Hospital News 2018 August Edition by Hospital News

Inside: From the CEO’s Desk | Evidence Matters | Safe Medication | Careers

August 2018 Edition

www.hospitalnews.com

FEATURED

Dream team unites

Stella and Thor Page 23

BENEFITS THAT WORK FULL-TIME FOR THOSE WHO DON’T

Long-Term Care

COVERAGE IS GUARANTEED

( ILULÄ [ WSHU MVY WHY[ [PTL JHZ\HS HUK JVU[YHJ[ OVZWP[HS LTWSV`LLZ HUK OVZWP[HS YL[PYLLZ

1.866.768.1477 | www.healthcareproviders.ca

NEWS

New app connects patients with their care team By Maria Hayes hen Sandy Lubert first met Claudia Leduc, a registered nurse in St. Joseph’s Healthcare Hamilton’s Mood Disorders Outpatient Clinic, it was because her psychiatrist knew she needed to connect with someone special. After being diagnosed with post-traumatic stress disorder (PTSD) and receiving care as an inpatient at St. Joe’s West 5th Campus, Sandy began to see Claudia at the clinic for counselling. “Claudia isn’t just my nurse, she’s a lifesaver,” says Sandy, a former teacher and mother of three amazing sons. “She has given me so many tools throughout my journey as a patient. The more tools you have on the road to recovery the better.” Claudia is now sharing a new tool with Sandy that she and her loved ones can use to help manage her care and monitor her health. Beginning June 28th, Sandy Lubert was one of 10 patients who first had access to MyDovetale from two participating clinics at St. Joe’s, which are the Mood Disorders Outpatient Clinic and the Kidney Transplant Clinic. MyDovetale is St. Joseph’s Healthcare Hamilton’s secure online portal where patients and their loved ones can view their health information, coordinate appointments, see test results, fill out questionnaires and message with their care team. Enrolled patients can access MyDovetale from any computer or digital device using the Apple or Android mobile application. Claudia was there when care teams on units and many clinics put down their pens to launch Dovetale, a bespoke digital health information solution that St. Joe’s developed in 2017 with Epic. MyDovetale is the patient’s window into the same solution. Claudia is excited for patients like Sandy to see the benefits of taking their therapeutic relationship online.

Claudia Leduc, RN in St. Joseph’s Healthcare Hamilton’s Mood Disorders Outpatient Clinic (right) with Sandy Lubert (left), one of 10 patients who first had access to MyDovetale beginning in June 2018. “MyDovetale is about bringing the care team closer to the patient’s story. I truly believe this is the missing link that will make compassionate care in the digital age a reality,” says Claudia, a registered nurse with in St. Joseph’s Healthcare Hamilton’s Mental Health and Addiction Service for over 18 years. “Connecting using MyDovetale will make Sandy a bigger part of her own care team.” Sandy and Claudia are looking forward to messaging one another on MyDovetale, so that Sandy can get timely answers to her health questions. That may mean less phone tag or extra appointments. Claudia is looking forward to assessing responses to questionnaires that Sandy can fill out from anywhere about her mood that day.

That may leave more time in their next appointment to focus on strategizing care tactics together. Sandy will also have timely access to test results that can help indicate if her medication is working as it should. Sandy is looking forward to how providing her partner access to MyDovetale will better include her in Sandy’s circle of care. “My partner works in tech, so she is very savvy. Access to MyDovetale will give her a bigger picture of what is going on in my care,” she says. “Also, when I’m really focused on my recovery, it can be difficult to keep track of all of my appointments and medications. If she can view all of this information too, it will be like two brains taking on what can feel like a burden. It will be a relief.”

More than anything, Sandy is grateful for her care team and St. Joe’s innovative approach to care. “I’ve met so many skilled clinicians here, it really takes a village to provide the best treatment,” she says. “I use apps and text my children all the time. It makes so much sense to have patients, family and loved ones engage in care this way.” “At St. Joe’s, we set out to develop a holistic and patient-centred digital solution. MyDovetale is a great example of providing that to those we are privileged to serve,” remarks Tara Coxon, Chief Information Officer, St. Joseph’s Healthcare Hamilton. “Now we’re looking forward to finding new and innovative ways to connect big data with better care for the people in H our region.” ■

Maria Hayes is a senior tublic Affairs Specialist at St. Joseph’s Healthcare Hamilton. 2 HOSPITAL NEWS AUGUST 2018

www.hospitalnews.com

Contents August 2018 Edition

IN THIS ISSUE:

New tool tackles major barrier to health innovation adoption in Ontario

▲ Cover story: Lightning strikes twice – SickKids dream team and an unexpected companion

▲ Bridging generations to enhance quality of life at Runnymede

▲ Program that improves health care experience for children with ASD looking to expand

COLUMNS Editor’s Note ....................4

In brief .............................6 Safe medication ............10 Evidence matters ...........14 From the CEO’s desk .....25 Careers ..........................31

▲ Creating a portable tracheotomy kit

Searching for better glioblastoma treatment options and outcomes

▲ Preventing childhood asthma

Our health system

fails the elderly By David Wiercigroch and Caberry Weiyang Yu ospital overcrowding is not a new issue. Limited bed spaces have plagued Ontario hospitals for years and are increasingly straining our system. Not only are long wait times a shameful expectation when patients arrive in the emergency department, providing care in a busy hospital hallway has become an ordinary occurrence. The problem has become so significant that the Ontario government added 1,200 hospital beds last fall in response, a move costing $100 million and requiring the re-opening of two shuttered Toronto hospitals. This major investment underscores an even bigger problem. The two reopened hospital sites are dedicated exclusively to providing space for alternative level of care (ALC) patients. These are patients who remain in a hospital or other acute care setting beyond their need for the intensity of services provided there. Due to barriers to their placement in the most appropriate care environment, they occupy beds that cannot be used for those waiting for acute care. The ALC problem is a significant one in many parts of Ontario. In fact, around one in seven hospital beds in Ontario are dedicated to ALC patients. Many ALC patients share common characteristics: they are elderly with a median age of 80 and often live alone. These patients are incapable of returning home after receiving care at the hospital due to their complex

needs, and they deteriorate while waiting in hospital for placement in a more appropriate setting, most often a long-term care home. The median waiting time for ALC patients is 10 days. ALC patients are a glaring reflection of our health system’s inability to address the needs of elderly patients with complex health challenges. At a time when the senior population is growing rapidly, the problem will only become more severe. The truth is, our current approach is not working and it’s bad medicine. Not only are high ALC rates costly, patients are constrained to stay in a setting that limits their mobility, accelerates their deterioration and makes them more susceptible to infections. Attempts to tackle ALC rates have proven successful in some jurisdictions, but most approaches focus on small scale efficiencies and local factors which have not succeeded in reducing the overall ALC burden. Today, the provincial ALC rate remains troubling. Alongside the addition of new hospital beds last fall, the Ontario government allocated an additional $40 million dedicated to providing specialized transitional care and supportive housing for seniors in long-term care and in the community. Continued on page 12

610 Applewood Crescent, Suite 401 Vaughan Ontario L4K 0E3 TEL. 905.532.2600|FAX 1.888.546.6189

www.hospitalnews.com

Editor

Kristie Jones

editor@hospitalnews.com Advertising Representatives

Denise Hodgson

denise@hospitalnews.com Publisher

Stefan Dreesen

stefan@hospitalnews.com Accounting Inquiries

accountingteam@mediaclassified.ca Circulation Inquiries

info@hospitalnews.com

ADVISORY BOARD Cindy Woods,

Senior Communications Officer The Scarborough Hospital,

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

ASSOCIATE PARTNERS:

UPCOMING DEADLINES SEPTEMBER 2018 ISSUE

OCTOBER 2018 ISSUE

EDITORIAL: August 10 ADVERTISING: Display – August 24 | Careers – August 28

EDITORIAL: September 14 ADVERTISING: Display – September 21 | Careers – September 25

Monthly Focus: Emergency Services/Critical Care/Trauma/Infection Control: Innovations in emergency and trauma delivery systems. Emergency preparedness issues facing hospitals and how they are addressing them. Advances in critical care medicine. Programs implemented to reduce hospital acquired infections. Developments in the prevention and treatment of drug-resistant bacteria and control of infectious diseases.

Monthly Focus: Patient Safety/ Mental Health and Addiction/ Research: Developments in patient-safety practices. Advances in the measurements of patient outcomes and program metrics. New treatment approaches to mental health and addiction. An overview of current research initiatives.

