). The long-lasting and stable nature of health data makes it particularly vulnerable to “harvest and store” attacks. In these attacks, cybercriminals steal encrypted data. While they can’t decrypt it at the time of theft, they store it in the hopes that they’ll be able to unlock it in the future – and that the information will still be relevant. As well, stolen personal information pertaining to long term

Dr. Peter Vaughan

Dr. Michele Mosca

QUANTUM COMPUTERS HAVE THE POTENTIAL TO UPEND HOW WE PROTECT HEALTH INFORMATION. WE MUST ACT NOW TO ENSURE THAT WE CAN SAFEGUARD OUR HEALTH SYSTEMS – AND OUR SYSTEMS’ HEALTH. or potential medical conditions could be used by cybercriminals for fraud and extortion. Current cybersecurity practices prevent unauthorized access to, and tampering with, patients’ charts and medical histories. If quantum computers can lock or alter patient health records, clinicians may not be able to trust their patients’ treatment plans and test results, putting their safety at risk. Certain patient demographics are more likely to be targeted by cybercriminals and more susceptible to their schemes. These patients tend to already be marginalized or underserved. Fraudsters possessing their medical history can masquerade as legitimate health care providers,

insurance agents or government employees. By citing specific and relevant, but stolen, personal health history, they could gain the trust of or intimidate a vulnerable person. Either way, the stolen information facilitates the extortion. The potential consequences of quantum computing are apparent, but quantum computers themselves are not yet widely available. So we can afford to act thoughtfully. Gradual reinforcements to cybersecurity systems can be done relatively cost-efficiently – as in medicine, pre-empting issues is more effective than trying to fix them after a crisis has arisen. This is especially true when you consider the time required to design, build and test quantum-safe features. Crisis

scenarios can result in expensive, onetime fixes. Proactivity helps more than reactivity; organizations can help keep their future costs down by engaging vendors in discussion about quantum safe features now. Canada has strong quantum computing experience, with a long history of investment and several areas of expertise across the country, such as: the University of Sherbrooke; “Quantum Valley” in Waterloo, Ontario; and Vancouver’s Stewart Blusson Quantum Matter Institute. With this foundation in place, we’re well-equipped to focus on quantum challenges, including in health care. Large technology companies like Google, Microsoft, Amazon and IBM are already working on solutions to these quantum cryptographic challenges, while Canadian entities like EvolutionQ and ISARA are addressing similar problems. Major standards organizations, like the National Institute of Standards and Technology in the U.S., are entering the final stages of a process to solicit, evaluate and standardize new quantum-resistant algorithms. Within this context, Canadian health care leaders must invest their time in understanding this threat before it arrives. Canada Health Infoway is beginning to collaborate with other organizations and share knowledge and approaches. Become part of this conversation by informing yourself, resourcing appropriately, and prioritizing a review of your cryptographic approaches and current state of readiness. Quantum computing will change how we handle health information. By working to understand and implement quantum safe computing now, we’ll be introducing an ounce of prevention instead of waiting until we need to apply H a pound of cure. Q

Dr. Peter Vaughan, C.M., C.D., is Chair of the Canada Health Infoway Board of Directors and a former Deputy Minister of Health and Wellness for Nova Scotia. Dr. Michele Mosca is co-chair of the Board of Quantum Industry Canada and co-founded the not-for-profit Quantum-Safe Canada. www.hospitalnews.com

JUNE 2022 HOSPITAL NEWS 13

NEWS

Local researchers using artificial intelligence to lead the way in bedside lung imaging By Celine Zadorsky team at Lawson Health Research Institute are testing a new form of artificial intelligence (AI), paired with portable ultrasound machines, to image and identify lung concerns in real time, right at the beside of critically ill patients. Approximately 100 critical care patients at London Health Sciences Centre (LHSC) will be part of this study which will test whether an AI model can automatically determine the presence of abnormal lung signals. Past studies have suggested that the AI model is very accurate in reading stored images, but this study will evaluate if it retains accuracy when asked to interpret live images being generated at the beside. The study is made possible through the use of novel hardware created in Waterloo, Ontario by startup tech company, Wavebase. “The (WaveBase) device attaches to the ultrasound machine and mirrors the ultrasound image in a second screen,” explains Dr. Robert Arntfield, Lawson researcher and Medical Director of the Critical Care Trauma Centre at LHSC. “The AI model searches the images for patterns in real time and predicts whether it is ‘seeing’ normal or abnormal lung tissue.” Although bedside lung ultrasounds are commonly used in critical care to detect concerns such as infections,

A new form of artificial intelligence (AI), paired with portable ultrasound machines is being used to image and identify lung concerns in real time, right at the beside of critically ill patients.

pneumonia or a collapsed lung, the pairing with real time diagnostic AI is a research milestone. It could expand the usage of bedside ultrasounds by enabling those with little or no ultrasound training to use the device. “Bedside lung ultrasounds in critical care can often have a large impact in identifying life-threatening conditions within minutes,” says Dr. Chintan Dave, Critical Care Medicine Fellow at LHSC and Western University.

“We would like to see members of the healthcare team, like critical care nurses or respiratory therapists, be able to use AI to accurately determine the health of the lungs rapidly at the bedside. Employing AI into the clinical workflow, could improve access to immediate diagnoses and treatments.” In order to be certain that the AI’s predictions are accurate, the phase one study will compare its interpretations to a gold standard experts’ interpreta-

tion of the same lung ultrasound scans. Once this accuracy is assured, the team will proceed with a second phase to assess the device with non-expert users and customized settings for more in-depth diagnostics. “We see a bright future for lung ultrasound imaging with AI within the critical care environment,” adds Dr. Arntfield. “We are trying to write the first chapter of this meaningful AI H story here at LHSC and Lawson.” ■

Celine Zadorsky works in Communications Consultant & External Relations at Lawson Health Research Institute.

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EVIDENCE MATTERS

Intraocular lenses for infants with Aphakia:

What does the evidence say? By Brit Cooper-Jones ur sight is such a key gateway to seeing and experiencing the world, and when a medical condition threatens our own or a loved one’s vision, it can be very distressing. This may be especially true for babies who are born with compromised vision, such as infants born with a condition called “aphakia.” Aphakia refers to a condition in which the eye does not have a lens – the flexible structure that enables light to focus on the retina. Sometimes babies can be born without a lens because of a genetic defect (called “congenital aphakia”), but this is rare. “Noncongenital aphakia” is much more common. It is when the lens of the eye needs to be removed as a result of incidents such as trauma or, most commonly, because cataracts are causing clouded and impaired vision. The conventional treatment for noncongenital aphakia in infants has been to correct the vision with glasses or contact lenses. However, there are some challenges associated with this treatment – the glasses are typically very thick and heavy, and the contact lenses can irritate the eye, cause infec-

tion, or be a hassle to use, all of which can lead to poor adherence. To help mitigate these challenges, many children receive an artificial intraocular lens (IOL) that is surgically implanted as a replacement lens. However, the age at which IOL implantation occurs is variable, and multiple questions remain regarding the best treatment for aphakia, particularly when it comes to infants (defined here as babies under 12 months of age). The first question is which treatment – IOL implantation or conventional treatment with glasses or contact lenses – leads to the best visual outcomes for infants? Then, the next questions are what is the comparative safety of the different treatment options (e.g., adverse events and/or the need for repeat procedures because of complications) and what is their comparative cost-effectiveness? Finally, it is important to look at the evidence on the optimal age for IOL implantation. That is, are there advantages and better outcomes associated with doing it sooner (i.e., in infants), or it is preferable to wait until patients are older (i.e., one to 12 years of age)? To help answer these questions, health care decision-makers turned to CADTH – an independent agency that finds, assesses, and summarizes the re-

