Hospital News September 2022 Edition by Hospital News

Emergency thewithoutcareER Page 12 Inside: Safe Medication | Long-term Care | Online Education | Evidence Matters www.hospitalnews.com September 2022 Edition FEATURED

Nurses and physicians have made it clear - solving the staffing crisis must be the first priority. The government has already missed a huge opportunity to step back from wage suppression and acknowledge that fair compensation for nurses is key to retention and recruitment, and a first step to reducing additional closures.

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PHOTO: THE CANADIAN PRESS

Government spin and attacks on public health care are a distraction Ontario can’t afford. It’s time to bring health-care professionals to the table to work together on solutions that will ensure all patients have a public health-care system they can count on.

There were dozens of emergency department closures over the summer because of the shortage of nurses. Even though this truth is painfully obvious, the new health minister and the Ontario government are trying to divert attention away from the root problem. They talk about adding beds and building hospitals, but that’s just a waste of taxpayer dollars when there’s not enough staff to provide care.

Crisis denying.

Contents SafeLongOnlineInEvidenceInGuestCOLUMNSeditor.....................4brief..............................6matters...........12emergency..................14education............18termcare...............26medication............31 September 2022 Edition IN THIS ISSUE: ▲ Blood on Board Program saving lives and time 10 ▲ Cover departmentthecareEmergencystory:withoutemergency 12 ▲ Identifying hazards and paramedicsolutionsdevelopingfortheservice 14 ▲ Emergency care and hospitalizationshigheramongcannabisusers 23 ▲ Pet Therapy Program for hospital healthcare workers 25 Powder could stop bleeding earlier forpatientstrauma 16 Learning through free gamifiedtraining 19

ay 19th was the 10-year anniversary of my brother Greg’s death. Greg was a healthy, intelligent 31-year-old who had only told us of his potential diagnosis of testicular cancer days before. Our family was shocked and devastated. A major factor in my brother’s early death was Canada’s poor health data infrastructure. Greg and his various health providers didn’t have access to all his health information. A red flag for testicular cancer was in his electronic medical record at one clinic but wasn’t available to the walk-in clinic doctor Greg saw when he started having back pain. One of his doctors moved his practice; the clinic didn’t have a process in place for follow-up. A specialist he was urgently referred to – via fax – was out of the office for an extended period and the referral sat there until Greg finally called the specialist’s office.

When my family wanted to learn what happened so we could help prevent this from happening again, we asked questions about how common cases like Greg’s were. The system couldn’t provide what we thought was basic information. We asked for statistics on surgeries like Greg’s and the frequency of blood clots for the hospital, region, province and nationally – which didn’t seem like a big ask at the time – and learned the information doesn’t exist. Since Greg’s death, we’ve learned a lot about healthcare and have realized that we made a lot of dangerous assumptions.

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• We need a health system that uses information to continuously learn, improve and innovate. Everyone deserves safe care, yet Canada has an unacceptable level of harm. One in every 17 hospital stays results in at least one unintended harmful event – and that is just hospital stays. Harm impacts the entire care team. It’s not okay to put people in a position where a single mistake could result in patient harm.

• Safe care is provided by teams.

• Teamwork requires information to make safe decisions.

4 HOSPITAL NEWS SEPTEMBER 2022 www.hospitalnews.com

to: subscriptions@ Canadianhospitalnews.comPublications mail sales product agreement number 42578518. Barb Mildon, RN, PHD, CHE VP Professional Practice & Research & CNE, Ontario Shores Centre for Mental Health Sciences Helen Reilly, Publicist Health-Care Communications Jane Adams, President Brainstorm Communications & Creations Bobbi Greenberg, Health care communications Sarah Quadri Magnotta, Health care communications Dr. Cory Ross, B.A., MS.C., DC, CSM (OXON), MBA, CHE Vice President, Academic George Brown College, Toronto, ON ADVISORY BOARD 610 Applewood Crescent, Suite 401 Vaughan Ontario L4K 0E3 TEL. 905.532.2600|FAX 1.888.546.6189 www.hospitalnews.com Editor Kristie editor@hospitalnews.comJones Advertising Representatives Denise denise@hospitalnews.comHodgson Publisher Stefan stefan@hospitalnews.comDreesen Accounting Inquiries accountingteam@mediaclassified.ca Circulation Inquiries info@hospitalnews.com Director of Print Media Lauren Reid-Sachs Senior Graphic Designer Johannah Lorenzo ASSOCIATE PARTNERS: By Teri Price But we can still build a world-class system OCTOBER 2022 ISSUE EDITORIAL: September 6 ADVERTISING: Display – Sept. 23 | Material – Sept. 27 Monthly Focus: Mental Health and Addiction/Patient Safety/ Research/Infection control: New treatment approaches to mental health and addiction. Developments in patient-safety practices. An overview of current research initiatives. Developments in the prevention and treatment of drug-resistant bacteria and control of infectious (rare) diseases. Programs implemented to reduce hospital acquired infections (HAIs). +ANNUAL INFECTION CONTROL SUPPLEMENT NOVEMBER 2022 ISSUE EDITORIAL: October 4 ADVERTISING: Display – Oct. 21 | Material – Oct. 25 Monthly Focus: Technology and Innovation in Healthcare/ Artificial Intelligence (AI)/Patient Experience/ Health Promotion: New treatment approaches to mental health and addiction. An overview of current research initiatives Programs and initiatives focused on enhancing the patient experience and family centred care. Programs designed to promote wellness and prevent disease including public health initiatives, screening and hospital initiatives. + SPECIAL MEDTECH SUPPLEMENT Continued on page 6

Hospital News is published for hospital health-care professionals, patients, visitors and students. It is available free of charge from distribution racks in hospitals in Ontario. Bulk subscriptions are available for hospitals outside Ontario. The statements, opinions and viewpoints made or expressed by the writers do not necessarily represent the opinions and views of Hospital News, or the Hospitalpublishers.News and Members of the Advisory Board assume no responsibility or liability for claims, statements, opinions or views, written or reported by its contributing writers, including product or service information that is advertised.

In the first year after Greg’s death, Dr. Ward Flemons and the team at the Health Quality Council of Alberta investigated what happened, releasing the Continuity of Patient Care Study. Five years later, we partnered again to produce the film, Falling Through the Cracks: Greg’s Story. To date, it has been screened more than 470 times and we’ve participated in almost every screening’s post-film discussion. These conversations have been an opportunity to deepen our understanding of healthcare and refine what we believe is crucially important for its future. We have learned a few things that we believe are fundamental truths:

• We need a health system that puts patient safety as a real priority and that doesn’t harm patients.

Hospital News is provided at no cost in hospitals. our advertisers, please mention you saw their ads in Hospital News.

“Dr. Chapman is a well-known RNAO member and an outstanding choice to inform federal HHR policy. Chapman’s expertise as a registered nurse (RN) in various roles and sectors is matched only by her incredible compassion,” says RNAO President Dr. Claudette Holloway. “This role has always been important, and even more crucial now given nursing shortages that have been exacerbated by the pandemic,” she adds. “We commend Prime Minister Justin Trudeau and Health Minister Jean-Yves Duclos for taking this important step. RNAO has advocated for the reinstatement of this role since it was eliminated under former Prime Minister Stephen Harper,” notes NursingHolloway.wasalsotop of mind during a meeting Premier Doug Ford held with his Maritime counterparts Monday. During media availability all premiers acknowledged the dire HHR crisis we find ourselves in. Holloway calls it a long-coming admission given the state of the crisis. “Ontario is in even more dire situation as we entered the pandemic with the lowest RN-to-population in Canada – a shortfall of 22,000 RNs. During the past two and a half years more RNs have left due to excessive workloads, deteriorating working conditions, stress and burnout – as well as reduced earnings caused by Ontario’s Bill 124.”