+ Online Education THANKS TO OUR ADVERTISERS Hospital News is provided at no cost in hospitals. When you visit our advertisers, please mention you saw their ads in Hospital News. 4 HOSPITAL NEWS AUGUST 2018

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 publishers. Hospital 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. Changes of address, notices, subscriptions orders and undeliverable address notifications. Subscription rate in Canada for single copies is $29.40 per year. Send enquiries to: subscriptions@ hospitalnews.com Canadian Publications mail sales product agreement number 42578518.

www.hospitalnews.com

Historic changes

at the Canadian Nurses Association By Mike Villeneuve

anadian Nurses Association (CNA) members reached a landmark decision on June 18, 2018, at their annual general meeting in Ottawa when they voted overwhelmingly to open membership to all regulated nurses in Canada. Since its founding in 1908, CNA has been the national professional home and voice of registered nurses (RNs) and more recently, nurse practitioners (NPs), who are all RNs. Currently, CNA represents some 139,000 RNs and NPs across all 13 Canadian provinces and territories, including nurses living in hundreds of Indigenous communities. The June 18 vote opened the door to welcome licensed and registered practical nurses (LPNs/RPNs) as well as registered psychiatric nurses (RPNs) – courageously setting the stage for a new future for CNA and professional nursing in Canada. Nurses are being called on to optimize their scopes of practice. They’re expected to deliver new kinds of care in new delivery models that respond to the need for managing chronic diseases, supporting Canada’s aging population, and dealing respectfully with palliative and end-of-life care. As an association, CNA represents nurses in the face of ongoing regulatory and legislative changes across the country. The vote was a game-changing decision for nursing and, ultimately, for the people of Canada. It answers the call for real collaboration within and among nursing categories as the profession is confronted with this complex menu of challenges. Employers, governments and the public can be confused by the number of nursing categories. What do the titles mean? Who can do what care safely? The public needs nurses to explain their practice and the value different categories of nurses bring to different care settings. And they expect nurses to speak forcefully and with unity in their public advocacy work for better health, better care, and better value for Canadian tax

www.hospitalnews.com

dollars. With their vote, members chose to increase CNA’s national leadership and political force to speak on behalf of the whole family of nursing. The vote means that any of the more than 400,000 nursing professionals in Canada will be able to join CNA. Like RNs and NPs, practical nurses are employed in all Canadian jurisdictions. These professionals are regulated as LPNs everywhere except Ontario, where they are titled as RPNs. They are educated at the community college level and have similar scopes of practice as RNs, but typically deliver care that is more predictable, less complex and less urgent than would be provided by an RN. Registered psychiatric nurses are regulated only in British Columbia, Alberta, Saskatchewan, Manitoba and Yukon. They are educated in a mix of college and university programs and deliver a broad scope of practice not unlike RNs but with deeper training in mental health, as implied in the title. CNA now must review its governance and membership models to evaluate the structures that need to be put in place to reflect the unique and collective needs of these different regulated nursing groups. There is a lot at stake here. The CNA board and operational team must move for-

ward prudently, consulting with all the categories of nurses about their needs and the best ways to support each of them. Careful and ongoing planning is required if the association is to tailor specific programs and services for each category while marshalling the power of unity when a strong collective political voice is needed. CNA must continue to translate evidence into

practical solutions and provide sound advice to governments, employers and Canadians, particularly on ways to deploy the right number and mix of nurses – and in what circumstances a specific category of nurse is warranted. In a 2010 commentary, Steven Lewis famously says, “Nursing’s combination of numbers, reputation and reach should translate into power and influence over how health care is financed, organized and delivered. Yet politically, the profession punches below its weight. The country is the worse for it.” He was right. CNA and the nurses of Canada have responded. To achieve the triple aim of better health, better care and better value, Canadians must have access to the right provider delivering the right care in the right place and at the right time. By working together more strategically as an inclusive, united, national professional association, a new CNA holds the promise to deliver a more powerful advocacy punch as we work together to deliver on those forH midable goals. ■

Mike Villeneuve is the Chief Executive Officer, Canadian Nurses Association.

EMERGENCY LOANS FOR HOMEOWNERS! WE REPRESENT OVER 400 LENDERS Manny provides 1st, 2nd and 3rd mortgages even with: • Horrible Credit • Bankruptcy • Unemployed • Power of Sale • Mortgage Arrears • Property Tax Arrears • Self-Employed • Pension & Disability

Does your bank offer payments THIS LOW? Mortgage Amount

Monthly Payment

Bi-Weekly Payment

$200,000 $220,000 $240,000 $260,000 $280,000 $300,000 $320,000 $340,000 $360,000 $380,000

$825.33 $907.86 $990.39 $1,072.92 $1,155.46 $1,237.99 $1,320.52 $1,403.05 $1,485.59 $1,568.12

$380.68 $418.75 $456.81 $494.88 $532.95 $571.02 $609.08 $647.15 $685.22 $723.29

$400,000

$1,650.65

$761.36

Licence # 12079 Mortgage Agent Manny Johar

Rates from

2.26%!

Amortization up to

30 Years!

As of January 2018, OAC – Based on 5 Year term & 30 Years Amortization

“My husband lost his job. We fell behind on our mortgage. The bank was seizing our home. I still can’t believe that you gave us an emergency mortgage with no proof of income. You saved our home & gave us extra cash to get by until he finds another job. Thanks Expert Mortgage!” C.S.

Call Manny 7 DAYS A WEEK

1.888.646.7596 or www.MannyJohar.ca Ask him about COMMERCIAL – FARM – CONSTRUCTION loans!

Manny Johar is Ontario’s mortgage SUPERSTAR! AUGUST 2018 HOSPITAL NEWS 5

IN BRIEF

Repeat hip and knee replacements cost $130 million annually W

hile the demand for hip and knee replacement surgeries continues to grow, repeat surgeries are an area that can benefit from improvements in short- and long-term revision rates. These surgeries happen when the joint needs to be fixed or replaced after the primary, or original, joint replacement procedure. New data released by the Canadian Institute for

A national snapshot

THE NEED FOR A REPEAT SURGERY – PARTICULARLY SHORTLY AFTER THE FIRST ONE – IS AN ESPECIALLY NEGATIVE OUTCOME FOR THE PATIENT’S QUALITY OF LIFE, AND IT COSTS THE HEALTH CARE SYSTEM A LOT OF MONEY.

Health Information (CIHI) reveals that these revisions cost almost $130

Hip and knee replacement surgeries • Between 2012 and 2016, the number of hip replacement surgeries performed each year increased 18 per cent, from 47,500 to almost 56,000. • The median length of stay (LOS) for hip replacements was threedays. • Between 2012 and 2016, the number of knee replacement surgeries performed each year increased almost 16 per cent, from 58,000 to 67,000. • The median LOS for knee replacements was three days.

million in inpatient health spending every year, at an average of more than $13,700 per surgery. This is more than 56 per cent higher than the cost of a primary joint replacement. In 2016, 9,400 hip and knee replacement revisions were performed in Canada, which represents eight per cent of all hip and knee replacement surgeries. The proportion of hip revisions being done decreased by 16 per cent from 2012 to 2016, while the proportion of knee revisions remained the same.

“For patients with debilitating pain due to osteoarthritis, joint replacements can improve their lives substantially. The need for a repeat surgery – particularly shortly after the first one – is an especially negative outcome for the patient’s quality of life, and it costs the health care system a lot of money. That’s why it’s important to look for opportunities to continue to reduce these additional surgeries,” says Nicole de Guia, Manager, Joint Replacement Registry, at CIHI. Hip and Knee Replacements in Canada, 2016–2017: Canadian Joint Replacement Registry Annual Report identifies key statistics related to hip and knee replacement surgeries performed in Canada, as well as different rates of early revision for hip and knee replacements based on sex, age, the type of procedure and other surgical H factors. ■

Protecting public health care. Protecting health care workers. Let us protect you.

6 HOSPITAL NEWS AUGUST 2018

organizing@opseu.org

joinopseu.org

www.hospitalnews.com

IN BRIEF

Can a calculator predict your risk of heart attack and stroke? anadian researchers have built and validated an online calculator that empowers individuals to predict their risk of cardiovascular disease. Their process was published recently in CMAJ, and the calculator is available at projectbiglife.com. Cardiovascular disease, a group of conditions that include heart attack and stroke, is the number one killer in Canada. While risk calculators already exist, they usually focus on factors that require medical tests, like blood pressure and cholesterol levels. “What sets this cardiovascular risk calculator apart is that it looks at healthy living, and it is better calibrated to the Canadian population,” says Dr. Doug Manuel, lead author on the paper and a senior scientist at The Ottawa Hospital, professor at the University of Ottawa, and a senior core scientist at the Institute for Clinical Evaluative Sciences (ICES). Based on survey data from over 100,000 Canadians, the calculator lets individuals accurately predict their risk of hospitalization or death due to cardiovascular disease within the next five years. For example, if their risk is five per cent, it means that five in 100 people like them will experience a serious cardiovascular event in the next five years. The calculator also provides heart age, an easy-to-understand measure of how healthy the heart is. Factors in the Cardiovascular Disease Population Risk Tool (CVDPoRT) calculator include: • Age • Smoking status and lifetime exposure • Alcohol consumption • Diet • Physical activity • Stress • Sense of belonging • Ethnicity • Immigration status • Education • Socioeconomic status of the neighbourhood • Diabetes • High blood pressure

www.hospitalnews.com

“WHAT SETS THIS CARDIOVASCULAR RISK CALCULATOR APART IS THAT IT LOOKS AT HEALTHY LIVING, AND IT IS BETTER CALIBRATED TO THE CANADIAN POPULATION.” “A lot of people are interested in healthy living, but often we don’t have that discussion in the doctor’s office,” says Dr. Manuel. “Doctors will check your blood pressure and cholesterol levels, but they don’t necessarily ask about lifestyle factors that could put you at risk of a heart attack and stroke. We hope this tool can help people – and their care team – with better in-

formation about healthy living and options for reducing their risk of heart attack and stroke.” The calculator can also be used by policy makers to better understand population health risks and help plan for the future. “In cardiovascular disease, an ounce of prevention is worth a pound of cure,” says Dr. Manuel. “Deci-

sion-makers need to understand the underlying causes of these conditions, like access to nutritional food, and being able to walk or bike in a community.” CVDPoRT will be added to a list of existing calculators on Project Big Life that help Canadians estimate their own life expectancy based on habits and lifestyle choices. The calculator was based on data from the Statistics Canada Canadian Community Health Surveys and housed at ICES. Currently calibrated for use in Canada, it can be adapted for any of the 100 countries around the world that collect health survey H data. ■