search on drugs, medical devices, tests, and procedures. CADTH conducted a Health Technology Review that systematically reviewed the literature and identified a total of 18 studies on the questions of interest. These included three randomized controlled trials and 15 non-randomized studies. CADTH also engaged two family caregivers to provide family perspectives. Overall, when compared with conventional treatment with glasses or contact lenses, IOL implantation does not appear to result in a greater improvement in visual outcomes in infants with aphakia. The overall incidence of adverse events (most notably, the need for additional surgeries due to complications) was higher in infants who received IOL implantation than in children aged one to 12 years. While the quality of the evidence was low overall, the studies concluded that there does not appear to be a benefit, from a clinical effectiveness or safety standpoint, to proceeding with IOL implantation in infants with aphakia (rather than offering conventional treatment or waiting to implant IOLs at a later age). No cost-effectiveness studies were identified. This is an important limitation not only from a health care system funding perspective but also

from a patient/family perspective. The cost to families of the IOL procedure was identified as a potential concern and barrier both in the literature and by the caregivers that CADTH engaged with. Equity concerns were also raised about the cost and accessibility of treatment, and this was noted as a useful area for future research. When families and caregivers shared their perspectives on treatments for aphakia, they reported experiencing stress about the use of contact lenses as well as about the outcomes of IOL surgery, complication risks, and effects on the child. However, despite the stressors associated with each of the treatment options, families overall emphasized the importance of timely and effective treatment to ensure their child’s optimal development. Overall, there does not appear to be strong evidence supporting early IOL implantation for infants with aphakia. For a more fulsome review of the evidence, see CADTH’s full report on the topic at cadth.ca/intraocular-lenses-infants-aphakia. 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.ca/ H Liaison-Officers. ■

Brit Cooper-Jones is a knowledge mobilization officer at CADTH. 16 HOSPITAL NEWS JUNE 2022

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Trailblazers in health care:

Celebrating the recipients of the 2022 CMA Awards ombating antimicrobial resistance. Launching innovative solutions for physician burnout. Championing refugee health. These are just a few examples of how recipients of the 2022 Canadian Medical Association (CMA) Awards are having an impact – at home and abroad – despite more than two years of the COVID-19 pandemic. “These 12 extraordinary recipients are true role models – through clinical work, research, mentorship and advocacy they are making exceptional contributions,” says CMA President Dr. Katharine Smart. “Not only are they helping to transform health care today, they are also shaping future generations of physicians.” Learn more about the remarkable recipients of the 2022 CMA Awards below.

“THESE 12 EXTRAORDINARY RECIPIENTS ARE TRUE ROLE MODELS – THROUGH CLINICAL WORK, RESEARCH, MENTORSHIP AND ADVOCACY THEY ARE MAKING EXCEPTIONAL CONTRIBUTIONS.” University of Calgary, she has helped lead the charge to better support physicians, create much-needed resources and ensure high-quality patient care in Alberta. Among her many achievements, she is the co-founder and physician lead for Well Doc Alberta, a pan-provincial physician wellness initiative focused on education and prevention.

Dr. John Conly F.N.G. Starr Award for lifetime achievement Dr. John Conly’s work has improved human health on a global scale. An infectious disease specialist and professor at the University of Calgary, Dr. Conly has worked for decades on antimicrobial resistance, infection prevention and health care innovation; his contributions have significantly affected medical practice, research and policy. In 2002, he founded the research and test-site Ward of the 21st Century. More recently, he chaired the World Health Organization’s COVID-19 Infection Prevention and Control Guidance Development Group. Dr. Conly is described by colleagues as humble, creative and a dedicated humanitarian. For his vision and collaborative leadership, he is this year’s recipient of the CMA’s highest honour.

Dr. Meb Rashid CMA Award for Political Advocacy Please note that to reflect our commitment to reconciliation and the need to acknowledge the colonial harm done to Indigenous Peoples, the CMA has renamed the Sir Charles Tupper Award for Political Advocacy to the CMA Award for Political Advocacy. A champion for refugee health in Canada, Dr. Meb Rashid has helped address systemic discrimination and racism in health care. He is the founder and medical director of the Crossroads Clinic at Women’s College Hospital in Toronto. He co-founded Canadian Doctors for Refugee Care, which helps refugees access health insurance. His political advocacy includes successfully fighting federal cuts to refugee health coverage, which began in 2012 and were reversed by the Federal Court in 2014. Dr. Rashid is also actively fostering the next generation of refugee health advocates across the country.

Dr. Jane Lemaire Dr. Léo-Paul Landry Medal of Service Dr. Jane Lemaire is a passionate advocate for recognizing physician wellness as a quality indicator of the health care system. Currently a clinical professor in internal medicine at the

Dr. Cornelia Wieman May Cohen Award for Women Mentors The definition of a physician leader, Dr. Nel Wieman not only holds the distinction of being the first Indigenous woman to become a psychiatrist in Canada, but through decades of

18 HOSPITAL NEWS JUNE 2022

clinical and advocacy work she has also mentored countless women and Indigenous physicians and medical learners. The deputy chief medical officer at First Nations Health Authority (FNHA) and the president of the Indigenous Physicians Association of Canada (IPAC), Dr. Wieman prioritizes nurturing future physicians as well as building bridges with grassroots organizations. Dr. Boluwaji Ogunyemi CMA Award for Young Leaders (Early Career) With a deep commitment to health equity, Dr. Boluwaji Ogunyemi supports patients who are Black, Indigenous and People of Colour (BIPOC) in his dermatology practice. He is also in the process of setting up a specialty dermatology clinic for this underserved patient population. Beyond his clinical work, Dr. Ogunyemi advocates for inclusion in medicine through peer-reviewed publications, public speaking and freelance writing for media outlets such as The New York Times. He is known among his peers and colleagues at Memorial University of Newfoundland as a physician leader, educator and active community volunteer. Dr. Shannon Ruzycki CMA Award for Young Leaders (Early Career) Recognized for advancing equity, diversity and inclusion (EDI) in the medical workplace, Dr. Shannon Ruzycki is leading tangible changes locally as a general internist at the University of Calgary, provincially with Alberta Health Services and nationally with the Canadian Resident Matching Service. Her work led to the development of a provincial peer support network for physicians who

have experienced harassment or discrimination. As a champion for EDI principles, she advocates for structural changes in medicine and incorporating EDI literacy into medical education. Dr. Shane Arsenault CMA Award for Young Leaders (Resident) A resident in neurology at Memorial University of Newfoundland, Dr. Shane Arsenault is known as the voice of his peers. His work as a representative of the Professional Association of Residents of Newfoundland and Labrador (PARNL) has contributed to the Faculty of Medicine’s strategic planning. He has also worked as the PARNL representative of Resident Doctors of Canada (RDoC) and served as a liaison member between RDoC and the Royal College of Physicians and Surgeons’ Committee on Specialties. Dr. Amit Persad CMA Award for Young Leaders (Resident) Dr. Amit Persad is a force for resident physicians in Saskatchewan. The neurosurgery resident implemented virtual rounds at the University of Saskatchewan to help medical students learn during the COVID-19 pandemic. As chief negotiator for Resident Doctors of Saskatchewan (RDoS), he helped reach a collective bargaining agreement with the Ministry of Health and the university. He was RDoS’s president in 2020–21 and recently spearheaded a professionalism task force. Armaghan (Army) Alam CMA Award for Young Leaders (Student) Army Alam’s mental health advocacy has national reach. The University of British Columbia medical student co-founded the Canadian Peer Support Network, which brings peer support initiatives and training to organizations across Canada, and is an advisor for the Bell Let’s Talk Diversity Fund, which funds mental health initiatives for the Black, Indigwww.hospitalnews.com