RNAO opposes medical procedures and surgeries being performed by for-profit corporations because these entities are legally obliged to prioritize the interests of shareholders and investors – not those of patients. “We cannot allow shareholders to carve out money and drain scarce HHR resources from the public purse, thus aggravating the nursing shortage and people’s health,” says Grinspun. “This is nurses’ line in the sand – crossing the line would bankrupt the system ethically and financially, and deliver worse outcomes for most Canadians.” Grinspun says the challenges facing the health system are not insurmountable, and that Canada’s well-regarded health system can be fixed. “RNAO is eager to continue working with all governments to do what we need to do for the benefit of our patients and for communities – right across this country.” ■ H

H JOIN NOW! 800-268-7199join.RNAO.ca STRONGER TOGETHER48,500STRONG JOIN RNAO AND GET 2 MONTHS FREE* Satisfy the CNO’s professional andmonthsrequirement–protectionliability(PLP)andtheofSeptemberOctoberareonus. *Applications will be dated per date of receipt. Special offer applies to new or lapsed members applying for 2022-2023 membership year. ARE“CANADIANSFEELING THE NURSINGEFFECTSDEVASTATINGOFTHECRISIS.”

Key

Retaining and recruiting nurses: to getting Canada’s health system back on its feet

“We also urge the prime minister to use his authority to ensure premiers fully uphold the principles and spirit of the Canada Health Act (CHA). This includes prohibiting for-profit corporations from performing medical and surgical procedures that require overnight stays,” says Grinspun. She adds, “We ask nurses and all Canadians to be vigilant and disclose any such practices.”

RNAO CEO Dr. Doris Grinspun says the federal government must take further actions. While thanking deeply Prime Minister Trudeau for appointing an outstanding CNO, she calls on him to increase federal transfer payments to the provinces – and to do so with strings attached to ensure investments are made to improve HHR policy.

The federal government took a major step towards that goal by announcing that it was reinstating the role of Chief Nursing Officer (CNO) for Canada and appointing Dr. Leigh Chapman to the position.

SEPTEMBER 2022 HOSPITAL NEWS 5www.hospitalnews.com NEWS ealth system challenges in Ontario and across Canada can be overcome if premiers, territorial leaders and the federal government make health human resources (HHR) – and especially nursing – a priority, says the Registered Nurses’ Association of Ontario (RNAO).

All four premiers emphasized the need to collaborate with health sector experts and adopt “best practices” to solve the challenges facing the health system. Many of these best practices can be found in the Nursing Through Crisis report released by RNAO in May. They range from ensuring competitive compensation and reducing workloads to building career paths for nurses and other health professionals in Canada so they continue working here for decades to come. Building career paths includes helping registered practical nurses (RPN) and licensed practical nurses (LPN) become RNs by providing flexible and ready access to bridging programs, supporting RNs to develop expertise in clinical areas, or furthering their careers as clinical nurse specialists, nurse practitioners (NP), managers or educators. It also means enabling NPs to work to their full scope of practice, vastly improving access and flow of patients throughout the health system.

“The exodus of nurses from fulltime work positions in hospitals and other settings can only be stopped if full-time permanent positions are better rewarded and recognized over agency positions,” says Holloway. And she notes, “It is urgent for our province to capitalize on existing proven programs such as the Nursing Graduate Guarantee and the Late Career Nursing Initiative, and to build a mid-career nursing initiative to entice nurses to stay in “CanadiansOntario.”are feeling the devastating effects of the nursing crisis. Whether it is long wait times accessing the system, closures of emergency rooms, delays in procedures and surgeries or trying to get the care they need in home care and long-term care, no sector is immune,” adds Holloway. The crisis is drastically compounded by short staffing, a situation that Holloway says “creates moral distress which affects nurses’ ability to provide the highest quality of care. It is untenable and cannot continue.”

“Pharmaceutical security for Canada” was published August 22, 2022.

Pharmaceutical drug security should be a priority in Canada

A recently released series of reports from the Pan-Canadian Health Data Strategy Expert Advisory Group honestly outlines the current problems in health information in the country and provide an actionable strategy to create the healthcare system that we need and deserve. They call for a learning health system that uses interoperable data standards and person-centred data architecture, with collaboration across health jurisdictions and stakeholders. This would create a robust health system based on data-supported insights and evidence-based decisions.

Key findings include:

“Canada’s pharmaceutical supply has become highly dependent on foreign imports and vulnerable supply chains and recent Canadian investments for pandemic preparedness do not address the entirety of pharmaceutical shortcomings,” writes Dr. Shoo Lee, Department of Paediatrics, University of Toronto and Mount Sinai Hospital, Toronto, with coauthors. “A cohesive national policy is needed to address this problem.”

Continued from page 4

The authors suggest several steps to improve the security of pharmaceutical drugs in Canada including:

The 2021 National Physician Health Survey is available online . It illustrates the many factors impacting physician health and wellness including the pandemic, increased administrative burden, lack of work-life integration, bullying and harassment in the workplace and lack of professional fulfillment.Between October and December 2021, more than 4,100 physicians, medical residents and medical students completed the survey, up from nearly 3,000 CMA members in 2017. ■ H

Bold collaboration is needed for success, and we all have a role to play. Before Greg’s death, we assumed that healthcare, like other sectors, had evolved over time to adopt tools for effective communication and information sharing. We were wrong. As citizens across Canada, we need to support the system changes and mindset shifts needed. This isn’t going to happen overnight. There isn’t a single sector, organization, or jurisdiction that can independently cause this change. Just as a team is required for patient care, we need collective action to prevent more people from falling through the cracks.

Health information systems must be intentionally designed to enable teams to provide safe care by giving access to information whenever decisions are being made.

• Strengthening domestic manufacturing of pharmaceuticals

Canada’s poor health data

For more than a decade, Canada has experienced ongoing drug shortages, such as the shortage of epinephrine self-injectors (i.e., EpiPens) over the last five years, and recent shortages of hydroxychloroquine for the treatment of rheumatoid arthritis and inflammatory bowel disease owing to use by some to treat COVID-19.

■ H Teri Price is the Executive Director of Greg’s Wings Projects.

We need a system that enables health providers to do their best work, where they’re surrounded by a team that relies on each other, and where the whole team, including patients, have access to the information they need.As Dr. Ewan Affleck puts it, “information is the currency of care.”

■ H S “EVERY DAY, WE HEAR PHYSICIANS EXPRESSING DESPAIR AT THE STATE OF OUR HEALTH SYSTEM, THE STRAIN THAT ALL HEALTH WORKERS ARE FACING AND THE FACT THAT OUR PATIENTS ARE SUFFERING,”

6 HOSPITAL NEWS SEPTEMBER 2022 www.hospitalnews.com IN BRIEF

• One-quarter (25%) of physicians and residents experience severe (10%) or moderate (15%) anxiety

• Developing a list of medicines essential to prevent death or severe illness

“Every day, we hear physicians expressing despair at the state of our health system, the strain that all health workers are facing and the fact that our patients are suffering,” says Dr. Alika Lafontaine, CMA president. “Since this survey was completed, the strain on health workers has continued to grow with no signs of a break coming. Physicians need help and support so they can continue to provide quality care to patients.”

Canada’s pharmaceutical market is small, making up just 2% ($18 billion USD) of total global revenue in 2019. The country relies heavily on imported medications, making it vulnerable to supply chain disruptions and drug shortages. In June 2022, 23 Tier 3 drugs were in short supply; this category includes critical drugs with the potential for the greatest negative impact on drug supply and the health system.

For patients to be engaged partners who participate in making decisions in their own care as contributing members of their team, they also need access to their information.

• Collaborating with international partners to strengthen supply chains

The Canadian Medical Association (CMA) has released the full results of its 2021 National Physician Health Survey. Conducted in November 2021, the survey shows a physician workforce that is struggling under the weight of an under-resourced health system and pandemic challenges.

s emergency departments buckle under pressure due to staffing shortages and Canadians struggle to find the care they need in a timely manner, a newly released survey illustrates the despair Canadian physicians are experiencing amidst the biggest health care crisis of our times.

hortages of essential medicines threaten Canadians’ health and ensuring access to critical drugs at all times should be a government priority, write authors in an analysis in CMAJ (Canadian Medical Association Journal).