Record number of children vaccinated in 2017 record 123 million children were immunized globally in 2017, according to data released by the World Health Organization and UNICEF. The data shows that: • Nine out of every 10 children received at least one dose of diphtheria-tetanus-pertussis (DTP) vaccine in 2017, gaining protection against these deadly diseases. • An additional 4.6 million infants were vaccinated globally in 2017 compared to 2010, due to global population growth. • 167 countries included a second dose of measles vaccine as part of their routine vaccination schedule and 162 countries now use rubella vaccines. As a result, global coverage against measles and rubella increased from 35 per cent in 2010 to 52 per cent. • The human papillomavirus (HPV) vaccine was introduced in 79 countries to help protect women against cervical cancer. • Newly available vaccines are being added as part of the life-saving vac-

DESPITE THESE SUCCESSES, ALMOST 20 MILLION CHILDREN DID NOT RECEIVE THE BENEFITS OF FULL IMMUNIZATION IN 2017.

cination package – such as those to protect against meningitis, malaria and even Ebola. Despite these successes, almost 20 million children did not receive the benefits of full immunization in 2017. Of these, almost 8 million (40 per cent) live in fragile or humanitarian settings, including countries affected by conflict. In addition, a growing share are from middle-income countries, where inequity and marginalization, particularly among the urban poor, prevent many from getting immunized. As populations grow, more countries need to increase their investments in immunization programmes. To reach all children with much-needed vaccines, the world will

need to vaccinate an estimated 20 million additional children every year with three doses of the diphtheria-tetanus-pertussis vaccine (DTP3); 45 million with a second dose of measles vaccine; and 76 million children with 3 doses of pneumococcal conjugate vaccine. In support of these efforts, WHO and UNICEF are working to expand access to immunization by: • Strengthening the quality, availability and use of vaccine coverage data. • Better targeting resources. • Planning actions at sub-national levels and • Ensuring that vulnerable people H can access vaccination services. ■ AUGUST 2018 HOSPITAL NEWS 7

NEWS

Bridging generations

to enhance quality of life at Runnymede By Michael Oreskovich epression and feelings of isolation are common among seniors with dementia, but meaningful social interactions can make a big difference. By bringing together patients and enthusiastic kindergarten students, Runnymede Healthcare Centre provides seniors under its care with an opportunity to connect with young children. The benefits are undeniable – quality of life for patients has been transformed, earning Runnymede recognition among peers. This further cements the hospital’s reputation for prioritizing patient-centred care as it looks ahead to expanding its role as a Community Healthcare Hub with long-term care services. The intergenerational program brings kindergarteners in from nearby Swansea Public School to participate in shared activities and projects with Runnymede’s senior citizen patients. Held on site at the hospital once per month throughout the school year, program activities are designed to encourage as much interaction as possible between the generations and include games, crafts and group fitness. The excitement the students bring when they visit Runnymede is palpable and has an extremely positive impact on the patient experience, boosting patients’ engagement when they interact. Since the same students participate over the course of an entire school year, strong bonds often form over time, providing the seniors with a unique opportunity to share their knowledge and experience with a younger age group. “The children really enjoy being able to visit and help some of our patients with activities, and our patients love the energy the children bring to the program,” says Sarah King, Runnymede’s manager of activation and volunteer services. “The kids are great

Runnymede’s intergenerational program creates a unique environment where kindergarten students and senior citizen patients can interact and enrich each other’s lives.

THE INTERGENERATIONAL PROGRAM BRINGS KINDERGARTENERS IN TO PARTICIPATE IN SHARED ACTIVITIES AND PROJECTS WITH RUNNYMEDE’S SENIOR CITIZEN PATIENTS. because they’re so accepting of everyone just the way they are – we definitely see that our patients let their guard down with the children, and their personalities open right up.” Through surveys and direct observation, the hospital staff continue to ensure the intergenerational program is targeted to the patients’ needs and interests. Overall satisfaction among participating patients remains high

and includes positive changes in their overall mood. Hospital staff also noted that patients had a higher level of involvement and engagement in other hospital activities once they participated in the program, and became more socially engaged with peers and staff overall. These impressive outcomes led to the intergenerational program receiving recognition at a May 2018 best practices conference for rehab

organizations in the Greater Toronto Area. It’s not just the patients who benefit. The program provides children with an opportunity to develop a greater appreciation for senior citizens and helps them become comfortable around people with different types of disabilities. According to Rebecca Forte, teacher at Swansea Public School, the kids are learning important lessons about empathy. “They understand that patients may not always be able to communicate in familiar ways, but they are still involved and understand what is happening,” she says. “Many kids today don’t live close to grandparents like kids of earlier generations; having a chance to interact with older people in the community is so valuable for them.” As a result of the hospital’s drive to constantly improve, the program was recently expanded to enhance the benefit that patients receive. Recently, the hospital took the ambitious step of broadening the program to a full week. The kindergarten curriculum was integrated into the goals and objectives of selected activation programs, and patients and students shared lunch together every day. The intergenerational program’s expansion was a resounding success, and is part of an ongoing trend at Runnymede, where continuous quality improvement and delivering an outstanding patient experience are top priorities. “Fostering socialization and promoting our patients’ mental and emotional health is crucial to our patients achieving overall health and wellness, and the intergenerational program does just that and we’re very proud of it,” says King. “The evidence shows we’re achieving our intended results and we plan to develop the program further so it can continue to be a rich and rewarding experience for H everyone involved.” ■

Michael Oreskovich is a Communications Specialist at Runnymede Healthcare Centre. 8 HOSPITAL NEWS AUGUST 2018

www.hospitalnews.com

UPCOMING PROGRAM DATES

March 8 - June 8, 2019 14 days over 3 months

Masters CertiďŹ cate in Healthcare Management Embrace health sector challenges to deliver better care and lead people more eďŹ&#x20AC;ectively.

The Masters CertiďŹ cate in Healthcare Management â&#x20AC;&#x201C; the ďŹ rst comprehensive certiďŹ cate program of its kind in Canada â&#x20AC;&#x201C; addresses the unique leadership issues facing healthcare professionals, providing tools, techniques, and best practices to eďŹ&#x20AC;ectively lead in the complex world of Ontarioâ&#x20AC;&#x2122;s healthcare sector.

Key Program Takeaways

Our program faculty includes leaders in healthcare, business, and academia who will share their insight and knowledge with participants in an integrated and experiential learning environment.

Ă¤ /HDUQ WR XQGHUVWDQG DQG UHVSRQG WR ZRUNSODFH issues diďŹ&#x20AC;erently to improve results. Ă¤ &RPELQH FRUH EXVLQHVV FRPSHWHQFLHV ZLWK healthcare industry leadership skills and knowledge. Ă¤ $SSO\ EHVW SUDFWLFHV IURP RWKHU LQGXVWULHV WR promote a culture of accountability, innovation and collaboration. Ă¤ *DLQ XVHIXO WRROV WHFKQLTXHV DQG FKHFNOLVWV WR take back and apply immediately to facilitate your work and share with peers. Ă¤ (QKDQFH FDSDELOLWLHV WR OHDG DQG PDQDJH LQ D IDVW changing, multi-disciplinary environment. Ă¤ 'HYHORS VWUDWHJLHV WR PDQDJH FRPSOH[LW\ DQG promote organizational success. Ă¤ %XLOG \RXU SURIHVVLRQDO KHDOWKFDUH QHWZRUN

Flexible Format! Ă¤ $FKLHYH \RXU 0DVWHUV &HUWLÄ&#x2022;FDWH LQ DV OLWWOH DV GD\V over three months, or complete all individual modules at your own pace within three years. Ă¤ Flexible Format Option: Any of the individual 2-day modules may also be taken as a stand alone program.

Through this program, todayâ&#x20AC;&#x2122;s healthcare professionals will have an opportunity to examine innovative business models that can be applied to healthcare and acquire new knowledge and skills to enhance their capability to lead in a complex and ever-changing system.