NEWS

Dedicated mental health transport team enous and People of Colour (BIPOC) communities. He is also the youngest sitting board member of the Mental Health Commission of Canada. Angela Huynh CMA Award for Young Leaders (Student) Angela Huynh’s research is already making a difference. While working toward her MD at Western University, she has made significant contributions to both the Ontario and Canadian guidelines for COVID-19 vaccine administration. She has been the first author of numerous publications related to COVID-19. In addition, she rejoined her PhD supervisor’s laboratory when the pandemic hit to help in the transition from research on clotting and thrombosis to a focus on COVID-19. Dr. Stephanie Smith Dr. Brian Brodie Organizational Leadership Development Award (Resident) After noticing the rise in burnout and depression among medical learners, Dr. Stephanie Smith developed a program called STRIVE – Simulated Training for Resilience In Various Environments. A medical officer at CFB Gagetown in New Brunswick, she developed the program based on her experience deploying as a critical care nursing officer in the Canadian Armed Forces. She is now expanding STRIVE across Canada. Mehul Gupta Dr. Brian Brodie Organizational Leadership Development Award (Student) Mehul Gupta isn’t waiting for his MD to make an impact. In 2017, he founded Youreka Canada, a national non-profit empowering young innovators, thought leaders and active citizens through educational opportunities and mentorships. He has also worked closely with Kids Help Phone and on campaigns to increase awareness of mental health resources for Canadian youth. Mr. Gupta is currently studying medicine at the UniH versity of Calgary. ■ www.hospitalnews.com

for Northern Ontario By James MacDonald s a Registered Nurse working at nursing stations in Ontario’s northern First Nations communities, Richelle Robinson experienced firsthand the challenges of providing care to people in crisis in a location with few local resources available. “Unfortunately, because we didn’t have the ability to do effective mental health care and follow up within the community, they needed to go out of the community to get a more thorough assessment, then maybe set up with longer term treatment plans,” says Robinson. “Perhaps they were suicidal and needed to remain with us under care and watch. If that is the case, they would sometimes remain in the nursing stations for several days while we waited for a transfer.” Today, as a specialized Mental Health Nurse, Robinson is playing a key role in a new program intended to improve availability and quality of care for patients who need to leave their community for follow up and treatment. A graduate of Trent University’s Registered Nursing program, Robinson is one of the first members of a mental health transport team dedicated to Northern Ontario. The program, which launched on April 19 as a one-year trial, is managed by Ornge, Ontario’s air ambulance and critical care transport provider, and is based at the Thunder Airlines hangar in Thunder Bay. This team will only perform mental health-related transports. According to the Canadian Mental Health Association, in any given year, one in five people in Canada will personally experience a mental health problem or illness. Systemic inequalities such as racism, poverty and discrimination can result in worsening mental health symptoms, especially if

IN NORTHERN ONTARIO COMMUNITIES LOCATED OFF THE ROAD NETWORK, HUNDREDS OF MENTAL HEALTH PATIENTS EACH YEAR REQUIRE AN AIR MEDICAL TRANSFER. mental health supports are not readily available. In Northern Ontario communities located off the road network, hundreds of mental health patients each year require an air medical transfer. The effective transportation of mental health patients requires timely availability of aircraft and specialized staff. “Based on our experience providing transport services to Ontario’s remote north, we recognize the significant burden of mental illness in Northern and First Nations communities, and the need for these patients to receive timely and expert care,” says Dr. Bruce Sawadsky, Chief Medical Officer for Ornge. “With the launch of this trial, our goal is to bring mental health expertise to the patient in transport and increase the quality of care provided.” The team, which will be available from 9:00 a.m. to 9:00 p.m. seven days a week, is comprised of a Registered Nurse who is experienced and specially trained in mental health care, as well as trained security personnel with experience in a healthcare setting. There will also be a Primary Care Flight Paramedic on board the aircraft during transport. “With the bed-to-bed service that we’re doing, we will go into wherever they are – the hospital or a nursing station – and do our assessment first. That gives me an opportunity to get the story from the client as well as to

develop a quick rapport,” says Robinson. “With my skills, I am able to perhaps address some of the anxieties that they’re having and act as an ally for them as we’re doing the transfer.” To ensure the safety of the patient and crew members on board the aircraft, the Registered Nurse and security personnel have completed specialized training, including non-violent crisis intervention and de-escalation. The Registered Nurse will carry psychiatric medications and will be capable of administering them to the patient if necessary. “At the end of the transfer, the team can have a discussion about what we experienced and what we saw, what I noticed in terms of body language and behavior,” says Robinson. “It gives us an opportunity to share what we know and offer a few teaching points that in future will ensure more trauma-informed care is being provided.” Hospitals and nursing stations can access the team through Ornge’s patient booking process. The usage will be analyzed over the next year. “My hope is that we will be reducing wait times on transfers, because having these individuals sitting in an emergency department or a nursing station for hours and days on end is really not in their best benefit,” added Robinson. “And so if we can reduce that time and get care to them sooner, that’s really what we’re hoping H for.” ■

James MacDonald is the Director of Communications and Public Affairs at Ornge JUNE 2022 HOSPITAL NEWS 19

CANADIAN SOCIETY OF HOSPITAL PHARMACISTS

Welcome to the annual CSHP special

Hospital pharmacy and the COVID-19 pandemic: Where do we go from here? n this special section of Hospital News, the Canadian Society of Hospital Pharmacists (CSHP) is proud to share a glimpse into the fascinating world of hospital pharmacy. Like all members of the interprofessional care team, Canadian hospital pharmacy staff have weathered the immense challenges of 2020 and beyond by banding together to support one another more than ever. We’ve grappled with drug shortages, combated medical misinformation, and identified the cracks in our health systems that need our attention. All the while, hospital pharmacy teams have continued to provide exceptional patient care as trusted medication experts.

Looking back at these challenging years, we’re asking ourselves: Where do we go from here? How can we apply lessons learned during the pandemic to advance patient care through safe, effective medication use? In these next pages, you’ll find stories of hospital pharmacy teams’ answers to these questions. You’ll see remarkable innovation and dedication to patient care, whether it’s through enhancing the safety of mass vaccination clinics or leveraging technology in novel ways. As CSHP’s CEO, every day I witness the hospital pharmacy community’s unshakeable dedication to advocating for our patients. If anything, the pandemic has crystallized our priorities as a profession: to innovate and enhance

pharmacy practices for a safer and more equitable future. The stories in these pages give me confidence that the lessons we’ve learned during the pandemic will improve the use of medication in Canadian health systems, thanks to the tenacity and collaborative spirit of our hospital pharmacy teams. CSHP represents pharmacy professionals working in hospitals and other collaborative healthcare settings who seek excellence in patient care through the advancement of safe and effective medication use. We offer our 3,000+ members educational opportunities, 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 across Canada through the Canadian Pharmacy Residency Board. To learn H more, visit CSHP.ca. ■ Sincerely, Jody Ciufo, Chief Executive Officer, Canadian Society of Hospital Pharmacists

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CANADIAN SOCIETY OF HOSPITAL PHARMACISTS

Robots, FaceTime, and translators on-call:

How technology during Covid-19 has shaped hospital pharmacy practice By Karen Dahri ach spring I give a lecture on the use of technology in everyday clinical practice to our first-year entry-to-practice Doctor of Pharmacy students at the University of British Columbia. I start off the session by speaking about how technology has impacted our practices by allowing us greater access to information when we are providing care to our patients. In the last twenty years, we have moved from carrying a “peripheral brain,” which was just a small black binder with drug facts, to having a smartphone in our pocket filled with healthcare-related apps that allow for quick access to information at the point of care. In March 2020, that became one of the last in-person lectures that I gave for a long time as the Covid pandemic came to the forefront of everyone’s lives. For hospital pharmacists, engaging with and educating patients about their medications is a key part of our day-to-day activities. Covid forced us to reassess how we carried out all of our regular clinical interactions. For example, interviewing a patient on their medications prior to admission became fraught with concerns around the risk associated with the interaction. Utilizing basic technology such as the telephones in patients’ rooms became a simple way of maintaining communication while minimizing risk and preserving the limited supplies of protective gear. Technology also helped patients connect with friends and family members who no longer could come to the hospital for visits. Patients FaceTimed their loved ones on smartphones and iPads, and hospital pharmacists could also speak remotely to caregivers as they needed to ensure that caregivers understood the patient’s medications upon discharge. Zoom , a program that most of us were unaware of pre-Covid, became commonplace, allowing us to continue to support our clinic patients,

22 HOSPITAL NEWS JUNE 2022

COVID FORCED US TO REASSESS HOW WE CARRIED OUT ALL OF OUR REGULAR CLINICAL INTERACTIONS. many of whom take complex medication regimens that require close monitoring by pharmacists. Better use of technology has been prioritized these past years, offering

solutions to issues that existed in pharmacy long before Covid. Many of our patients do not speak English, which can be challenging as we often have limited access to translator

services. Ensuring that patients understand and feel confident in their medication is a core value of hospital pharmacy, so I was glad to see that my local health authority adopted a virtual translation service during the pandemic. This offered access to numerous different translators immediately when needed and allowed patients to ask us any questions about their medications.

Hospital pharmacy heroes he everyday work of a hospital pharmacy team is high-stakes, with life-saving implications for our patients,” says Zack Dumont, President of the Canadian Society of Hospital Pharmacists (CSHP). “Unfortunately, many people have no idea what a hospital pharmacy professional does! Whether you know it or not, there’s a highly trained team of directors, managers, pharmacists, technicians, and assistants in the hospital making sure you receive the best, safest medications for your needs.” As trusted medication experts, hospital pharmacy professionals make vital contributions to the healthcare system. Pharmacy technicians and assistants play essential roles in the dispensary, compounding medications in-hospital and preparing IV admixtures. Pharmacy technicians also conduct Best Possible Medication Histories, ensuring that the interprofessional care team has accurate and up-to-date information about which medications patients have been taking at home. This goes a long way towards preventing drug interactions and ensuring medication continuity for patients in hospital. Meanwhile, for a hospital pharmacist, it’s all part of a day’s work to develop pharmaceutical care plans

“

to suit each patient’s unique needs, reconcile medications on admission and discharge, prevent drug therapy problems, and educate patients to make sure they understand and adhere to their medication regimens. Quality interprofessional care is incomplete without hospital pharmacy professionals ensuring safe, effective medication use. A robust body of evidence shows that hospital pharmacists’ expertise yields major benefits, both for individual patients and for Canada’s healthcare system. Team-based care involving clinical hospital pharmacists decreases readmissions and lengths of hospital stays, improves patients’ medication adherence, and saves the healthcare system significant financial costs. Examples abound, but one recent study estimated that by preventing adverse drug events, the interventions of a Canadian hospital pharmacist saved their hospital up to $1.37 million in a 6-month time frame, while preventing an additional 867 days in the hospital for surgical patients. This work is complicated by drug shortages – a problem that existed long before COVID-19, but one the pandemic has exacerbated. Hospital pharmacy teams typically spend hours each week sourcing alternative

drugs for their patients when shortages cause problems. They also carefully triage inventory to ensure an equitable supply of medications based on each patient’s needs. At the federal level, pharmacists from organizations including CSHP participate in Health Canada’s Tier Assignment Committee, developing national strategies to manage shortages and conserve drugs with minimal disruption to patient care. In grappling with issues as complex as drug shortages, the knowledge and ingenuity of medication experts is essential. To the already weighty responsibilities hospital pharmacy teams carry, the pandemic has added major pressures. Each day of this long crisis, pharmacy teams have served on the frontlines, caring for patients, championing evidence-based care in the face of rampant misinformation, and preparing and administering COVID-19 vaccines on a massive scale. They are exhausted. “Faced with widespread hospital protests and threats of harassment, hospital pharmacy teams have continued to show up each day to deliver outstanding patient care,” says Jody Ciufo, CEO of CSHP. “The dedication of Canadian hospital pharmacy professionals is nothing short of extraordinary. These individuals are H heroes.” ■ www.hospitalnews.com

CANADIAN SOCIETY OF HOSPITAL PHARMACISTS Staffing shortages have been an ongoing issue in pharmacy long before Covid-19, but the pandemic required us to consider scenarios in which even larger numbers of staff may be off sick. As a result, remote order verification procedures were detailed, which would maintain an individual hospital dispensary’s ability to function while utilizing staff at other sites. This represented an effective solution to a long-standing issue. In response to staffing shortages and to minimize risky contact during

the pandemic, some countries even began to make use of robots to deliver patient medications and meals. Now, as we begin to move forward from Covid, some of the technology we have used will remain and strengthen hospital pharmacy practice. Other aspects will never be able to fully replace in-person interactions, but we will carry forward the spirit of innovation and willingness to experiment that marked these diffiH cult months. ■

Dr. Karen Dahri BSc, BSc (Pharm), PharmD, ACPR, FCSHP is a clinical pharmacist in Internal Medicine at Vancouver General Hospital and an Associate Professor (Partner) with the Faculty of Pharmaceutical Sciences at UBC.

Race, genetics, and drug therapy: Personalized pharmacy treatment By Bhawani Jain e all have different genetics and backgrounds, so why should we all receive identical medical treatment for a diagnosis or condition? Today, personalized medicine is on the rise, with treatments tailored to a patient’s unique characteristics, genetic differences, and environmental conditions. Hospital pharmacists selecting safe and effective medication for their patients need to be conscious that certain drug treatments do not work universally in the same ways for all patients. Quality patient care can require hospital pharmacists to consider genetic and racial variations that impact medication therapy. For instance, an estimated 45 per cent of individuals of East Asian descent carry the Aldehyde Dehydrogenase 2 mutation (ALDH2*2). This could impact the efficacy of certain medications. Patients with this mutation have a lowered ability to metabolize nitroglycerin to nitric oxide. Because nitroglycerin is a vasodilator used to prevent and treat angina and heart attacks (among other uses), patients with the ALDH2*2 mutation may need significantly more nitroglycerin to achieve therapeutic results. Hospital pharmacists should be conscious of this genetic mutation

and the populations it commonly impacts, speaking with patients about their backgrounds and screening for ALDH2*2 as appropriate to determine the ideal drug therapy for each person. Similarly, hospital pharmacists may take into account research showing that Black individuals with hypertension tend not to respond to treatment with angiotension-con-

verting enzyme (ACE) inhibitors, although ACE inhibitors are common first-line treatments for hypertension in other patient populations. Although research has not determined precisely why, other types of medications have been shown to achieve greater therapeutic results in Black individuals. The American College of Cardiology and the American Heart Association there-

fore recommend medications such as diltiazem or chlorthalidone to most effectively treat hypertension in Black patients. As members of the interprofessional care team, hospital pharmacists can highlight the differences in response to ACE inhibitors to improve health outcomes. As a final example, hospital pharmacists may note that an estimated 70% of Kurdish Jewish individuals are genetically predisposed to hemolysis, the destruction of red blood cells, due to a glucose-6-phosphate-dehydrogenase (G6PD) deficiency. Studies show that episodes of acute hemolysis are often triggered by medication, so hospital pharmacists need to be alert to drugs that could put patients with G6PD deficiency at risk. If clinically appropriate, patients should be asked whether they identify as Kurdish Jewish and screened for G6PD deficiency using laboratory testing. High quality patient care can require the interprofessional care team to respectfully discuss race with patients when clinically relevant. As trusted medication experts, hospital pharmacists tailor drug therapies to suit each patient’s individual needs, and often, that involves open and evidence-based discussions of genetic H variations to optimize patient care. ■