• Stockpiling these medications in the national emergency strategic stockpile (NESS) or requiring drug companies to do so

• Nearly half of respondents (48%) screened positive for depression, up significantly since the CMA’s 2017 survey (33%).

• Eight in 10 (79%) physicians and medical learners score low on professional fulfillment; less than six in 10 physicians and medical learners indicate being satisfied with their career in Preliminarymedicineresults released in March showed that more than half of physicians and medical learners (53%) had experienced high levels of burnout and that nearly half of respondents (49%) were considering reducing their clinical work in the next 24 months.

National survey shows physician workforce in despair A

“Investment in API [active pharmaceutical ingredient] and pharmaceutical manufacturing technologies should be integral to Canada’s strategy to become pharmaceutically self-sufficient,” they write.

By Abigail Carter-Langford

privacy’s role in enabling

UnderstandingTinteroperability

Health Infoway (Infoway) is committed to driving interoperability in Canada by working to establish collaborative frameworks to engage stakeholders in priority projects, and to support and publish terminology standards. Equally important, Infoway is also working to clarify the role privacy laws can play in building interoperable solutions. To learn more about how privacy laws can help enable interoperability, download Privacy as an Enabler: Sharing Personal Health Information for Interoperability Primer. www.infoway-inforoute.ca. H

Privacy legislation can also provide guidance for roles and responsibilities when information is shared between multiple providers. When custodians share information, they not only share custody and control of PHI, but they also share accountability. Shared accountabilities may pose unique legislative compliance challenges, since custodians may be unsure which obligations are applicable to them. As technologies and practices change, privacy laws, too, are evolving, with a number of new laws and changes proposed. These include calls for changes to consent provisions, stronger enforcement powers and a balanced approach for data protection that enables appropriate access for health innovation.These types of proposed changes could help Canada shift to a truly patient-centric model. They would entail further embedding data sharing requirements in privacy legislation, implementing pan-Canadian standards for data sharing to make it easier to share data across jurisdictions and a more robust data governance model. Improving digital literacy and privacy education for patients, third-party service providers and data custodians could also help further establish the notion of patient agency overCanadaPHI.

SEPTEMBER 2022 HOSPITAL NEWS 7www.hospitalnews.com here are many challenges to enabling interoperability in health care within and across jurisdictions – there is a plethora of IT systems speaking different languages in a multitude of care settings across several jurisdictions, each with unique needs and requirements. A lot of work needs to be done – and is being done – to enable data to flow across these silos. However, one misperceived barrier isn’t really a barrier at all, but can in fact provide guidance and clarity when building interoperability into systems and workflows. This misperceived barrier? Privacy laws.

To understand how privacy laws can aid interoperability in health care, we must first understand what interoperability is and why it is so important that information be shared between health care Interoperabilityproviders.is a means of enabling health information to flow seamlessly and consistently across the health care continuum. It not only means that data flows between different systems but that these systems are speaking the sameWhylanguage.isthis important? When patients are dealing with a complex health issue, it often means seeing a variety of providers – primary care providers, specialists and perhaps even the occasional trip to the emergency department (ED). Additionally, patients who live in one province may become injured in another while on vacation or experience a flare up of an existing condition. When information flows smoothly between these settings, it improves the continuity of care. Access to information about the medications patients are taking or any allergies they have can, for example, help EDs avoid potentially fatal errors. Interoperability prevents duplications and delays, and helps improve patientInteroperabilityoutcomes. is also aimed at improving patients’ access to their personal health information (PHI). The ability to access one’s own PHI is a cornerstone of providing patient-centred care.Unfortunately, there is a common misconception that privacy laws in Canada are a barrier designed to prevent the sharing of information between authorized providers. Privacy laws, in fact, support the protection of PHI and access to that information as deemed necessary, including providing access directly to patients and health care providers when required for the provision of care. Enabling interoperability and the flow of data between systems can open up a host of questions. How can a clinician obtain meaningful consent from the patient for sharing a patient record? Can a clinician block or mask personal health information within a patient’s record? What if a clinician does not want to share a patient’s information? Which clinician is responsible for the patient’s record when information is shared? Privacy laws can provide some clarity when it comes to these types of questions. Canadian privacy laws include guidance on rules for the collection, use, disclosure and security of PHI. They also make clear that while health care providers are the custodians of the information the data belongs to the patients. Canadians have a right not only to access their PHI, but to correct the information. Privacy laws also provide processes for the independent review of decisions made by PHI custodians and recourses for violation of the legislation.

INTEROPERABILITY IS A MEANS OF ENABLING HEALTH INFORMATION TO FLOW SEAMLESSLY AND CONSISTENTLY ACROSS THE HEALTH CARE CONTINUUM. IT NOT ONLY MEANS THAT DATA FLOWS BETWEEN DIFFERENT SYSTEMS BUT THAT THESE SYSTEMS ARE SPEAKING THE SAME LANGUAGE.

Abigail Carter-Langford is Chief Privacy & Security Officer and Executive Vice President, Governance, Risk & Compliance with Canada Health Infoway.

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EmergencyP room physicians can accurately predict serious outcomes for syncope (fainting) patients with a validated risk score

It found that the Score helped ER physicians accurately predict 30-day serious outcomes for syncope patients after being released from the ER. They could determine if a patient was at risk for ventricular arrhythmia and whether they should be admitted. Verylow-risk and low-risk patients could generally be discharged, while brief hospitalization could be considered for high-risk patients.

■ H rojected to save the Canadian healthcare system approximately $70M per year, the CANet-funded Canadian Syncope Risk Score (CSRS) is helping doctors improve syncope care in the emergency room (ER), reducing the burden on hospitals throughout Canada. Syncope is the temporary loss of consciousness due to the incomplete delivery of oxygen to the brain. A complete recovery immediately follows it. In some high-risk cases, syncope eventually leads to potentially fatal conditions like arrhythmias.

SEPTEMBER 2022 HOSPITAL NEWS 17www.hospitalnews.com IN EMERGENCY

“We believe CSRS implementation has the potential to improve patient safety and health care Thiruganasambandamoorthyefficiency,”says.

Dr. ThiruganasambandamoorthyVenkatesh

Syncope accounts for one to three percent of all emergency department visits.Before creating the CSRS tool, doctors did not have standardized guidelines on evaluating syncope patients, differentiating between low- and highrisk cases, which patients to send back home, and whom to assess further.

Ana Gajic is the senior communications advisor at Unity Health Toronto earlier and potentially decreasing mortality. The added bonus, she says, is these products are also safer. “We are bringing resuscitation straight to the patients at the site of injury. You can do this in an ambulance, you can do this at the side of the highway.”

While the signals in preliminary studies have been positive, this large trial is needed to show whether the factors could replace plasma as a standard of care in Canada and beyond. This study is part supported by the Department of National Defence, as the therapy could be used to treat casualties on the

ABOUT CANet Our Network brings together health care professionals, academia, government, industry, not-for-profit, and patients to support new ideas and ground-breaking cardiac research.

Althoughbattlefield.traumasdecreased during the pandemic due to less travel, commuting and entertainment opportunities, the trial was permitted to continue and is well on its way to recruiting the trauma centres it requires. The plan is for 11 trauma centres across Canada with about 350 patients enrolled. So far, trauma centres in Toronto, London, Hamilton and Kingston are up and running. On the horizon, Dr. Pavenski hopes to participate in a similar trial in cardiovascular surgery at St. Michael’s and is excited to reopen some of the studies that paused during the pandemic.

Building off the success of a groundbreaking theatre production and film called Cracked: New Light on Dementia, KITE senior scientist Dr. Pia Kontos and KITE senior research associate Romeo Colobong have launched a new online educational tool designed to nurture understanding of Dementiadementia.in New Light: A Digital Learning Experience uses a cinematic display featuring audio and visual assets to educate audiences about the challenges faced by people living with dementia, due to the detrimental effects of stigmatization, and provides a roadmap for how society can become more inclusive and supportive.