Overview of Program Content Advanced Leadership in the Healthcare Sector Ă¤ The Role of the Healthcare Leader Ă¤ System Integration in Healthcare â&#x20AC;&#x201C; The Ontario Experience Ă¤ Excelling with Emotional Intelligence Critical Thinking and Project Management Ă¤ Thinking Skills for a Turbulent World: The Art of Framing and Reframing Ă¤ Practical Project Management Communication and Problem Solving Ă¤ Successful Communication Ă¤ Resolving ConďŹ&#x201A;icts â&#x20AC;&#x201C; Your Own and Othersâ&#x20AC;&#x2122; Leading Change & Innovation Ă¤ Leading Change in Healthcare Ă¤ Innovative and Creative Thinking

Collaboration and Lean Process Design Ă¤ Collaboration in Cross Functional Teams Ă¤ Lean â&#x20AC;&#x201C; A Prescription for Healthcare IT Integration and Appreciative Leadership Ă¤ Information Technology in Healthcare Ă¤ The Power of Appreciative Leadership Finance, Strategy and Courageous Leadership Ă¤ Financing and Implementing Your Strategy Ă¤ Courageous Leadership: Your Personal Call to Lead from the Edge Ă¤ Learnings Consolidating / Program Closure

Request Brochure for Complete Details http://seec.online/12013a

www.hospitalnews.com

7HO _ _ HPDLO H[HFHGLQIR#VFKXOLFK \RUNX FD

AUGUST 2018 HOSPITAL NEWS 9

SAFE MEDICATION

Defusing an angry or upset patient By Lindsay Yoo and Certina Ho ealthcare providers, including physicians, nurses, pharmacists, and other allied healthcare professionals, encounter many different scenarios during a typical shift; this often involves the challenge of navigating unexpected situations, for instance, defusing an angry or frustrated patient. Handling a difficult situation that involves an angry or upset patient is a reality that most, if not all, healthcare providers will face or have faced at least once in their career. How individuals respond and resolve the issue is just as important as the issue itself, if not more so; the approach taken by the provider, and the way in which the situation is dealt with can make the difference between a satisfactory and resolved outcome versus the abrupt end of a compromised patient-provider relationship. Despite attempts to de-escalate a hostile situation, emotions sometimes threaten to take over. Being prepared with an approach in mind, or at least being aware of how to deal with such scenarios, can be helpful to mitigate tensions that are inherent in these types of situations.

WHERE TO SPEAK WITH THE ANGRY PATIENT?

If a patient is noticeably irate and is causing a disruption to the provision of services to other patients, try asking the patient to see if they would accompany you to a more private setting such as the counselling room or an office. Doing so may help further calm the patient down, as this shows a sincere interest in speaking with the patient and that he or she will receive your full attention. At the same time, however, be vigilant and judge the situation appropriately; never attempt to defuse an angry patient who could be dangerous (e.g. verbally or physically abusive) by yourself or place yourself in a situation where you would be alone with him/

her. Instead, ask a colleague to join the discussion. If you find that the patient is becoming progressively hostile or threatening as the discussion goes on, do not hesitate to contact security or the police when necessary. In anticipation of such a potential situation that may arise, it may be helpful for you and your staff to come up with a secret code or phrase that signals to other members of the team to call for help.

TAKE PROACTIVE STEPS TO PREVENT A RECURRENCE

Although not directly related to defusing an angry patient, taking steps

to prevent a similar occurrence in the future is an important consideration. If possible or if applicable, steps should be taken to address any underlying issues that may contribute to a patient’s anger. The below considerations can be included in staff training and orientation. A proactive approach can include taking measures such as meeting and discussing with staff to tackle the issue, making improvements to a process, or seeking clarification and documentation to prevent the same situation from happening again. As difficult and frustrating as this encounter may be to the provider and to

staff members, this is also a valuable learning opportunity to re-evaluate the system and make improvements to ensure that the service being provided to your patients is the best it can be. De-escalating an intense situation with a patient is not an easy task; however, with a calm and considered approach, it can be less daunting. Consulting with fellow colleagues and coworkers on what they would do in such a situation, or what they have done in the past, can be helpful to glean different perspectives and ideas to better handle these challenging enH counters. ■

KEY CONSIDERATIONS TO DEFUSE AN ANGRY OR UPSET PATIENT Key Considerations

DO’s

DON’T’s

1. Stop, focus, and use your best listening skills

Stop whatever you are in the middle of doing

Multi-task (e.g. listen and do something else at the same time)

Give the patient your full attention, and listen to him/her

Assume that you know all the facts about the situation without letting the patient finish his/her explanation, clarifying facts, and/or inquiring about certain points

Summarize or paraphrase what you have heard/ understood and ask questions to clarify

Interrupt the patient while he/she is speaking

Express through your facial expression (e.g. keeping eye conttact) and body posture (e.g. stand or sit up straight) that you are paying attention, receptive, and in control

Use any hostile or dismissive facial expressions or body language (e.g. clenching the jaw, frowning, smirking, rolling of the eyes)

2. Remain calm and commit to keeping your cool

Resist being drawn into the anger; detach from the situation and try to observe as a third-party person or bystander

Take the patient’s remarks personally

3. Sympathize and acknowledge the anger

Resist the temptation to rationalize with the patient at the very beginning. This should be attempted after the issue is resolved and the patient has calmed down

Respond to the patient’s anger with your anger

Sympathize with what the patient has told you, and how he/she feels

Fault the patient for the situation or be overly defensive

Address the patient by his/her name; use a soft, firm, and slow voice when speaking to the patient

Shout over the patient

Offer a sincere and straightforward apology for the problem they are having (or perceive to be having) and/or the emotions that they are experiencing

Infer that you accept blame for something for which you are not responsible or have no control over

4. Apologize

Show empathy for the patient – acknowledge the emotions 5. Look for a solution

Ask the patient what he/she believes should be done, or offer your own feasible resolution to the problem

Try to win or argue with an angry patient

Lindsay Yoo is a Pharmacist at LMC Diabetes & Endocrinology; Certina Ho is a Project Lead at the Institute for Safe Medication Practices Canada (ISMP Canada). 10 HOSPITAL NEWS AUGUST 2018

www.hospitalnews.com

NEWS

Sonographer regulation: A win-win for patients and practitioners

Hospitals and clinics will benefit from a standardized system that ensures they hire only legitimate and qualified Sonographers. Through the public record, on the regulatory college website, employers can search the candidate’s name and verify their registration status with the CMRTO and can even view any infractions issued against them by patients or employers and subsequent disciplinary actions such as fines, suspensions or license revocation.

By Greg Toffner n a move that will benefit both patients and practitioners, the Ontario government recently passed the “Strengthening Quality and Accountability for Patients Act” which includes Diagnostic Medical Sonographers (DMSs) becoming regulated under the Regulated Health Professions Act (RHPA) by the College of Medical Radiation Technologists of Ontario (CMRTO). This is a historic and meaningful step that will help grow the Sonography profession and increase the standard of care to patients in Ontario. Sonographers and their supporters have been trying to achieve regulation for over 20 years. In 2013, as the official voice and advocacy association for Sonographers, Ontario Association of Medical Radiation Sciences (OAMRS) submitted a comprehensive proposal for regulation of Sonographers to the Health Professions Regulatory Advisory Council (HPRAC). After years of lobbying and meetings with key stakeholders on behalf of Ontario Sonographers, it was announced that Sonographers would be regulated by the CMRTO beginning in 2018. Sonographers will now join the 28 other regulated health professions under the RHPA.

WHAT THIS MEANS FOR SONOGRAPHERS

The new regulation benefits both practicing and soon-to-be Sonographers as it raises the profile and credibility of the profession by requiring minimum entry to practice standards to practice. It legitimizes the educational qualifications and certification exam requirements for Sonographers and through this function, will also prevent unqualified practitioners from entering the system and establishes a disciplinary framework to manage professional misconduct. Up until now, there has been no recourse for removing incompetent practiwww.hospitalnews.com

WHAT THE FUTURE LOOKS LIKE

THE NEW REGULATORY FRAMEWORK WILL CREATE ACCOUNTABILITIES FOR SONOGRAPHERS AND BY VIRTUE, ALSO COMMAND AN INCREASED RESPECT FOR THE PROFESSION. tioners from practicing, however CMRTO will now be the official, legal regulatory authority that is backed by law. The new regulatory framework will create accountabilities for Sonographers and by virtue, also command an increased respect for the profession. The regulation also adds a Sonographer presence to the CMRTO council providing Sonographers with a voice that was previously unheard among policy and decision makers in the healthcare system.

or complaints if they feel they haven’t been treated effectively by their DMS.

All practicing and entering DMSs will be required to pass an accredited college or university program and a certification exam approved by the CMRTO to receive their protected title that will allow them to practice the profession in Ontario. The work of DMSs is integral to the strength of our health care system. The regulation of these highly trained medical professionals ensures patients across Ontario have access to safe and effective diagnostic services. For more information on SonograH pher regulation, visit OAMRS.org. ■

Greg Toffner is President & CEO, OAMRS.