Bhawani is a second-year pharmacy student at the University of Waterloo and worked as a Professional Practice Intern at CSHP earlier this year. www.hospitalnews.com

JUNE 2022 HOSPITAL NEWS 23

CANADIAN SOCIETY OF HOSPITAL PHARMACISTS

Preventing pediatric COVID-19 vaccine errors at mass vaccination sites By Ambika Sharma, Heidi Huang, Shabina Rangarej, Dorothy Tscheng, and Alice Watt anada’s mass COVID-19 vaccination clinics have represented a historic mobilization of resources and expertise to inoculate record numbers of Canadians. The numbers are impressive; for example, a single vaccination site in Toronto administered more than 26 000 doses in a single day. These accomplishments are undeniably a feat worth celebrating, yet with vaccine doses being administered in such large numbers, it was likely that some errors would occur. In this regard, the Institute for Safe Mediation Practices Canada (ISMP Canada), a nonprofit organization committed to the advancement of medication safety in Canada, has received reports of adult COVID-19 vaccines being in-

YOU

advertently administered to children eligible for the pediatric dose. In light of these concerns, hospitaland community-based clinics have been developing effective strategies to systematically prevent confusion

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between pediatric and adult vaccine doses. For example, the Michael Garron Hospital in Toronto, Ontario, which hosted several mass vaccination clinics, created clear, segregated processes for pediatric and adult dose preparation, patient registration, and dose administration. Throughout the vaccination process, the hospital consistently used a distinctive colour (green) to differentiate pediatric vaccine doses from adult doses. Designated staff prepared only pediatric doses in green-labelled syringes and stored those vaccines in foam coolers marked with green labels. Upon patients’ arrival, staff gave children in the eligible age group green wristbands to signify that they would need a pediatric dose. Those patients were then led toward the pediatric vaccination stream, where selected staff administered only pediatric doses in a distinct area clearly marked with green signs.

Furthermore, dedicated site leads independently double-checked each pediatric patient’s eligibility before administering the vaccine. Along with clear check processes and specific staff assigned to administer pediatric doses, colour differentiation is one effective way to provide simple visual cues at a clinic. When consistently implemented at each step in the vaccination process, such strategies reduce the risk of vaccine dosing errors. These techniques and lessons learned, applied here in the context of a mass vaccination clinic, are also suitable for use in other health systems to enhance medication safety. Acknowledgement: ISMP Canada extends appreciation to Michael Garron Hospital for allowing details of its organizational actions to be shared, with the goal of preventing COVID-19 vaccine dosing errors in children eligiH ble for the pediatric dose. ■

Ambika Sharma, RPh, PharmD, BScPhm, HBSc, is a Senior Medication Safety Specialist at ISMP Canada, a Course Coordinator at the University of Toronto’s Leslie Dan Faculty of Pharmacy, and a community pharmacist in a compounding pharmacy. Heidi Huang, RPh, BScPhm, is a pharmacy Vaccine Lead at Michael Garron Hospital. Shabina Rangarej, RN BScN, MN, is Clinical Operations Manager for the COVID-19 vaccine clinics at Michael Garron Hospital (MGH). Dorothy Tscheng, RPh, BScPhm, CGP is the Director of Practitioner & Consumer Reporting & Learning overseeing the analysis and knowledge translation outputs from these programs. Alice Watt RPH, BScPhm is a Senior Medication Safety Specialist at ISMP Canada and a hospital pharmacist at a community hospital. 24 HOSPITAL NEWS JUNE 2022

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CANADIAN SOCIETY OF HOSPITAL PHARMACISTS

Changing prescribing culture to prevent inappropriate polypharmacy By Rajan Anand magine you take seven medications a day, and have done so for years. Increasingly, you find yourself groggy during the day, and your memory feels murky. One day you become disoriented and fall, winding up in the ER. A hospital pharmacist takes your medication history and discovers that the drugs you were prescribed years ago are actually to blame for the fall, the memory loss, and the grogginess. It turns out you no longer needed to be taking these medications, and their side effects had been compromising your quality of life for years. An increased likelihood of falls, ER visits, adverse drug events, medication interactions, and even death: These

are risks associated with polypharmacy, or the concurrent use of 5+ medications. In addition to endangering patients, the negative effects of inappropriate medication use place an enormous economic burden on the Canadian healthcare system as patients take medications that (at best) may not be needed and that (at worst) land them in the hospital. As trusted medication experts, hospital pharmacists are well positioned to play an active role in changing Canadian prescribing culture. Hospital pharmacists are trained to systematically identify which drugs should be discontinued for a given patient, spotting situations when the potential harm from a drug outweighs its potential benefits.

The pharmacist takes into account the context of the patient’s care goals and preferences, and supports the safe, effective use of medication. In Canada, harm from polypharmacy largely impact adults over 65 years of age, whose risk of medication-related harm is estimated at five times that of younger people. Compared to youth, seniors on average are prescribed more medications, have been on medications longer, and experience physiological changes that place them more at risk of experiencing side effects from drugs. Hospital pharmacists pay particular attention to older adult populations when they are admitted to, transferred within, or discharged from the hospital, as these are optimal

times to start a deprescribing initiative if needed. Deprescribing interventions are collaborative in nature. Pharmacists work alongside prescribers and the interdisciplinary care team to identify drugs that aren’t necessary. They engage the patient and their caregivers in the process, making sure that the patient’s preferences and goals are heard. Hospital pharmacists also communicate with community partners to ensure continuity of care after the patient leaves the hospital. By working collaboratively, interprofessional healthcare teams can leverage medication expertise to reduce inappropriate polypharmacy and improve H health outcomes. ■

Rajan Anand is a University of Saskatchewan PharmD class of 2022 graduate. Driven by his passion for pharmacy, he takes pride in delivering the best patient centered care possible.