■ H New digital learning tool for understanding dementia B IMMERSIVE LEARNING EXPERIENCE USES CINEMATIC DISPLAY OF AUDIO AND VISUAL ASSETS TO EDUCATE AUDIENCES ABOUT THE CHALLENGES FACED BY PEOPLE LIVING WITH DEMENTIA. BE THE FUTURE OF EMERGENCY coned.georgebrown.ca/emergencyPREPAREDNESS Register now for fall courses! For more information, contact us at 416-415-5000, ext. 6651, or kmelo@georgebrown.ca Our programs are geared to health and security professionals and can be conveniently completed at your own pace on a course-by-course basis. You can pursue these programs fully online or by taking a mix of online and on-campus delivery methods. Emergency Management Program Public Health Emergency Management Program Explore your professional development opportunities with Continuing Education at George Brown College Interested in Emergency Management Ontario (EMO) certiﬁed courses? You can receive both a record of completion from George Brown College and an EMO certiﬁcate with the following courses: BEM: Basic Emergency Management Basic Incident Management System 200 Intermediate Incident Management System 300

“People living with dementia are often thought of as completely unaware of their surroundings and incapable of any meaningful communication,” said Dr. Kontos, who is also a professor at the Dalla Lana School of Public Health at the University of Toronto.“Thisdeprives them of opportunities to be social, make decisions regarding their own care, and legitimizes care that is dehumanizing.”

Project collaborators Drs. Sherry Dupuis, Christine Jonas-Simpson, Julia Gray, and Alisa Grigorovich worked with Dr. Kontos, Colobong, and Forge Media + Design to create this innovative educational initiative. It was created in response to feedback from audience members of Cracked who urged the team to create an online educational tool that delved deeper into some of the key messages of the “Theproduction.digitallearning experience will help audiences understand the perspectives of people living with dementia and their families,” said Colobong. “This will encourage them to challenge their own assumptions and to help to build a better world for people living with dementia.”

To participate please visit https:// dementiainnewlight.com/Currently,thereareover 500,000 Canadians living with dementia today. This number is expected to grow to just under 1 million by 2030. Given the prevalence of dementia, the team feels that everyone would benefit from using this educational tool – people living with dementia, family caregivers, health care providers, policy makers, and so many more.There are plans in the works for it to be used to enhance training programs for personal support workers and nurses, providing a much-needed and comprehensive curriculum on stigma and relational caring.

18 HOSPITAL NEWS SEPTEMBER 2022 www.hospitalnews.com ONLINE EDUCATION

Learning specialized long-term care competencies through free traininggamifiedT

he COVID-19 pandemic has significantly impacted the long-term care sector. With staff shortages across the board, there is an urgent need to increase and train workers to ensure quality of care for the most vulnerable members of our society. Grounded in a serious and immersive game world, the Learning Inter-Professionally Healthcare Accelerator (LIPHA) is changing the way new hires and students in Ontario’s longterm care (LTC) sector learn and build specialized competencies in LTC.

“We need new approaches to recruitment, skill building, re-skilling, and up-skilling in frontline health care. LIPHA uniquely fills that need, with an innovative, engaging, and cost-effective training approach supporting the next generation of longterm care staff who ensure older Ontarians live their best possible lives,” says Dr. Allison Sekuler, President & Chief Scientist, Centre for Aging + Brain Health Innovation (CABHI) and Baycrest Academy for Research and Education at Baycrest Centre for Geriatric Care, and Sandra A. Rotman Chair in Cognitive Neuroscience, Rotman Research Institute. Using a mix of short and full simulations, eLearning, game activities and resources, LIPHA motivates and rewards the learning of foundational knowledge on LTC best practices along with providing a safe space to practice caring for realistic, simulated LTC residents.

By Nicole Pacampara

Continued on page 20

SEPTEMBER 2022 HOSPITAL NEWS 19www.hospitalnews.com ONLINE EDUCATION

Just Culture in Healthcare Certiﬁcation Course Understanding and reinforcing just culture principles helps you create a culture of learning that sustainably reduces risk and improves patient safety.

Always Keep Learning

LIPHA was developed as a partnership between the Ontario Centres for Learning, Research, and Innovation in Long-Term Care (Ontario CLRI) at Baycrest, George Brown College, Toronto Metropolitan University (formerly known as Ryerson University), and Baycrest, as part of an eCampus Ontario grant. The platform enhances the onboarding and training of frontline workers in the long-term care sector – from personal support workers, nurses, to students considering a career in the field. It’s accessible online anytime, anywhere, and on any device.

This year through the Government of Ontario Ministry of Long-Term Care’s PSW Education Fund, 7,000 free LIPHA seats are rolling out to long-term care homes and post-secondary education institutions across Ontario. This is made possible through a collaboration among CABHI powered by Baycrest, the Ontario CLRI at Baycrest, and the Kunin-Lunenfeld Centre for Applied Research and Evaluation within Baycrest’s Rotman ResearchLIPHAInstitute.isnow actively recruiting new organizations interested in using the platform for training. Ontario-based long-term care organizations and educational institutions can access LIPHA at no cost. A variety of learning packages for PSWs and nurses are available, including 14-16 hours (new hires), 20-35 hours (student clinical experiences) and an 8-hour introductory microcredential (new hires and senior students). Technical, implementation, and education support is provided to enrolled organizations to help with the rollout of LIPHA. Additionally, staff backfill funding support is available for long-term care homes. Looking to sign up your organization or learn more about the platform? Visit LIPHA’s website and get in touch with the LIPHA team. ■ H Nicole Pacampara is a Digital Marketing and Communications Specialist at the Centre for Aging + Brain Health Innovation (CABHI).

LIPHA’s real-life learning scenarios were fine-tuned using input from CABHI’s Leap platform, a virtual community connecting older adults and caregivers with innovators. With the involvement of this community in LIPHA’s development, the platform ensures its design, delivery, and growth are informed by the lived experiences of older adults and caregivers – the ultimate beneficiaries of LTC workforce improvements in recruitment, retention, and professional development.

LONG-TERM CARE ORGANIZATIONS AND EDUCATIONAL INSTITUTIONS CAN ACCESS LIPHA AT NO COST.

Minister Jill Dunlop, Ontario Ministry of Colleges and Universities, visiting CABHI’s Innovation Showcase and members of the LIPHA team. (L – R): Stacey Guy, Faith Boutcher, Jenna Pirmohamed, Matthew Goulbourne, Minister Jill Dunlop, David Conn, Shusmita Rashid, Daniel Galessiere.

There is no better time than now to continue learning.

Free gamified training Continued from page 19

“LIPHA’s applicability with existing and prospective frontline healthcare workers, and its gamified and self-directed approach allows learners to become more engaged with their training, yielding benefits like better retention, which leads to better care.”

Successful Patient Interactions

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More than 600 learners across seven LTC homes and three schools completed the program through an investment of $1.2 million by the Government of Ontario’s Ministry of Colleges and Universities (MCU). Administrators praise the platform for its positive impact on the training of new hires, the quality of care provided by learners, student interest in gerontology and aging, and student confidence in providing care for older adults.

Helping physicians and other healthcare providers communicate more effectively with their patients, the program is designed to increase work satisfaction and reduce risk for the long term.

“I really enjoyed the platform because it uses a unique approach to learning compared to traditional approaches,” says one LTC Home. “…it will be beneficial for training processes for staff.”

Supporting healthcare managers, people leaders, and those looking to grow into leadership, this program gives you skills and strategies to promote professional behaviour in your team and become a more effective leader.

Learners are scaffolded to higher levels of performance as they master increasingly challenging simulations while receiving instant feedback. As they progress, through the game world on a healer’s journey set in ancient Carthage, LIPHA fosters knowledge, skills, and values essential to supporting safe, person-centred, relational, and team-based care.