EXTERNAL IMPACTS

Ultimately, this regulation is in the best interest of the public. When people go to a hospital or clinic they can now be assured they will be treated by a regulated health professional like they would when they see a doctor, nurse or surgeon. The regulatory body, in this case, the CMRTO provides an accountability mechanism for patients to voice concerns

Canada’s Leading Healthcare Architect 1 Valleybrook Drive Toronto, Canada M3B 2S7 Telephone: 416.467.8000 Fax: 416.467.8001 Email: info@parkin.ca

1737 West 3rd Avenue, Suite 220 Vancouver, Canada V6J 1K7 Telephone: 604.283.8054 Email: vancouver@parkin.ca

20 James Street, Suite 200 Ottawa, Canada K2P 0T6 Telephone: 613.739.7700 Fax: 613.739.7780 Email: ottawa@parkin.ca

AUGUST 2018 HOSPITAL NEWS 11

NEWS

New tool tackles major barrier to health innovation adoption in Ontario By Elise Johnson rocurement myths are well-known barriers to innovation adoption in Ontario. A new tool is available to help hospitals pull innovation into Ontario’s health care system faster, improving patient care and health system efficiency. The Art of the Possible: A Quick Reference Guide to Ontario Broader Public Sector Procurement Myths, created by the Council of Academic Hospitals of Ontario (CAHO), offers straightforward explanations and supporting resources to facilitate hospital procurement of new health technologies or innovations. In a 2016 survey across CAHO members, Ontario’s 23 academic research hospitals, 76 per cent of respondents identified policies, directives and procurement rules as major hurdles to innovation adoption within their organizations. Aiming to address this challenge, CAHO convened a small panel of experts to develop a quick reference guide with the goal of dispelling myths and identifying what’s really possible when it comes to procurement in Ontario. “Health care organizations are risk averse by nature, and this also permeates approaches to procurement,” says Sarah Friesen, President of Friesen Concepts and procurement expert on The Art of the Possible development panel. “By debunking some of the more prevalent myths, this guide will increase confidence in exploring innovation procurement opportunities that can improve patient outcomes and deliver value for money.” The Art of the Possible guide is part of CAHO’s ongoing efforts to remove barriers to business and promote innovation adoption within Ontario’s health care system through its work as an Innovation Broker with the Office of the Chief Health Innovation Strategist. CAHO has made significant contributions to Ontario’s innovation ecosystem during its first year as an Innovation Broker, including the following accomplishments:

12 HOSPITAL NEWS AUGUST 2018

“THIS GUIDE WILL INCREASE CONFIDENCE IN EXPLORING INNOVATION PROCUREMENT OPPORTUNITIES THAT CAN IMPROVE PATIENT OUTCOMES AND DELIVER VALUE FOR MONEY.” • Published a list of critical problems within CAHO hospitals that require innovative solutions • Established a streamlined intake process for testing innovative technologies that gives innovators simultaneous access to CAHO members • Made over 40 connections between innovators and CAHO hospitals to

pursue opportunities for validation testing of new technologies within clinical settings • Fostered a culture of innovation adoption within CAHO hospitals by providing tools and resources to address barriers, including The Art of the Possible guide “Our Innovation Broker work is

motivated by our commitment to provide patients with the best available care and to help build the health system of the future,” says Brian Mackie, co-chair of CAHO’s Innovation Broker Task Force and Vice President of Finance and Chief Financial Officer at Baycrest Health Sciences. “Ontario’s sickest and most complex patients depend on the specialized care that academic research hospitals provide and this work is helping us pull new technologies into our hospitals faster so that we can do a better job delivering on that promise.” CAHO hospitals play a unique and vital role in the province’s health care

Our health system fails the elderly Continued from page 4

SOLVING LONG HOSPITAL WAIT TIMES REQUIRES A FUNDAMENTAL SHIFT IN THE WAY WE CARE FOR THE ELDERLY While this is a good start, a longterm solution will require a fundamental shift in the way we care for the elderly. It will require involvement across the healthcare system from front line staff to hospital administrators and policymakers. Practices like earlier screening of functional decline followed-up by the arrangement of community supports, applying best practices in discharge planning and patient flow tracking systems can all help reduce ALC days. A clear component of the path forward must be to enable greater access to long-term care.

We know that a major cause of ALC days is a shortage of long-term care spaces. Canada currently spends 14 per cent of its health care dollars in long-term care, which is lower than the average spent by 10 other OECD countries. A significant investment in more long-term care spaces is needed to address the chronic shortage and to put supports in place that reflect increasingly complex health needs. At the same time, placement of ALC patients in long-term care is not always the best solution. Many patients are capable of remaining at home with increased sup-

ports and wish to do so. By bolstering community and home care supports, our system can become increasingly patient-centered in its care for our elderly population and redirect some patients who would otherwise be placed in long-term care. Increasing community supports must also include the often underappreciated members of the care team – informal caregivers, who are reporting increasing levels of burnout and their inability to support their loved ones. Investments should focus on homemaking services, caregiver support and respite services, and new models of care such as group home models to care for high-risk seniors. These big shifts require courage, collaboration and political will. We must act now to meet the changing health H care needs of our aging population. ■

A version of this commentary appeared in Policy Options. David Wiercigroch is a medical student at the University of Toronto and a Contributor to EvideneceNetwork.ca based at the University of Winnipeg. He is a graduate of the Master of Public Administration program at Queen’s University and has an interest in health system improvement through public policy. Caberry Weiyang Yu is a medical student at Queen’s University and a Contributor to EvidenceNetwork.ca based at the University of Winnipeg. She conducts research on healthcare equity and access to care. www.hospitalnews.com

NEWS

system. Collectively, they provide specialized patient care services, train the next generation of health care professionals and conduct leading-edge research to discover tomorrow’s care today. “The Innovation Broker work provides an opportunity for CAHO hospitals to strengthen the business side of Ontario’s health care system by facilitating connections between innovators and our members,” says Michelle Noble, Executive Director of CAHO. “This work exemplifies the role of academic research hospitals in building a healthier, wealthier and smarter Ontario.” CAHO is calling all innovators with an innovation that will help improve care and increase efficiency in Ontario’s health system to submit a request for a validation test site. Visit CAHO’s Innovation Broker webpage for more H information. ■ Elise Johnson, Communications Advisor at the Council of Academic Hospitals of Ontario (CAHO).

TAKE YOUR NEXT STEP IN COMMUNITY SERVICES Explore your professional development opportunities with George Brown College Continuing Education George Brown College has a range of certiﬁcates that are offered on a part-time basis through Continuing Education. Courses for these certiﬁcates start this September: • Addiction Studies • Advanced Counselling • American Sign Language • Community Mental Health Case Management • Grief and Bereavement Counselling • Health Services Management

• Life Skills Coaching • Restorative Care • Settlement Studies • Social Services Management • Supported Employment Specialist

coned.georgebrown.ca/community Register now for fall classes! For more information, contact us at 416-415-5000, ext. 2126, or cecommunity@georgebrown.ca.

www.hospitalnews.com

AUGUST 2018 HOSPITAL NEWS 13

EVIDENCE MATTERS

Searching for better glioblastoma treatment options and outcomes By Barbara Greenwood Dufour lioblastoma is the most common type of primary brain cancer in adults, with approximately 1,200 Canadians diagnosed with it each year, according to some estimates. It’s a particularly aggressive type of cancer and, even with the best medical treatment available, people who develop glioblastoma typically live for less than two years. Therefore, the goal of glioblastoma treatment is to add time to a patient’s life rather than cure the cancer. Why is glioblastoma so hard to treat? Standard treatment starts with surgery to remove as much of the tumour as possible; however, because glioblastoma cells spread like tentacles throughout the brain, it’s impossible to surgically remove the entire tumour without also removing and damaging healthy brain tissue. Surgery is followed by a few weeks of concurrent radiation and chemotherapy to destroy the remaining cancer and, after that, patients undergo six cycles of maintenance chemotherapy to slow the regrowth of cancer cells. But the blood-brain barrier — a network of cells surrounding the blood vessels in the brain that protect the central nervous system from harmful substances — limits the amount of chemotherapy that can reach the brain. Temozolomide is the chemotherapy drug commonly used to treat highgrade gliomas and for maintenance therapy as well. Six cycles of temozolomide therapy is thought to offer patients 14 to 16 months of extended survival. So, could additional cycles extend survival even longer? To find out, CADTH – an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures – recently conducted a review of the evidence of the effectiveness of extended temozolomide therapy. CADTH looked for existing research on 12 cycles of maintenance

temozolomide therapy in adults with high-grade gliomas, including glioblastoma. According to the two randomized and one non-randomized controlled trials found, an extended regimen might improve survival outcomes compared with six cycles, but the evidence is limited. And temozolomide therapy, as with all chemotherapy, comes with the risk of serious side effects; and the risk increases when therapy is prolonged. Therefore, the benefit of extending maintenance temozolomide therapy is currently uncertain. A recent increase in research and innovation related to glioblastoma treatment might change how glioblastoma is managed in the future. CADTH continually scans the hori-