JULY

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JUNE 2022 HOSPITAL NEWS 25

CANADIAN SOCIETY OF HOSPITAL PHARMACISTS

Hospital Pharmacy’s PReSS team tracks down life-changing medication for sisters By Lise Diebel

elentless, debilitating seizures plagued Waterloo sisters Evelyn and Janelle Wong for most of their

young lives. The Hamilton Health Sciences (HHS) patients were diagnosed with Dravet Syndrome as infants. This rare, severe and drug-resistant form of epilepsy is characterized by frequent and often prolonged seizures. Janelle, 6, experienced up to 200 mini-seizures a day, lasting about one second each. Longer seizures of one minute or more happened about five times a week. The longest one she ever experienced lasted almost two hours. Evelyn, 7, no longer has as many mini seizures, but experienced convulsions of one minute or more about twice a week. Between the two girls, there have been hundreds of trips to the hospital emergency department over the years, including admissions and ICU care. This constant barrage of attacks significantly impacted their overall cognitive development, growth, fine motor skills and language, says their mom Hilde Wong. The girls are patients of Dr. David Callen, a pediatric neurologist at HHS McMaster Children’s Hospital. Finding medication to manage seizures was an uphill battle due to the drug-resistant nature of Dravet’s. “The girls tried about 10 different seizure medications over their lives and nothing was helping,” says Hilde. But thanks to the combined efforts of the girls’ parents, Callen and the HHS Pharmacy Research Support Services (PReSS) team, the girls started taking a new medication last fall. It has dramatically reduced the frequency and severity of their seizures. The PReSS team helps HHS patients gain access to medications unavailable in Canada through its Special Access Program. Fenfluramine, the medication the girls have been on for just over six months, isn’t marketed in Canada.

Photos by Josh Carey, Hamilton Health Sciences

Above: The HHS Pharmacy Research Support Services (PReSS) team Left: The Wong family

“The impact of this new medication has been profound,” says Hilde, who is sharing her daughters’ story for Pharmacy Appreciation Month in March. “Their improvement has been remarkable. In just two days we could see that this drug was working.” Janelle went from as many as 200 mini-seizures a day to just 15, and one larger seizure a week instead of five. Evelyn, who often experienced

seizures of one minute or more, has about three a month instead of eight. The girls haven’t visited the hospital emergency department since starting fenfluramine because their seizures can be managed at home.

PRESSING WORK

The nine-member PReSS team is based at three HHS sites – McMaster University Medical Centre (MUMC),

Juravinski Hospital and Cancer Centre (JHCC) and Hamilton General Hospital (HGH). The team supports over 150 clinical trials across HHS and also helps patients like the Wong sisters gain access to medications not on the Canadian market. Before being authorized for sale in Canada, drugs must successfully go through Health Canada’s review process to assess safety, effectiveness and quality. The Special Access Program, a branch of Health Canada, allows physicians to prescribe drugs not currently available here if conventional therapies have failed or are inappropriate. The drug’s manufacturer must also agree to release the product.

PHARMACY DETECTIVES

Hilde learned about fenfluramine through a Facebook support group for families impacted by Dravet Syndrome. She asked Callen if it might help her girls, and he reached out to

Lise Diebel works in communications at Hamilton Health Sciences. 26 HOSPITAL NEWS JUNE 2022

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CANADIAN SOCIETY OF HOSPITAL PHARMACISTS Karen Charles to investigate further. She is the PReSS team’s pharmacy research coordinator and Special Access Program coordinator. Charles has a big, red `easy’ button – the kind sold at Staples – on her desk at MUMC, but make no mistake. There’s nothing easy about the complex web of multi-level, international connections that the PReSS team navigates every day to track down and procure such medications. “The work involved in bringing these medications to our patients is extremely complicated,” says Gita Sobhi, PReSS manager and institutional coordinator of the Special Access Program. “Karen is a great detective with many years of experience in this line of work.” When physicians identify a drug that might help their patient, it’s the PReSS team’s job to track it down, get all of the necessary approvals and arrange payment. Time is often of the essence, since these patients are often very sick. “They’ve tried every available drug on the Canadian market and nothing is working,” says Callen.

SCOURING THE GLOBE TO ACCESS MEDICATIONS

When procuring fenfluramine for the Wong sisters, Charles learned that the Irish company marketing this drug had given some patients in British Columbia special access, so she applied through Health Canada to also make it available for the girls. The complicated process required her to get pre-approval from the drug company before she could send the request to Health Canada. Pre-payment was also required, and since the drug wasn’t covered by insurance the Wongs would be responsible for paying a whopping $7,000 per month to treat both children. PReSS and Callen helped the family successfully apply for the cost to be covered on compassionate grounds. “The PReSS team members are really the wizards behind the curtain,” says Callen. “They work with physicians, international drug companies and various levels of government at home and abroad to get these medications to our patients as quickly as possible.” Another important team member is pediatric neurology nurse practitioner Christina Carter, who works with Callen, his patients and their families. This includes being the link between Callen, the patient and family, and PReSS team. Her role further highlights the www.hospitalnews.com

THE PRESS TEAM HELPS HHS PATIENTS GAIN ACCESS TO MEDICATIONS UNAVAILABLE IN CANADA THROUGH ITS SPECIAL ACCESS PROGRAM. high level of collaboration involved in procuring special access medications. “I can’t say enough about the vital work that this team effort plays in supporting our patients,” says Callen. The work is both exhausting and rewarding.

“I think a lot of people would be surprised to know what hospital pharmacy teams do behind-thescenes,” says Charles. “In PReSS’ case, we literally scour the globe and cut through miles of red tape to procure special access medications for

some of our sickest patients who have run out of options.”

LIFE-CHANGING IMPROVEMENTS

With their lives no longer ruled by convulsions, Evelyn and Janelle’s cognitive skills are improving. “It’s really helping them developmentally,” says Hilde. “Their speech is getting better because they’re able to express themselves more with words. Accessing this medication has been life-changing for H our family. We are forever grateful.” ■

Pharmacy technicians broadening their services outside the dispensary By Teresa Hennessey or healthcare professionals, the pandemic brought new opportunities to put our skills to use in unique ways, and pharmacy technicians were no exception. Although often behind the scenes, pharmacy technicians are taking on new roles and responsibilities outside of the pharmacy dispensary. You’ll find pharmacy technicians practicing on hospital care units and in clinics, but the majority of the almost 10,000 licensed pharmacy technicians in Canada practice in pharmacy dispensaries. From the dispensary, pharmacy technicians ensure medications are prepared and distributed safely and accurately. Pharmacy technicians’ medication preparation skills were sought early in the pandemic response, when many jurisdictions aimed to vaccinate the general population as quickly as supply would allow. Many pharmacy technicians were deployed to vaccination clinics to improve throughput by reconstituting vials and pre-drawing vaccine doses. This work involved calculating the volume of doses required, and managing the in-use time of reconstituted vials and syringes. The demand for pharmacy technicians’ support of vaccination efforts did not stop there. Their infection-prevention and aseptic-technique expertise was transferred to the technical task of administering drugs and

vaccines by injection. In September 2020, Nova Scotia pharmacy technicians became the first in Canada to be authorized to perform injections. To date, the pharmacy technician’s scope of practice has been expanded to include injection authorization in four provinces in Canada and other jurisdictions internationally. For many years, pharmacy technicians have been involved in medication reconciliation activities, specifically the collection of complete and accurate medication histories. As virtual healthcare expanded during the pandemic, so too did the incidence of telepharmacy, “the use of telecommunications technology to facilitate or enable the delivery of high-quality pharmacy services in situations where the patient or healthcare team does not have direct (in-person) contact with pharmacy staff.” Pharmacy technicians who may have relied heavily on in-person interviews to compile best possible medication histories transitioned to performing this service by telephone or using other virtual technologies. Pharmacy technicians can now also be found providing case investigation and contact tracing services virtually. These public health measures have been employed for years by licensed health professionals to limit the spread of communicable diseases, yet it was the high demand for COVID-19 trac-

ing that made this became a role for pharmacy technicians. Are these new practice opportunities here to stay? The National Association of Pharmacy Regulatory Authorities seems to think so. The organization’s Model of Standards of Practice for Pharmacists and Pharmacy Technicians publication was recently updated to include administering medications, performing point of care testing and virtual care models as core roles for Canadian pharmacy technicians. Even though authorized scopes of practice may differ between jurisdictions, the pharmacy technician’s role will continue to expand as service delivery models adjust to a post-pandemic state. Pharmacy technicians will continue to be medication preparation and distribution experts, but their role is more broadly inclusive of any technical aspect of pharmacy or public health services to support optimal care for patients. As the requirement for pharmacy technicians to practice within a pharmacy dispensary is challenged, other opportunities are likely to emerge. If the pharmacy profession continues to progress and pharmacy technicians remain willing to take responsibility for activities outside of the traditional dispensary roles, service delivery models will likely continue to improve as pharmacy technicians are H deployed to new practice areas. ■