Effective Team Interactions Learn practical strategies for improving communication skills, building psychological safety and ensuring clear communication within your team. Change and Quality Help your team move from idea to execution through the development of a tailored, realworld action plan for quality improvement.

“Closing the skills gap in long-term care requires an innovative approach to make progress quickly,” says Dr. David Conn, Executive Vice President, Education, Baycrest Academy.

Saegis offers accredited courses on workplace culture, communication, and change and quality that can help develop safer, healthier teams and improve patient safety.

20 HOSPITAL NEWS SEPTEMBER 2022 www.hospitalnews.com ONLINE EDUCATION

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“The LHSC stroke team has given me my life back,” said Wilene Leyen. “I can do almost everything I was able to do before I suffered the stroke and I’m very grateful Dr. Mayich was able to perform this procedure.” ■ H

22 HOSPITAL NEWS SEPTEMBER 2022 www.hospitalnews.com NEWS patient at London Health Sciences Centre (LHSC) is the world’s first to benefit from a new medical device developed to treat stroke by rapidly removing the offending blood clot in 10 minutes, ultimately reversing the symptoms of stroke and preventing permanent damage to the brain.

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Mechanical thrombectomy is a new minimally invasive treatment for strokes caused by blood clots which block blood flow to the brain. It is performed by a specialized team which includes neuroradiologists, stroke neurologists, neurosurgeons, imaging technologists and anesthesiologists who are on-call 24-7 to provide this emergency service.

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As a research-intensive teaching hospital LHSC is committed to finding and developing innovative health care solutions to treat patients for a variety of emergency conditions, including stroke. On June 24, 2022, Dr. Michael Mayich and his team used a new device called a balloon distal access catheter (BDAC) to successfully remove a blood clot from an artery in the brain of Wilene Leyen. The procedure was performed through a tiny incision over the right hip and took less than 10 minutes, reconstituting blood flow to a large part of the brain and restoring Ms. Leyen’s movement and speech almost“Performingimmediately.more than 200 emergency stroke surgeries each year, our team at LHSC knows the importance of identifying strokes and acting quickly,” said Dr. Michael Mayich, an Interventional Neuroradiologist at LHSC. “When a blood clot is causing a stroke, over 2 million brain cells can be lost each minute, so seconds count. By locating and removing the clot in a shorter period of time, the patient has a higher probability of regaining mobility and speech. This device offers the possibility of removing clots in fewer attempts, shortening the procedure and maximizing the chances of good outcomes for our patients”.

• LHSC is the first hospital in the world to use the BDAC to treat a patient experiencing a stroke. The BDAC combines the roles of a balloon guide catheter and distal access catheter increasing chances of success on the first pass and potentially improving patient outcomes

Stroke is the third leading cause of death in Canada and a leading cause of disability and 50 per cent of patients who suffer a stroke will be left with a permanent disability Since 2015, thrombectomy has become the new standard of care treatment for certain groups of acute stroke patients

LHSC was the first hospital in the world to use the BDAC to treat a patient experiencing a stroke. The device uses a balloon to temporarily halt flow in a vessel while suction is applied to remove clots causing the stroke and restoring flow to the endangered part of the brain. The Health Canada approved device was developed by Vena Medical, based in Kitchener-Waterloo and has since been used to treat stroke patients at The Ottawa Hospital.

The study, published in BMJ Open Respiratory Research and led by researchers at Unity Health Toronto and ICES, found serious physical injury and respiratory-reasons were the two leading causes of ED visits and hospitalizations among cannabis users.

Emergency care and hospitalizations higher among userscannabisV

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“Our research demonstrates that cannabis use in the general population is associated with heightened risk of clinically serious negative outcomes, specifically, needing to present to the ED or be admitted to hospital,” said Dr. Nicholas Vozoris, lead author, a respirologist at St. Michael’s and an associate scientist at the hospital’s Li Ka Shing Knowledge Institute.

MORE protection LESS transmission That’s the PCR plus advantage. From Cepheid. Visit www.cepheid.com/en/HAIs In Vitro Diagnostic Medical Device. © 2022 Cepheid. More isits to the emergency department and hospitalizations are 22 per cent higher among individuals who use cannabis compared with those who do not, according to a new study.

SEPTEMBER 2022 HOSPITAL NEWS 23www.hospitalnews.com NEWS

“Unlike tobacco, there is some uncertainty or controversy regarding the adverse health impacts of cannabis. Some individuals may perceive that cannabis has some health benefits and is otherwise benign. Our research highlights to those using – or considering to use – cannabis, that this behaviour is associated with important negative health events.”

Learn

Continued on page 24

To compare health outcomes among cannabis users and individuals who don’t use cannabis, researchers used data collected in a survey of individuals who self-reported cannabis use and linked it with health administrative data from ICES for Ontario residents ages 12 to 65 years old.

The findings suggest an association between cannabis use and negative health events, which the researchers say should underline the need to educate and remind the public of the harmful impacts of cannabis on health. Recreational cannabis use has increased in Canada since decriminalization in October 2018.

24 HOSPITAL NEWS SEPTEMBER 2022 www.hospitalnews.com NEWS

he COVID-19 pandemic shed greater light on the importance of Canadian hospitals ensuring they have adequate resources and staffing in place to provide ventilation to critically ill patients who need assistance breathing.Intensive care units at hospitals across the country were forced to scramble to add beds, medical staff and ventilators to keep up with surging demand, particularly during the earlier waves of the pandemic.

In addition to having greater odds of going to the ED or being hospitalized, the findings show that one of every 25 people who use cannabis will go to the emergency department (ED) or be admitted to hospital within a year of usingAmongcannabis.the reasons cannabis users went to the ED or were hospitalized, acute trauma – defined as bodily injury – was the most common, with 15 per cent of cannabis users who got medical attention receiving it for this reason, and 14 per cent receiving care for respiratory reasons.

“We’ll use traditional full-support modes when a patient is acutely ill, but as soon as they’re stable enough to breathe spontaneously with assisted ventilation, then we get them on PAV,” says Veniott. Richard Kauc, a Respiratory Therapist and Ventilation Specialist at Medtronic Canada, is hopeful the study may provide more hospitals the data they need to offer patients greater access to PAV. Medtronic manufactures critical care ventilators with PAV for the global market.

Now, as the pandemic continues to simmer and they try to best manage strained budgets amid a health human resources crisis, hospitals and their government funding partners may be asking themselves what kind of ventilation is most cost-effective and delivers the best outcomes for patients?

A recently released Canadian research paper – Proportional-Assist Ventilation with Load-Adjustable Gain Factors for Mechanical Ventilation: A Cost-Utility Analysis – provides food forThethought.study synthesized available evidence from previous research to explore the cost-utility of two methods of ventilation used in Canada – pressure support ventilation (PSV), a form of mechanical ventilation in which each breath is supported by a constant pressure set by a clinician, and proportional assist ventilation (PAV), in which the ventilator’s software adjusts the level of assistance to match the activity of a patient’s respiratory effort. It found that PAV is more cost-effective, delivering a savings of $7,642 per patient, compared to PSV. At the same time, PAV also benefited patient care, increasing a measurement of quality of life by 16 per cent.

Using propensity score matching – a statistical matching technique – researchers compared the health outcomes of nearly 4,800 individuals who reported any cannabis use in the preceding 12 months with the health outcomes of over 10,000 individuals who reported never having used cannabis, or having used cannabis only once and more than 12 months ago. Researchers incorporated 31 different variables while matching study participants to minimize an unfair comparison, including demographics, multiple physical and mental health diseases, and tobacco, alcohol and illicit drug use.

“Mechanical ventilation plays an important role in critical care and there will likely always be a need for it to some extent in Canadian ICUs, but based on all of the data we collected and analyzed, it’s likely that Canadian hospitals will find PAV to be more cost-effective than conventional ventilation support for Canadian hospitals and lead to more positive outcomes for patients,” says study co-author Rhodri Saunders.