zon for emerging drugs, medical devices, and procedures that could have a significant impact on patient care and the health care system but are not yet widely available, in routine clinical use, or licensed for use in Canada. Through its Horizon Scanning service, CADTH recently identified two emerging treatments for glioblastoma. One, called SonoCloud, was featured in CADTH’s Health Technology Update newsletter. The other, called Optune, was the subject of an Issues in Emerging Health Technologies bulletin. SonoCloud has been developed to open the blood-brain barrier to improve chemotherapy delivery. SonoCloud uses a small ultrasound device implanted in the skull to activate mi-

crobubbles that, shortly before a chemotherapy session, are injected into the bloodstream. The pulsed ultrasound causes the microbubbles to expand and contract, temporarily forming tiny openings in the blood-brain barrier that chemotherapy drugs can pass through. The effectiveness of this technology is unclear – trials have so far shown only that SonoCloud safely and effectively opens the blood-brain barrier. Future trials will determine if its use during chemotherapy has an effect on glioblastoma disease progression and patient survival. The Optune system delivers low-intensity, alternating electric fields – “tumour-treating fields” – to the brain. This is thought to disrupt cancer cell division and cause cell death. Four adhesive patches (transducer arrays) are placed on the head and connected to a portable electric field generator, which can be plugged into an electrical outlet or used with a rechargeable battery pack so the patient can be mobile during treatment. Patients are expected to use the system for at least 18 hours per day. Optune has been proposed as an add-on to standard glioblastoma treatment. It’s intended only for tumours located in the upper region of the brain, and it’s currently unclear which patients it’s most likely to benefit. However, early evidence suggests that, in some patients with newly diagnosed glioblastoma, Optune may add additional months of life. These are just a few examples of the new therapies and treatment approaches being explored that may eventually offer better ways to delay the recurrence or progression of glioblastoma. For more information on CADTH or to freely access any of the documents mentioned in this article, visit www.cadth.ca. You can also follow us on Twitter: @CADTH_ACMTS, or talk to our Liaison Officer in your region: www.cadth.ca/contact-us/ Ht liaison-officers. ■

Barbara Greenwood Dufour is a Knowledge Mobilization Officer at CADTH. 14 HOSPITAL NEWS AUGUST 2018

www.hospitalnews.com

Adam goes the distance.

Meet Adam. This type A personality gets up before dawn every morning to run and competes in marathons and road races at every opportunity. Whether running outdoors or running to a courtroom, Adam is in a constant competition. A runner’s focus and a well-defined plan ensure that even the smallest aspects of a complex personal injury case are done exactly right. Before he joined Oatley Vigmond, Adam practiced with a prominent Toronto litigation firm, defending physicians in malpractice claims. With this valuable experience and insight into the way Canadian doctors are defended, Adam now uses that understanding on behalf of clients injured at the hands of the health care profession. Successfully settling a case and seeing the smiles on his clients’ faces while he helps them to move on with their lives is gratifying for Adam. To him, it’s the same feeling as crossing the finish line in a race, knowing he has given it his all.

To learn more about Adam visit www.oatleyvigmond.com/adam

Proud Member PE

O N A L I N JU

2017-18

TOP 10 BOUTIQUE

1.888.662.2481 oatleyvigmond.com

LONG-TERM CARE NEWS

Food production

in long-term care

By Dale Mayerson and Karen Thompson ltimately, the goal in meal service in long-term-care (LTC) is to ensure that the food and nutrition team achieves a high level of resident satisfaction within the given resources. Nutrition Managers and Registered Dietitians responsible for food and nutrition services in LTC homes are faced with the challenge of planning the menu but the quality and accuracy of the food served is directly affected by the quality of the food production processes in a home. Food production forms a link between menu planning, meal service, pleasurable dining, and nutrition and hydration care. Standardized production practices all originate from a well-planned menu and include purchasing guidelines, production planning, standardized recipes and portion control.

FOOD PURCHASING AND PRODUCTION CONTROL

Achieving accurate and consistent purchasing practices that adhere to a planned menu is the goal. When

WHEN PLANNING A MENU, PRODUCTS ARE SELECTED CONSIDERING RESIDENT LIKES AND DISLIKES, NUTRIENT PROFILE, EASE OF STORAGE/PREPARATION, TO REDUCE WASTE AND COST. planning a menu, products are selected considering resident likes and dislikes, nutrient profile, ease of storage/ preparation, to reduce waste and cost. How well a food holds during production and service is also important. French fries may be crispy and delicious when prepared in the kitchen but may be quite different by the time they are served to the residents. Optimal product selection can improve food safety. For instance, the use of pasteurized liquid eggs carry less risk of contamination than fresh eggs. Cost is an important consideration in selecting products and is always considered one of the criteria for product selection. The least expensive product is not always the best choice. It is also important to note that some products may not be liked by the res-

Sticking your head in the sand? Unplanned long term care cost can push you into a serious financial crisis Get Home & Long Term Care Coverage NOW

For More Information:

1-844-823-2100

“The Long Term Care Insurance Specialist” 16 HOSPITAL NEWS AUGUST 2018

info@healthcostsolutions.ca WWW.healthcostsolutions.ca

idents, even if they meet all of these criteria. Once product specifications are determined, purchasing requirements should match a home’s needs. A forecasting system is an important part of a standardized food production system and should determine daily requirements for each menu item based on resident popularity and diet distribution. This system provides the information to scale recipes and to determine the appropriate quantities to purchase.

RECIPES AND PORTION CONTROL

Recipes are designed for ease of use in an institutional kitchen and include the basic information including quantity and type of ingredients, time and temperature for preparing and cooking, number and size of portions. Recipes also include identification of internationally recognized Hazard Analysis Critical Control Points (HACCP), principles of time, temperature management, and sanitation, which is a valuable tool for preparation of safe food. Recipes are designed and tested for safety, cost effectiveness, nutrient and texture profile, ease of preparation and service in the home setting and most importantly to ensure they are liked by the residents. Accuracy and consistency in preparing food items requires regular oversight, monitoring, communicating and follow up with food production staff. Standardized portion control is a recurring theme in standardized food

production. Identification of the standard portion for each menu item, recipe or purchased ‘ready to use’ product must be identified and communicated throughout the production process. The standard portion clearly influences purchasing, forecasting and recipes; as well it directly impacts residents and staff at point of service in the dining room. Inaccuracies or inconsistencies at any step will affect nutrient intake and cost.

HOW FOOD PRODUCTION AFFECTS NUTRITION CARE

Food production processes can have a significant impact on nutrition and hydration care. An organized and well-planned food production process is an important part in ensuring the requirements of the resident population meet Canada’s Food Guide and the Dietary Reference Intakes as part of the planned menu. Residents have a wide range of food concerns that homes work diligently to accommodate. Many residents in LTC struggle to maintain their body weight or may require increased protein to prevent age related muscle loss intake. How can food production affect these residents? Consider that a smaller than standard portion of entrée was ordered or that the cook made the dessert without adding the required skim milk powder or that the service staff used a smaller scoop size at point of service. Each of these changes results in the resident receiving less calories and protein than they are supposed to, undermining the impact of nutrition strategies that are in place to boost their health and wellbeing. Individual residents may have specific allergies, hypersensitivities or intolerances to specific foods. In addition there are residents that avoid specific food items for cultural and

www.hospitalnews.com

LONG-TERM CARE NEWS ethnic observances. The home must have a quality standard food production process to be able to state with certainty that a resident is not receiving any undesirable foods. Cooks must follow standardized recipes and have any suggested changes approved by the Nutrition Manager or Dietitian before implementing. Consistent purchasing standards need to consider all foods served including ingredient lists as they relate to individual dietary requirements. Consider that arrowroot cookies may contain lard and not be suitable for those residents observing Jewish or Muslim eating practices or that Worcestershire sauce may contain anchovies that could cause a significant allergic reaction in certain individuals. Providing appropriate levels of fibre is a goal for all LTC homes. When it is consistently consumed, the residents and nursing staff will benefit from the decreased use of pharmaceutical laxatives. To achieve this, homes may be routinely offering multigrain products, prunes, flax flour or bran as additions

to hot cereals or as a topping on hot or cold cereal to boost daily fibre intake. In order to be effective, these products need to be available and routinely used according to the menu plan and recipes.

Well-managed food production paves the way for an organized and accurate meal service, pleasurable dining and consistent nutrition and hydration care. Along with careful menu planning, a well-managed food

production is critical to having a standardized food service and in managing food costs. A successful menu and food production system will help to make every H bite count. â&#x2013;

Dale Mayerson B Sc RD CDE, and Karen Thompson, B A Sc RD are Registered Dietitians with extensive experience in Long-term care. They are co-authors of â&#x20AC;&#x153;Menu Planning in Long Term Care and Retirement Homes: A Comprehensive Guide.â&#x20AC;?

Your Home Healthcare Provider of Choice

Providing quality, experienced healthcare professionals wherever you call home.