Teresa Hennessey is a Pharmacy Operations Manager with Alberta Health Services JUNE 2022 HOSPITAL NEWS 27

FROM THE CEO’S DESK

Running on fumes

We must support burned-out health-care workers By Dr. Rose Zacharias very day, health-care workers don masks and care for their patients. But if you could see our uncovered faces, you would see what the cumulative impact of years of unaddressed burnout looks like. Supporting health-care workers has not been the top priority during more than two years of unprecedented strain on the health-care system. Coming out of the COVID-19 pandemic, we will call on this workforce once again to fix the gaps exposed during the pandemic while working even harder to catch up on the growing backlog of health-care services. We need to act now to ensure these workers are well enough, and provided with the supports they need, to do their jobs. Burnout was prevalent before the pandemic. Organizations including the Ontario Medical Association have long been sounding the alarm bells on this issue. It can lead to increased depression, substance use and suicidal thoughts. It can also reduce productivity, increase turnover and possibly decrease patient access to care. The OMA’s Physician Health Program provides confidential support to physicians struggling with substance use, mental health concerns and other behaviours. In 2021, the program saw 25 per cent higher volumes than in previous years. The complexity in cases referred for assessment in the last 18 months has also risen. The OMA has also tracked burnout among the profession. Almost three quarters (72.9 per cent) of physicians surveyed by the OMA said they experienced some level of burnout in 2021 after one year into the pandemic, up from 66 per cent the previous year. More than one-third (34.6 per cent) reported either persistent symptoms of burnout or feeling completely burned out in 2021, up from 29 per cent in 2020. This is not just an Ontario phenomenon. According to the Canadian

28 HOSPITAL NEWS JUNE 2022

Dr. Rose Zacharias is the president of the Ontario Medical Association.

SUPPORTING HEALTH-CARE WORKERS HAS NOT BEEN THE TOP PRIORITY DURING MORE THAN TWO YEARS OF UNPRECEDENTED STRAIN ON THE HEALTH-CARE SYSTEM. Medical Association’s 2021 National Physician Health Survey, more than half of physicians and medical learners (53 per cent) said they have experienced high levels of burnout, up from 30 per cent in 2017. As well, nearly

half (46 per cent) of Canadian physicians who responded are considering reducing their clinical work in the next 24 months. It’s important to remember that behind all these statistics are people

who continue to provide excellent care for patients. It is imperative that the health system respond to this wide-reaching issue. That’s why the OMA released a white paper identifying the top contributors to burnout and the top five solutions. Topping the list of solutions is reducing and streamlining documentation; studies have shown that physicians spend two hours on electronic documentation for every one hour of direct patient interaction. The other top solutions are: • More work-life balance through flexible work arrangements • Making digital health tools a seamless part of physicians’ workflow, including by ensuring different systems can speak to each other • Support for physician wellness at their workplaces • Fair and equitable compensation for all work, including administrative work that cannot be reduced Our work is not done. Finding solutions is just the beginning. Led by the OMA’s Burnout Task Force, we are working on implementing these solutions through advocacy and collaboration with stakeholders, including the Ontario Ministry of Health. The ministry has recently joined us in making health-care worker burnout a priority by establishing a new table that is focused on solutions. At the same time, we are exploring an interesting finding from the 2020 and 2021 member surveys on burnout. Patient interactions were the top contributors to burnout but addressing this issue did not rank as one of the top solutions in these two surveys. This is not surprising because as physicians, we take an oath to protect our patients and do no harm. Our work to address patient interactions as a top contributor to burnout is in its early stages and includes examining issues ranging from ensuring health system capacity to meet www.hospitalnews.com

FROM THE CEO’S DESK

ALMOST THREE QUARTERS (72.9 PER CENT) OF PHYSICIANS SURVEYED BY THE OMA SAID THEY EXPERIENCED SOME LEVEL OF BURNOUT IN 2021 AFTER ONE YEAR INTO THE PANDEMIC, UP FROM 66 PER CENT THE PREVIOUS YEAR. patients’ expectations for convenient, flexible and modern options for communication and access to care, to abuse and harassment from patients and the threat of complaints and litigation. The challenge before us will be finding a solution that will positively impact the provision of care for both patients and physicians. Nearly two and a half years into the COVID-19 pandemic, we have experienced six waves of the pandemic and have worried about caring for our patients, our loved ones and ourselves while the health-care system and the

world around us were being pushed to the brink. We have had to absorb a new level of exhaustion and uncertainty, while maintaining resilience and competence at the front line. These resources are not infinite. The challenges the health-care system is facing are piling up while the healthcare workforce’s ability to fix them is dwindling. The health-care system must heed our warnings, break down barriers and solve this crisis once and for all. Ontario’s physicians and the people they H care for are depending on us. ■

Dr. Rose Zacharias is the president of the Ontario Medical Association. The OMA represents Ontario’s 43,000 plus physicians, medical students and retired physicians, advocating for and supporting doctors while strengthening the leadership role of doctors in caring for patients.

What is home care? Home care is about trust. It is feeling comfortable with a provider coming into the home of someone you care ĨŽƌ ĂŶĚ͕ ƉŽƐƐŝďůǇ͕ ĂƐƐŝƐƟŶŐ ǁŝƚŚ ƚŚĞ ŵŽƐƚ ŝŶƟŵĂƚĞ ĐĂƌĞ͘ Bayshore’s home care services are extensive, varied, ĂŶĚ ƉĞƌƐŽŶĂůŝǌĞĚ ĨŽƌ ĞĂĐŚ ŝŶĚŝǀŝĚƵĂů͘ tŚĞƚŚĞƌ ŝƚ͛Ɛ ũƵƐƚ Ă ůŝƩůĞ ĂƐƐŝƐƚĂŶĐĞ ĨŽƌ ĚĂŝůǇ ƚĂƐŬƐ Žƌ ƌŽƵŶĚͲƚŚĞͲĐůŽĐŬ ĐĂƌĞ͕ Bayshore’s caregivers can help your loved ones to live ƚŚĞŝƌ ďĞƐƚ ůŝĨĞ ǁŚŝůĞ ƌĞŵĂŝŶŝŶŐ Ăƚ ŚŽŵĞ͘

Let’s talk. 1.877.289.3997 bayshore.ca www.hospitalnews.com

PERSONAL CARE | HOME SUPPORT | NURSING JUNE 2022 HOSPITAL NEWS 29

NEWS

Nurse serves up fundraisers for people facing food insecurity By Lise Diebel etween her full-time job at Hamilton Health Sciences (HHS), a busy volunteer schedule and doing her masters degree online, Julie Freeman has a very full plate. But when Freeman’s favourite restaurants stopped offering indoor dining due to the pandemic, she still found time to cook up a plan aimed at helping them stay in business while also supporting residents facing food insecurity. “I live downtown and love the restaurant scene,” says Freeman, a registered nurse currently working as a clinical informatics specialist with HHS’ health information technology services (HITS). This work supported the launch of HHS’ new hospital information system on June 4. This new system, called Epic, will store all patient health information electronically and securely in one place, making it fast and easy to access. It’s considered among the best systems in the world and is used internationally by many topranked hospitals and medical schools. “I really enjoy problem solving, figuring out where pieces fit together and organizing people,” says Freeman, who developed Feast in the Hammer fundraisers to support local restaurants in December 2020 and again in January 2022 when indoor dining temporarily shut down. Fundraisers had a dual role of also helping Hamilton residents faced with food insecurity by providing free meals.