Respiratory Therapist Danny Veniott says the study provides further confirmation for what he sees firsthand on a daily basis in his role as Program Manager of the Respiratory Therapy and Airways Clinics at St. Mary’s General Hospital in Kitchener.

“Our own data shows us we’re able to get more people off the ventilator and able to do it much more quickly when we use our PAV protocol, than with other modes of ventilation, including PSV,” he says.

New research finds Better patient outcomes and reduced costs for patients on ventilators

The primary goal of the study was to explore whether there was a link between cannabis use and respiratory-related hospitalization or ED visits. The researchers found no significant associations between cannabis use and respiratory-related ED visits, hospitalizations, or death from any cause. However, they did find that overall visits to the ED or hospitalizations for any reason was significantly higher among cannabis users.

“The true merits of PAV should be seen in the quality outcomes – less time on a ventilator, less time in the ICU and less likely to die,” he says. “This study looked at existing research that shows better patient outcomes and wanted to see of there was also an economic benefit, and the answer was, ‘Yes.’” ■ H

St. Mary’s began using PAV as its predominant form of ventilation nearly a decade ago after a pilot project convinced leadership of the patient benefits, including less ventilation time, quicker recovery, fewer negative side effects and reduced reliance on sedatives and medications. The hospital treats approximately 1,300 patients per year who require ventilation, including those with chronic obstructive pulmonary disorder, multi-system failure and acute cardiac issues.

“The results of our research support that health care professionals and government should discourage recreational cannabis consumption in the general population. Given the context of cannabis decriminalization in Canada, which has very likely facilitated the broader use of this product in the population, more efforts need to made from our health and political leaders to educate and remind citizens about the harmful impacts of cannabis on health,” said Dr. Vozoris, who is also a scientist at ICES.

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Roxane Bélanger is a communications specialist with Medtronic Canada.

By Roxane Bélanger

Pet Therapy Program for hospital healthcare workers B

“When the Pet Therapy dogs greet me during my workday, I immediately feel my shoulders relax and I can’t help but smile,” said Kelsey McCormick, Clinical Resource Nurse at BC Children’s Hospital. “After visiting with the therapy dogs, I feel calmer and more equipped to deal with the tasks at hand. I become more patient, my thinking becomes clearer, and I feel like I am a better communicator.” “It is so wonderful to see the benefits that the therapy dogs provide BC Children’s Hospital healthcare workers,” said Lisa Knight, Child Life Specialist and one of the Pet Therapy program coordinators. “This is a specialized program specifically tailored to meet the unique needs of B.C.’s top healthcare staff and assist in alleviating some of the stress and anxiety that they experience on a regular basis. Pet therapy can also improve energy levels, self-esteem, and verbal communication skills.”

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SEPTEMBER 2022 HOSPITAL NEWS 25www.hospitalnews.com NEWS C Children’s Hospital Foundation in partnership with PetSmart Charities of Canada™ have launched a Pet Therapy Program specifically designed to assist BC Children’s Hospital staff cope with stress, anxiety, and work-related health issues. As the pandemic continues to challenge healthcare workers, the Pet Therapy Program will help to promote the physical and mental healing power of therapy animals for BC Children’s Hospital staff.

“It is wonderful to see the Pet Therapy Program dogs visiting the hospital and putting smiles on the faces of the healthcare staff,” said Malcolm Berry, President and CEO of BC Children’s Hospital Foundation. “The past two and half years have provided challenges for everyone, and the staff at BC Children’s Hospital, are no exception. As the pandemic landscape continues to evolve, our healthcare workers have pivoted and adapted accordingly to ensure that B.C.’s sickest and most seriously injured children continue to receive excellent care. When our dedicated hospital staff are taking their breaks during their shifts, the therapy dogs provide a healthy and peaceful healing environment, and a much-needed distraction for care workers during their busy day.”

“PetSmart Charities of Canada understands the healing power of animals, especially their ability to reduce depression, anxiety, and work-related mental health issues,” said Kate Atema, Director of Community Grants at the national charity. “We are excited to once again be working with BC Children’s Hospital Foundation on an innovative Pet Therapy Program specifically dedicated to the hospital staff.“It is wonderful to see BC Children’s Hospital Foundation being proactive and looking for ways to provide useful tools, activities, and programs for their healthcare workers to engage in that help reduce their stress levels,” added Atema.

All volunteers and pets in BC Children’s Hospital’s Pet Therapy Program are evaluated and certified by St. John’s Ambulance and BC Pets and Friends. The hospital’s pet therapy program offers monthly staff wellness group events and supports resiliency rounds for nurses on inpatient floors. Each visit allows opportunities for staff to pet the dogs and take a mental break from the busyness of their day.

The study’s author, Dr. Stephen Verderber of UofT’s John H. Daniels Faculty of Architecture, Landscape, and Design, emphasizes the urgency for re-examining Ontario’s approach to refurbishing existing homes and building new ones.

“We applaud the Government’s commitment to adding desperately needed capacity into the LTC sector, however, success cannot be measured solely by the number of additional beds being provided,” he says.

The scale of financial commitment announced by the provincial government has the potential to bring about the paradigm shift in the quality of care for which residents and their families have long advocated. However, this rush to build new facilities will be a missed opportunity if the government neglects to first update standards and design guidelines to support enhanced infection control. Best practices must align with modern clinical approaches to dealing with LTC residents, particularly those living with physical or cognitive impairments. In the case of residents with cognitive impairments, traditional approaches have used the built environment as a means of keeping residents’ movements carefully controlled. However, the effort to solve one critical problem (resident safety) has unintentionally created new issues – increased isolation and reduced mobility.

26 HOSPITAL NEWS SEPTEMBER 2022 www.hospitalnews.com LONG-TERM CARE NEWS Let’s What1.877.289.3997talk.ishome care? Home care is about trust. It is feeling comfortable with a provider coming into the home of someone you care for and, possibly, Bayshore’s home care services are extensive, tasks or round-the-clock care, Bayshore’s caregivers can help your loved ones to live PERSONAL CARE | HOME SUPPORT | NURSINGbayshore.ca

“The built environment must be considered as important a parameter of care as any other medical intervention,” says Dr. Diana Anderson, an Architect and Geriatrician with Jacobs Canada.

“I hope the Government of Ontario takes this opportunity to move beyond bricks-and-mortar solutions to considering data-driven design ideas, such as those identified in the UofT study, to inform health-based solutions.”

The report identifies a number of exemplary case studies that model design excellence in long-term care residences. It also suggests 50 design considerations for use by design professionals, healthcare providers, gov-

New report reimagines a better built-environment for long-term care T

THIS RUSH TO BUILD NEW FACILITIES WILL BE A MISSED OPPORTUNITY IF THE GOVERNMENT NEGLECTS TO FIRST UPDATE STANDARDS AND DESIGN GUIDELINES TO SUPPORT ENHANCED INFECTION CONTROL.

he University of Toronto (UofT) Centre for Design + Health Innovation has released a new, comprehensive study, “Reimagining LongTerm Care Architecture in Post-Pandemic Ontario – and Beyond.” The report, supported by the Ontario Association of Architects (OAA) and consulting firm Jacobs Canada, explores how the built environment can better support long-term care (LTC) communities.TheCOVID-19 pandemic had disproportionate impacts within Ontario’s LTC sector, exposing many structural vulnerabilities within these congregate facilities. Unless steps are taken to update standards and modernize design guidelines to better align to current and emerging clinical approaches, such vulnerabilities will remain largely unresolved – even in newly built LTC homes.

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The award is designed to give a new entrepreneur the financial resources, mentorship and training as they focus on making their ideas viable and rapidly deployable in service to older adults and caregivers.

AGE-WELL announces recipients of its 2022 Emerging Entrepreneur Award T ernments, and other decision-makers working in this sector.