416.421.4243 integracare.on.ca

www.hospitalnews.com

AUGUST 2018 HOSPITAL NEWS 17

LONG-TERM CARE NEWS

Innovation and the aging experience Seniors want new products and services that empower independence and choice By Trish Barbato anada’s seniors are not afraid of innovation. They want businesses to develop products and services that empower them to lead healthy, fulfilling lives at every stage of life, whether they live independently, require assisted living, stay in a long-term care setting or require hospital care for complex, chronic conditions. These kinds of innovations are hard to find, or come about as an afterthought, in large part because seniors are not viewed as a primary market for many products and services, even healthcare products, despite being one of the largest demographic groups. There is a tremendous business opportunity for Canadian companies. Imagine the potential for organizations

Helping people live with independence, dignity and in comfort since 1925. • Nursing • Physio and other therapies • Personal care and support • Homemaking

Also specializing in:

• Palliative support needs • Dementia care • Respite • Wound care

18 HOSPITAL NEWS AUGUST 2018

www.vha.ca 1.888.314.6622

that figure out how to research and design new innovative products for this growing segment of the population. The opportunities are truly endless. As someone who works for an organization that operates long-term care homes and retirement residences, I believe that seniors should live life to the fullest. That’s why it’s critical to invest in innovations that improve the aging experience, as well as in startups and other research-oriented companies that are developing products and services that will benefit seniors and have a big impact on healthcare providers. In my job, I see countless opportunities for companies to get involved with innovators. I continue to be inspired by the exciting advancements I see every day because of the direct impact

www.hospitalnews.com

LONG-TERM CARE NEWS

they can have on seniors’ health and quality of life and working conditions for healthcare workers. For example, a company called WinterLight Labs has developed an artificial Intelligence-based tablet technology, which enables early detection and treatment of Alzheimer’s disease and dementia. A wearable device from Geko has been shown to increase circulation to lower limbs to speed up the healing time of wounds, improving rehabilitation and mobility. And a tele-monitoring system for the management of urinary incontinence, invented by Sensassure, uses smart technology to give care providers real-time data about their patients or residents, detecting wetness quickly and allowing for more efficient, targeted care. Can you imagine what kind of possibilities still exist? No need to wake people up in the middle of the night, saving staff time and improving quality of sleep! We know that seniors want more options for products that empower

allow them to be healthier and more independent. Some shared how robotic assistants could enable them to carry out day to day tasks, such as cooking and cleaning, and would empower them to be more self-reliant. Others imagined how driverless vehicles will empower seniors in general, because they won’t have to worry about their driver’s license being taken away or need to rely on transit or family for transportation. Overall, the report challenges businesses to explore how their products and services can be adapted to better serve seniors and to invest in the development of new innovative products and services for older adults at every stage of life and health. Seniors raised a common theme during the consultations: they built this nation through hard work and innovative thinking over the past century. It’s time for businesses, and society at large, to engage older adults in deH veloping tomorrow’s innovations. ■

THE MAJORITY OF CANADIAN SENIORS, 87 PER CENT, SAYS THEY BELIEVED INNOVATION WOULD HELP SOLVE MANY WORRIES THEY HAVE ABOUT AGING. their independence and will allow them to live their lives to the fullest. This was the overwhelming consensus of a national poll and survey of older adults conducted by Revera from January to April 2018. In June, the results were reported in the Revera Report on Ageism: Innovation and the Aging Experience. The report explores how older Canadians view innovation and the role it can play in providing greater independence and choice as we age. Insights were gathered through a series of roundtables held with seniors living in long-term care and retirement residences and a national survey with 1,099 Canadians over the age of 65.

The majority of Canadian seniors, 87 per cent, says they believed innovation would help solve many worries they have about aging. Eighty-four per cent of seniors believe Canada’s private sector can do more to improve the aging experience. In fact, 59 per cent of those polled say they are looking for products and services to help them live independently longer. Women, especially, say that the private sector should be investing in products that promote independence (91 per cent). Residents spoke of their loss of independence as they have aged – having to rely on others for medications, transportation to doctor’s appointments, and preparation of meals – and how innovations would

Trish Barbato is Senior Vice President, Innovation and Strategic Partnerships, Revera Inc.

>OLU `V\ 5LLK 8\HSPÄ LK *HYL

WE WILL BE THERE! Nurses PSWs - Alzheimers HCA - Sick Kids Massage Therapy Homemakers Companions

Sitters Foot Care Nurses Drivers Live in Caregivers Denture Services at home Palliative Care

>HP[PUN MVY `V\Y UL_[ JHSS Royal Canadian Health Care Services Inc.

Serving all of Ontario including HAMILTON • TORONTO • OTTAWA

24 HOURS 7 DAYS A WEEK www.hospitalnews.com

905.669.5453 info@rchcs.com www.rchcs.com

AUGUST 2018 HOSPITAL NEWS 19

LONG-TERM CARE NEWS

Dementia

in long-term care he number of Canadians over the age of 65 is growing significantly and so is the number of seniors living with dementia in the country. While dementia is not a natural part of aging, the biggest risk factor associated with a diagnosis is age. According to data published in Dementia in Canada, a new report by the Canadian Institute for Health Information (CIHI), it is estimated that the number of Canadians living with dementia will

double over the next 20 years due to the aging population and population growth. Seniors with dementia have complex care needs. About two-thirds of them live in the community – either at home, with a caregiver or in an assisted living facility – and they need considerable support from caregivers or formal home care services to do so comfortably. As dementia progresses and care needs change, many will be moved into long-term care (LTC) facilities.

Personalized home care services

Support is just a phone call away.

CANADIANS LIVING WITH DEMENTIA WILL DOUBLE OVER THE NEXT 20 YEARS DUE TO THE AGING POPULATION AND POPULATION GROWTH.

CHALLENGES IN CARE

CIHI’s report revealed that 69 per cent of residents in LTC had dementia in 2015-2016. Symptoms of dementia,

such as verbal and physical abuse and resisting care, can be challenging to manage. Severe cognitive impairment affected 40per cent of residents, 50 per

Personal Care Caregiver Relief Nursing Companionship Meal Preparation Medication Reminders Light Housekeeping Palliative / End of Life Care Physio & Occupational Therapy Hospital Bedside Care

www.bayshore.ca

1.877.289.3997 clientservice@bayshore.ca 20 HOSPITAL NEWS AUGUST 2018

www.hospitalnews.com

LONG-TERM CARE NEWS

THE DOWNWARD TREND OF USE OF RESTRAINTS AND POTENTIALLY INAPPROPRIATE ANTIPSYCHOTICS IN LTC IS A POSITIVE SIGN FOR RESIDENTS AND LTC STAFF ALIKE. cent had responsive behaviours (such as verbal and physical abuse), 31 per cent had signs of depression and 82 per cent required extensive assistance or were dependent on assistance for activities of daily living. Nancy Cooper, the Director of Quality and Performance at the Ontario Long Term Care Association says, “It’s a double challenge. In addition to managing behaviours, the loss of cognition in seniors with dementia means their loss of ability to walk or do activities of daily living. Many of the residents need to be fully supported with feeding, toileting, cleaning their mouth, dressing,

etc. The most frequent challenging behaviour is refusing care.” To help manage some of the behaviours exhibited by residents (with and without dementia), LTC facilities sometimes turn to physical restraints (such as wheelchair lap belts or bed rails) or chemical restraints such as potentially inappropriate antipsychotic medications.

RESTRAINT AND ANTIPSYCHOTIC USE DECREASING IN LTC

The practice of using physical or chemical restraints in LTC is a contro-

versial one, and over the last five years, we are starting to see notable decreases in their use. This is largely attributed to policy changes and educational programs for staff that focus on person-centred care. Various policy changes have been rolled out across the country. Among them is Ontario’s Long-Term Care Act, which requires LTC homes to reduce the use of restraints (both chemical and physical) wherever possible. In response, Behavioural Supports Ontario (BSO) launched a teambased program in 2010. This program enhances health care services for Ontario’s seniors, their caregivers and their families who are living and coping with responsive behaviours associated with dementia and other illnesses. On BSO, Cooper says, “[they] provided specific skill set training to a few staff in the LTC homes in Ontario. The staff became the in-house ex-

perts to spread the knowledge. They helped others to replicate what they do. Where these teams are embedded, everyone in the home is better adapted to manage the care of seniors living with dementia.”

THE WAY FORWARD

The downward trend of use of restraints and potentially inappropriate antipsychotics in LTC is a positive sign for residents and LTC staff alike. A person-centered approach means meaningful relationships are able to form between care-receivers and providers and this ultimately improves the quality of life for residents in their declining years. CIHI regularly reports on the use of restraints and potentially inappropriate antipsychotics in the Your Health System: In Depth web tool to help inform health care decision makers on trends and steer evidence-based perH formance improvement. ■

This article was submitted by the Canadian Institute for Health Information. www.hospitalnews.com

AUGUST 2018 HOSPITAL NEWS 21

Dr. Stuart Turvey with a patient.