SERVING UP SUCCESSFUL FUNDRAISERS

“There were a lot of logistics involved,” says Freeman. “Feast in the Hammer turned out to be a much bigger project than I realized.” Money raised through a Go Fund Me account was used to buy fullpriced meals from several Hamilton restaurants. These meals were then

Julie Freeman Photo by Josh Carey, Hamilton Health Sciences

donated to clients of organizations including Good Shepherd, The Mark Preece Family House and Living Rock ministries. Meals were delivered by Freeman and a network of volunteers she recruited. Freeman oversaw the fundraising, restaurant recruitment, volunteer recruitment and coordination with community organizations. In order to be as inclusive as possible, Freeman involved restaurants offering halal, vegetarian, vegan and gluten-free meals, and also considered options for people with allergies. The 2020 fundraiser raised $7,000 in support seven restaurants and provided 500 meals. The second fundraiser in 2022 raised $13,000 in support of 23 restaurants. “We didn’t count the number of meals this time because as well as buying and delivering meals we also purchased end-of-day stock for the Community Fridges HamOnt program,” explains Freeman.

FOOD FOR THOUGHT

Community Fridges is a volunteer-run program with three fridges/ pantries in Hamilton where residents

can take free, fresh food or make donations. Freeman is one of the program’s volunteer coordinators. “Food insecurity is a huge issue in Hamilton and it’s invisible to a lot of people,” she says. “Many Hamilton residents don’t realize how hungry their neighbours are.” Freeman also volunteers with the Sexual Assault Centre, Hamilton and Area (SACHA) crisis line and is festival coordinator for the Barton Village Festival. “When people think of volunteerism in relation to HHS, they often think of community members who help out at our hospital sites,” says Nate Vandendool, HHS director

of the Clinical Resource Program, which includes volunteer resources. “But HHS is a community of 15,000 staff, physicians, researchers and volunteers,” says Vandendool, “and many of these people also volunteer in the community, giving their time and talents to a wide variety of causes, and it’s important to recognize them too.” Freeman hopes the worst of the pandemic is over, and Feast in the Hammer will no longer be needed. “But if indoor dining is shut down again, Feast in the Hammer will return to support local restaurants and help H out residents,” she says. ■

Lise Diebel works in communications at Hamilton Health Sciences. 30 HOSPITAL NEWS JUNE 2022

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NEWS

Honoring healthcare workers the actionable way

– with assistance By Susan Driscoll here’s been a lot of reasons to celebrate and honor healthcare workers not only in the past month, but the past few years as well. But healthcare workers need more than our praise and our recognition – they need our help. According to OSHA, workplace violence is four times more prevalent in healthcare than in other industries. One in four nurses report being assaulted on the job (American Nursing Association), which is helping fuel an exodus of nurses from the profession. According to McKinsey & Company, 32per cent of registered nurses surveyed in the U.S. in November 2021 said they may leave their current direct-patient-care role. This year the industry is responding more strongly than ever before to correct the workplace violence problems that continue to deeply hurt a profession of dedicated and thoughtful professionals. The U.S.-based Joint Commission is now requiring hospitals to provide detailed proof of workplace violence programs in place in order to become accredited. Legislators on both the state and federal levels have proposed legislation requiring hospitals to put plans in place to reduce violence and with stiffer penalties for those who commit such terrible violence. One common thread in all planning continues to be pro-actively training staff in the techniques of de-escalation. Crisis Prevention Institute (CPI) is the world-leader in de-escalation training and workplace violence prevention. For 40 years, CPI has provided training programs for healthcare professionals focused on the mitigation of behavior escalation and an increase in positive outcomes through proven de-escalation and behavior management strategies and techniques. According to a survey done by CPI, 95 per cent of healthcare organizations that experience training show improved staff de-escalation skills

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and improved overall safety since utilizing their training. CPI trains healthcare professionals to de-escalate crises before they become violent by arming health care professionals with evidence-based techniques and knowledge to foster an enviornment of patient-centered care. Due to the current increase in workplace violence and to honor hospital workers in a meaninginful, tangible way, CPI has compiled tips in a downloadable, free resource at www.crisisprevention.com/nurse-mantras. Our trainings prove that addressing behavior proactively can significantly change a situation’s trajectory and escalation. While we can’t control the emotions or actions of patients, families or even other staff, we can control the way we respond to situations so that it is constructive, positive and impacts real resolution. The following de-escalation tips are about support, not suppression, and about seeing each other with humanity and compassion. 1. Be Empathetic and Nonjudgemental. Do not judge or be dismissive of the feelings of the person in distress. Respect those feelings. 2. Respect personal space. Be aware of your position, posture and proximity when interacting with a person in distress. Allowing personal space shows respect, keeps you safer, and tends to decrease a person’s anxiety. If you must entere someone’s personal space to provide care, explain what you’re doing so the person feels less confused and frightened. 3. Use Nonthreateneing Nonverbals. The more a person is in distress, the less they hear your words – and the more they react to your nonverbal communication. Be mindful of your gestures, facial expressions, movements and tone of voice. Keep your tone and body language neutral. 4. Keep Your Emotional Brain in Check. Remain calm, rational and

professional. While you can’t control the person’s behavior, how you respond will have a direct impact on whether the situation escalates or defuses. 5. Focus on Feelings. Facts are important, but how a person feels is the heart of the matter. Watch and listen carefully for the person’s real message. Try saying something like “That must be scary.” Supportve words like

these will let the person know that you understand what’s happening. A full list of de-escalation tips can be found at https://www.crisisprevention.com/Blog/CPI-s-Top-10-De-Escalation-Tips-Revisited. This year, let’s give healthcare workers the praise and support they deserve by arming them with resources H to handle today’s challenges. ■

Susan Driscoll is president of Crisis Prevention Institute.

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Trustworthy Pharmacist worthy Biosimilars in your practice When it comes to biosimilars, you can trust in Teva Canada as a key partner. At Teva, we know that pharmacists like you care about your patients and the products you dispense. For this reason, we have commercialized safe and effective medications that you can trust. Our biosimilars are no exception. The increased availability of our biosimilars on the Canadian market can contribute to the healthcare system by reducing costs, increasing competition, and improving drug accessibility for all. With over 1,200 products currently available, we are committed to expanding our portfolio and continuing to help Canadians.1-3

References: 1. Teva. “Biosimilar medicines.” Available at: https://www.tevacanada.com/en/canada/ our-products/biosimilar-medicines/. Accessed on March 9, 2022. 2. Teva Canada. “Biosimilars in the Canadian market.” Available at: https://www.tevacanada.com/en/canada/our-products/biosimilarmedicines/biosimilars-canadian-market. Accessed on March 9, 2022. 3. Teva. Welcome to Teva Q1 2022. Customer Relations Presentation. Accessed on February 14, 2022. © 2022 Teva Canada Innovation G.P. – S.E.N.C. Montreal, Quebec, H2Z 1S8

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