“I am honoured to receive this award and thrilled for the opportunity to collaborate within AGE-WELL’s national network, which will help our general growth,” said Munn.

“This research could not have come at a better time,” says Susan Speigel, president of the OAA, which regulates the province’s architecture profession to protect the public interest. “We’ve known for a long time there were issues of concern within Ontario’s LTC sector, but this is one of the first times we’ve been able to take such a comprehensive look at the situation and begin identifying practical, evidence-based solutions and next steps that the architecture profession can bring into its practices.”

SEPTEMBER 2022 HOSPITAL NEWS 27www.hospitalnews.com LONG-TERM CARE NEWS

The Centre for Aging + Brain Health Innovation (CABHI) has provided a cash top-up of $5,000 for each recipient, bringing the total value of the salary award to $30,000 for each of the awardees.

Anika Munn is completing her master’s degree in public health at the University of Saskatchewan. She is a co-founder of LivingSafe, a startup developing a smart monitoring system designed to keep older adults safer by providing their caregivers with physical status data – such as vital signs –and alerts, for instance if a loved one wanders at night.

he 2022 recipients of AGE-WELL’s Emerging Entrepreneur Award are Liam Maaskant, co-developer of a walker with an elevating seat to give older adults greater independence at home, and Anika Munn, co-creator of a smart monitoring system to help older adults feel safer and more comfortable in various living settings.TheAGE-WELL Emerging Entrepreneur Award supports the development of emerging entrepreneurs to create and grow an innovative startup with potential social and economic impact in Canada. The innovation must address one of AGE-WELL’s 8 Challenge Areas and have potential to make a positive real-world impact in the lives of older adults and caregivers.

Liam Maaskant recently graduated from Dalhousie University where he received his degree in mechanical engineering. As co-founder of Axtion Independence Mobility Inc., he is developing a solution that expands the functionality of the rollator walker to include a motorized seat that moves up and down. This device aims to decrease older adults’ risk of falls while they engage in everyday tasks like reaching a lower drawer in the kitchen, transferring to the sofa or gardening in the flower beds.

“We designed our solution to help older adults live longer, more dignified lives at home by having a tool to stay active and engaged in the activities they love to do,” said Maaskant. “As a new graduate, I could not be more honoured and happier to receive this award. This will allow me to work full time on getting our device to people who need it.”

The devastating impact of COVID-19 on Ontario’s LTC sector is heartbreaking, but also a call to action.

“The vulnerabilities within Ontario’s LTC homes that led to the rapid spread of COVID-19 developed over several decades; no single government or political party has sole-ownership of this failure,” says Dr. Verderber. “However, the current government does have the financial tools, and the support of LTC residents, caregivers, their families, and Ontarians, to finally take decisive action to begin fixing this urgent problem.”

There are three key features of syndromes like ARDS that develop because of ICU care. First, they result from the consequences of support in the ICU – only if you survive to be put on a ventilator do you develop ARDS. Second, they aren’t unique to a particular initiating cause, such as trauma or pneumonia, but are a final common pathway of a number of acute illnesses. Both the body’s response and the treatment provided by the ICU team contribute to their evolution.Finally, and most importantly, these complications arise through the body’s complex biologic response to infection and injury – a response that’s biologically variable from one patient to the next. As we learn more about the biology, we’re opening the door to a new strategy of treatment – targeting the response of the host, rather than just the trigger that activated that response. This can be done if we know which treatment is most likely to help which individual patient but to do this, we need to think beyond the bacteria and beyond the syndromes we support and describe patients on the basis of the treatable processes that are responsible for the patients being critically ill. What we’re proposing is to take one step further back and say, how do we find common biologic traits across multiple physiologic processes and diseases, and therefore target the biologic process, not the doctor’s picture of what the common result is?

WHY ARE PROPOSINGYOUA CHANGE IN THE WAY WE DEFINE CRITICAL ILLNESS?

Melissa McDermott is an Ottawabased writer. AGE-WELL is a federally-funded Network of Centres of Excellence that brings together researchers, older adults, caregivers, partner organizations and future leaders to accelerate the delivery of technology-based solutions for healthy aging. www.agewell-nce.ca

Traditionally, we’ve defined diseases based on their clinical manifestations, meaning the physical result of these diseases or their common symptoms. Two hundred years ago, pneumonia caused a patient to have a fever and to cough up sputum; why this happened was unknown. With the identification of bacteria as the cause of these symptoms, and the discovery that antibiotics could kill bacteria, pneumonia was redefined as an infectious disease of the lung. But even with effective antibiotics, some patients continue to deteriorate, and prior to the advent of intensive care units (ICUs), deterioration was followed by death. The ICU had an impact on the nature of disease: if you got pneumonia and you became really sick, we could support you with a ventilator. This support gave rise to new complications and we created new terms for those complications. If you were on a ventilator and there wasn’t as much oxygen in your blood and your chest x-ray looked poor but you weren’t in heart failure, we said this was acute respiratory distress syndrome (ARDS). Patients with pneumonia could develop ARDS but so could any patient on a ventilator.

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n the wake of the COVID-19 pandemic, a group of critical care physicians from around the world are calling for a broader definition of critical care – one that looks beyond syndromes and the consequences of illness and addresses the biological make up that determines how a person responds to disease and its treatments.

28 HOSPITAL NEWS SEPTEMBER 2022 www.hospitalnews.com LONG-TERM CARE NEWS

AwardEntrepreneur

“Our solution is aimed at taking away numerous health and safety fears so older adults can live life more comfortably and, in some cases, stay in their homes “Empowering,longer.”mentoring and supporting emerging entrepreneurs is part of AGE-WELL’s commitment to drive the delivery of technology-based products that benefit older adults and their caregivers, and generate economic returns for Canadians,” said Dr. Alex Mihailidis, Scientific Director and CEO of AGE-WELL, Canada’s technology and aging network. “Congratulations to this year’s exceptional recipients who exemplify the passion to make a difference and the innovative spirit in Canada’s growing AgeTech sector. We welcome these emerging entrepreneurs to our network with all its expertise and resources, and are pleased to begin working in partnership with them to get their innovations into as many hands as possible, ensuring a real-world impact for “CABHI’sCanadians.”overarching mission is to advance innovative solutions to help older adults live their best possible lives. This year’s AGE-WELL Emerging Entrepreneurs epitomize that mission, providing critical solutions to help people maintain their independence, and age well at home,” said Dr. Allison Sekuler, President & Chief Scientist, CABHI. “When companies like these succeed, older adults will thrive. So, in addition to our cash contribution, award recipients will receive access to CABHI’s vast array of innovation services and our national and international network of scientific officers and validation, investment, and distribution partners, all supporting these creative entrepreneurs to significantly accelerate the spread, scale, and success of their companies.”

WHY IS NOW THE TIME TO CRITICALDIFFERENTLYTHINKABOUTILLNESS? We’ve seen this happen in other fields. In the 1940s, oncologists realized that ovarian cancer behaves differently from skin cancer, even though we use the word cancer to describe them both.

“Independent of its many causes, acute life-threatening illness is just the start of a process,” says Dr. John Marshall, a critical care surgeon at St. Michael’s Hospital, a site of Unity Health Toronto, and scientist at the Keenan Research Centre for Biomedical Science. “Many things happen that can change its course. These are less a result of the initial disease, than of its treatment and the way a person responds to it. Those all become part of a process, which can be modified.” With a team of experts in critical care, including Dr. David Maslove, a clinician-scientist at Queen’s University in Canada; Dr. Benjamin Tang, a physician and scientist at the University of Sydney in Australia; Dr. Manu Shankar-Hari, a clinician-scientist at the University of Edinburgh in the United Kingdom; and Dr. Patrick Lawler, a cardiologist and intensivist at University Health Network in Canada, Dr. Marshall co-authored a perspective piece on this topic that was published in Nature Medicine. We spoke with Dr. Marshall to learn more about why now’s the time to redefine critical care and what led to this call to action.

Scientists want a new definition for critical care medicine

HOW DO CURRENTLYWE DEFINE DISEASES IN CRITICAL CARE AND WHERE DID THAT APPROACH COME FROM?

ByIAna Gajic Here’s causeshapedCOVID-19howtheir

Continued from page 27 Continued on page 30

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Studies of breast cancer showed that some breast cancers are responsive to estrogen and others responded to a protein called vascular endothelial growth factor. Patients who had those responsive cancers could be identified and so it was possible to target the particular biological pathway and improve their outcomes. This was one of the first examples of what we’ve come to call “precision medicine.”

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Continued from page 29 definitionNew Photo credit: Yuri Markarov

We’ve brought together many people who’ve been doing studies and coming up with models to differentiate more homogeneous subpopulations within a larger population of ICU patients. The long-term aspirational goal is to meld this group into a global collaboration to share data and study this at the large scale needed to address the inherent complexity. Complexity in critical illness is going to be much more difficult than complexity in cancer because it includes how we treat patients, as well as economic factors, such as the capacity of our health care system to support patients and train physicians. It’s easy to be aspirational and to say this is what we need to do but what’s important is that we actually do it. One of the strategic decisions we made was that the people who realize this aspiration are those who are younger and have academic timelines that are measured in many decades. This is going to be a many-decade process. But we’re hopeful that we’ve taken the first step. CARE Ana Gajic is the senior communications advisor at Unity Health Toronto COVID-19 BECAME THE PROVING GROUND FOR THE HYPOTHESIS THAT RESOLVING HETEROGENEITY CAN AID IN FINDING EFFECTIVE TREATMENT.

In critical illness, we’ve conducted more than 100 clinical trials studying treatments that target biological processes that we know are involved in critical illnesses; none of these have led to effective treatments. Our perspective is that the inherent biologic heterogeneity of those patients – or differences between patients – means that we’re not targeting the right patient with the right drug. Our goal is to change this. HOW CAN WE LEARN FROM COVID-19 IN THIS AREA? COVID-19 became the proving ground for the hypothesis that resolving heterogeneity can aid in finding effective treatment. COVID-19 is a disease caused by a single virus but one that that has variable effects on those infected. We still have that problem of variability – not everybody responds the same way to treatments – but the fact that we’re looking at a single cause is making it easier to understand that variability. For example, we’ve been able to identify inherited genetic factors that make a patient more susceptible to severe disease. Knowing what these are suggests that there are ways of identifying those patients in whom they’re present, and targeting the abnormality specifically. We also learned through COVID-19 that we can work together and put aside competition to respond to a common threat. We’ve learned that it doesn’t cost anything to do that: progress is made much more quickly and everyone benefits, especially patients. WHAT DO WE NEED TO DO NOW AND WHAT ARE THE NEXT STEPS?

They proposed that we stage cancers based on the cell type and based on how advanced they are. In doing so, they paved the way for effective chemotherapy, and more recently, effective immune therapy.

TELEPHARMACY

SAFE TELEPHARMACYPRACTICESMEDICATIONIN

CAREPATIENTSSOLUTIONAHASTELEPHARMACYBECOMEPREVALENTFORTOSEEK

MEDICATIONTELEPHONE

REVIEWS

SafeL medication practices BytelepharmacyinAutumnChen,AnnieYao,andCertinaHo

Telephone counseling is not a new concept. Hospital pharmacies, specialty pharmacies, and community pharmacies have been offering telephone counseling services prior to the pandemic. During the pandemic, patients who previously preferred in-person medication consultation with their pharmacists were directed to telecommunication. This change has increased the demand of telepharmacy services. It is anticipated that the practice of telepharmacy will remain popular going forward.

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RETURN TO LISA’S CASE

Telepharmacy services in Canada were covered in a previous Hospital News article, where telepharmacy was referred (by the Canadian Society of Hospital Pharmacists (CSHP)) to as “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.” Readers can learn more about the Telepharmacy Guidelines published by the CSHP in 2018 at In the United States, there are other similar definitions of telepharmacy. During the COVID-19 pandemic, various new health services have emerged or moved from in-person to virtual activities. Telepharmacy has become a prevalent solution for patients to seek care. While pharmacies have remained physically open throughout the pandemic, some professional services have adapted the use of information and communication technology, such as, clinical verification of medication orders, telephone medication reviews, and telephone counseling, etc. In this article, we will focus on the latter two telepharmacy services, through which Lisa’s medication needs could be addressed. Further information regarding pharmacy services that have been implemented or expanded since the pandemic can be found at a resource prepared by the Canadian Pharmacists Association.

GOING FORWARD

Comprehensive medication reviews are one-on-one interviews between a pharmacist and the patient to identify and resolve any medication related issues. They are used to support patient education, safe medication practices, and promote interdisciplinary collaboration with other healthcare providers in the patient’s circle of care. In most provinces, medication review programs are publicly funded and available to eligible patients under the provincial drug plan. During the pandemic, provincial governments have allowed (in-person) medication reviews to be conducted via telephone or virtual appointments if they are deemed medically necessary, for instance, when patient has significant medication changes post-hospital discharge; when patient has a history of non-adherence or challenges with medication use; or when a medication review is requested by the patient’s primary care provider, etc.

COUNSELINGTELEPHONE

Telepharmacy services can improve healthcare access, particularly, in rural communities, and to patients who may be homebound due to complex medical conditions or mobility challenges. While information and communication technology improve accessibility, convenience, and accommodate patient preferences during the pandemic, it is important to be aware of some of the limitations. For example, telephone medication reviews and telephone counseling will rely on an effective two-way verbal communication between the pharmacist and the patient. Communicating medication names or strengths, discussing medications that are packaged in blister packs or multi-medication compliance aids, or demonstrating proper administration techniques for inhalers and injections over the phone can be challenging. Without face-to-face dialogues or interactions, there may be reduced level of trust and rapport, as well as possible concerns pertaining to confidentiality and/or privacy.

Lisa would greatly benefit from telepharmacy services, that is, telephone comprehensive medication review and telephone counseling with her community pharmacist. Being newly discharged from the hospital, changes to her medication regimen would require special attention. Telepharmacy will be helpful to identify and resolve potential drug-related problems that she may have during transitions of care. Patients can (or should) always actively participate in their own healthcare needs and management. For example, Lisa can engage in the telephone conversation with her pharmacist by using the “5 Questions to Ask About Your Medications” tool, a resource that supports patients to communicate their medication needs with their healthcare providers at medical appointments or follow-up clinic visits, and their telephone (or in-person) interactions with their community pharmacists, etc.

SEPTEMBER 2022 HOSPITAL NEWS 31www.hospitalnews.com SAFE MEDICATION isa returned home after a five-day hospital stay for her heart attack. She started on five new oral medications which she has not taken before. Since Lisa struggles to walk far with her chest pain, she wonders how her local pharmacy could help her (1) obtain the new medications, (2) understand the potential side effects, and (3) review and update her list of medications.

Autumn Chen is a PharmD Student at the Leslie Dan Faculty of Pharmacy, University of Toronto; Annie Yao is a combined PharmD/MBA Student at the Leslie Dan Faculty of Pharmacy and the Rotman School of Management, University of Toronto; and Certina Ho is an Assistant Professor at the Department of Psychiatry and Leslie Dan Faculty of Pharmacy, University of Toronto.

To further aid in accessibility and convenience for patients, pharmacies have information management systems that integrate electronic prescription processing and delivery services. Rather than providing a paper prescription to the patient or faxing the prescription to the pharmacy, a prescriber can utilize e-prescribing services. This is another safe medication practice where transcribing errors can be reduced, and clinical verification of the prescription by the pharmacist can be streamlined, while saving the patient a trip to drop off the prescription at the pharmacy. E-prescribing programs will also enable pharmacists to directly communicate with prescribers to advance safe and effective medication therapy management for patients.

CELEBRATING 25 YEARS 1997 2022

Hospital News September 2022 Edition

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