Preventing childhood asthma By Dr. Catalina Lopez-Correa he number of people, particularly children, suffering from asthma has grown significantly over the past few decades. Today, asthma is one of the most common chronic diseases affecting one in seven Canadian children. And while doctors don’t entirely understand why some develop this serious disease, and others don’t, researchers have determined that it could be a mix of your genetics, environment or other factors. Asthma affects the airways that carry air in and out of your body. With asthma, your airways get inflamed and swell up, causing the muscles around them to tighten, making it hard to get air in and out. At the same time, your airways might also make more mucus than normal, blocking your airway and making it difficult to breathe. Inflammation can be triggered by common substances in the environment such as pollen, pet dander, mold, or cigarette smoke. When you have asthma, your body perceives these substances as threats

and overreacts in response, causing inflammation in your airways to the point of malfunction. Dr. Stuart Turvey, one of the co-leaders of the Canadian Healthy Infant Longitudinal Development (CHILD) study, is following 3,500 Canadian children in the hopes of identifying the root causes of asthma. Turvey, a pediatrician who specializes in allergy and immunology at BC Children’s Hospital Research Institute, is working with Drs. Michael Kobor and Brett Finlay of the University of British Columbia and Dr. Padmaja Subbarao of The Hospital for Sick Children in Ontario to determine which infants in the CHILD study are most likely to develop asthma by looking at microbes in their stool samples. Turvey and his team believe evidence for the cause of asthma points to something either in (or missing from) the environment that children are growing up in. “When I went to medical school, I was taught to name bacteria and to kill them with antibiotics,” recalls Turvey, “But the reality is that in the vast uni-

verse of bacteria, only a handful of them make us sick, while the majority actually help make us healthy.” Children who are exposed to bacteria and viruses early in life are in a lower risk group for developing asthma. Alternatively, children who lack exposure are at a higher risk. This may include children born through Caesarian section, missing exposure to their mother’s vaginal birth canal, or babies who are given antibiotics, which wipe out bacteria in the gut, although these initial observations will need to be scientifically confirmed. As part of the CHILD study, stool samples were collected from children at birth, three months of age and one year. When some of these children began to develop asthma as they grew, researchers were prompted to examine the early stool samples (frozen in the lab) to see if there was something different in their microbial community (Microbiome). What they found (or more accurately, didn’t find) may have opened the door to preventing asthma. The team was able to discover the

absence of four bacteria: Faecalibacterium, Lachnospira, Veillonella and Rothia (FLVR). The absence of these four FLVR bacteria, which can be detected at as early as three months of age, suggests you may be in a higher risk group for developing asthma. Armed with this knowledge, the door may be opened to find ways to intervene, with the goal of preventing asthma from developing in the first place. Through funding by Genome British Columbia, Genome Canada, the Canadian Institutes of Health Research (CIHR), and other partners, Turvey and his team are using genetic sequencing to confirm their previous findings and to examine the entire microbiome to determine once and for all if these missing microbes are leading to asthma, and if so, look at developing ways to replace these missing microbes. A cure may still be a long way off, but the team is cautiously optimistic about the possibilities of using the microbiome to prevent or potentially H treat asthma. ■

Dr. Catalina Lopez-Correa, Chief Scientific Officer and Vice President, Sectors at Genome British Columbia. 22 HOSPITAL NEWS AUGUST 2018

www.hospitalnews.com

PAEDIATRICS

Lightning strikes twice: SickKids dream team and an unexpected companion By Lisa Nightingale even-year-old Stella has been courageously battling the odds since before she was born. At 18 weeks gestation, her mom Chantal and dad Tarek were told their third child would likely not survive. “They told us she tested positive for abnormalities that would impact her ability to survive,” says Chantal. “Every two weeks following that we had an ultrasound, and every time we did, doctors discovered another concern.” In preparation of Stella’s arrival, Chantal and Tarek met with different specialists at The Hospital for Sick Children (SickKids). “For the first three years of Stella’s life she had appointments every second day with various health-care professionals including neurologists, occupational therapists, physiotherapists, speech therapists, social workers and many others,” says Tarek. “SickKids became our second home and the dedicated staff became our extended family. We called Stella’s health-care team the Dream Team.” Dr. David Fisher, Plastic Surgeon and Medical Director of the cleft lip and palate program at SickKids was the leader of this Dream Team overseeing Stella’s care. “Stella’s care is a radiant example of why paediatric health care is a team effort. For patients born with complex health concerns, it is critical that every member of the interdisciplinary team be connected with a unified goal of providing the best quality care,” says Fisher. Over the past seven years, Stella and her family have continued to access many clinics and programs at SickKids that support Stella’s development and well-being. One of Stella’s personal favourites is Treble Clefts, a choir specifically for kids with facial differences that is co-led by Laurie Russell, Speech and Language Pathologist and Farah Sheikh, Social Worker. “It’s an abso-

STELLA’S CARE IS A RADIANT EXAMPLE OF WHY PAEDIATRIC HEALTH CARE IS A TEAM EFFORT lute delight working with these kids as they find their voice and often their confidence,” says Sheikh. “Music and singing can be therapeutic on so many levels and it is my privilege to facilitate this program.” Farah has been an important part of Stella’s SickKids journey and has proven to be a great confidant, resource and connector for the family.

As a Social Worker Farah is a mental health professional who works collaboratively with children, youth, families, the health-care team and the broader community to improve the lives of the patients she works with. She and her colleagues in the field are leaders in providing evidence-informed clinical assessment, intervention, consultation and teaching. They promote resil-

ience, enhance coping and capacity, and provide expertise at the intersection of mental and physical health in children. By building strong therapeutic relationships they work from a strengths-based, child and family centred, systems perspective. SickKids social workers are an essential component of the overall plan of care for patients and their families. For weeks, Stella would tell Farah at Treble Clefts practice how desperately she wanted a puppy. Animals and soft furry creatures have been a significant part of Stella’s learning and therapy over the years. Chantal, Tarek and the health-care team at SickKids often use Stella’s passion for animals to motivate her through tasks that are sometimes difficult to inspire. So when Sheikh received an email from a friend of a friend saying her Yorkshire Terrier had just had a litter of puppies and she was looking for a home for a very special one who had been born with a cleft lip, she knew the perfect family. “When Farah reached out to us to let us know this puppy had defied the odds, and needed an extra special home, we knew this was the puppy Stella had been waiting for,” says Chantal “The dedicated staff at SickKids have a way of going above and beyond and this introduction to our new family member is just one example of how the staff keep patients top of mind.” Stella and her two brothers named the tiny pup Thor meaning God of Thunder or in their words, Dog of Thunder. “He is powerful,” says Stella. When introducing her new furry friend, Stella points proudly to Thor’s cleft lip and her lip and says that “this is where the lighting strikes to give us our power.” Stella is training Thor up to be a therapy dog and hopes that one day he will be able to come to SickKids and share his joyful disposition with other kids. “He’s magical just like me,” Stella says. “Together we are going to do H great things!” ■

Lisa Nightingale is a Sr. Communications Specialist at The Hospital for Sick Children. www.hospitalnews.com

AUGUST 2018 HOSPITAL NEWS 23

2018 CAPHC Conference Join us forɺthe largest multidisciplinary annual child & youth healthcare event in Canada!

Fresh Thinkingɺ Brave Ideas

October 21 - 23, 2018ɺ Edmonton, Alberta LEARN MORE: caphc.org/edmonton-2018 | @CAPHCTweets | #CAPHC2018

24 HOSPITAL NEWS AUGUST 2018

www.hospitalnews.com

FROM THE CEO’S DESK

Harnessing creativity and risk-taking for impact By Julia Hanigsberg he stereotype we are all familiar with is that hospitals are risk-averse and rigid. Indeed, when entrusted with individuals’ health and safety, our appetite for risk is low. Further, healthcare is one of the most complex systems in existence, more complex than banking, manufacturing, or education. Why? At least in part because the various combinations of care, activities, events, interactions and outcomes are virtually infinite (Braithwaite, J., BMJ (2018;361:k2014)). So how do we get past our riskaverse tendencies and bring about change amid this complexity? A big part of the answer is embracing an innovative mindset. The challenge is how do we, as health care leaders, create an environment where the amazing ideas our staff, physicians, clients, and families have are harnessed into actions that make a positive impact and help us more effectively deploy our resources? Since the launch of our No Boundaries strategic plan last year, Holland Bloorview Kids Rehabilitation Hospital has been fostering a culture of innovation and collaboration with renewed vigor. We are creating new opportunities for people and teams to mobilize around their ideas because we know that achieving the bold ambitions of our strategic plan will require everyone’s ingenuity. One way we’re promoting creativity at all levels of the organization is through our No Boundaries Fund, funded by donor support. The No Boundaries Fund gives any member of our team the opportunity to apply for a small grant to address a need, provide a solution or leverage a potential opportunity aligned with our strategy. Now in its second year, applicants are encouraged to partner with a client or family on an idea. With this model, projects are making a big impact at

a low cost within a short timeframe. And our staff, clients and families are energized by the opportunity they have to turn their ideas into reality. So far we’ve launched a respite program, caregiver workshops, and a youth video feedback corner as a result. Another way we’re making big changes in small timeframes is through a methodology called rapid redesign. We just completed the first phase of a rapid redesign in LIFEspan, a service that supports young people bridging from pediatric services at Holland Bloorview to adult services at the University Health Network’s Toronto Rehabilitation Institute. The redesign involved introducing a new element to the LIFEspan service every week, evaluating how it went and deciding whether to keep it, tweak it or let it go. In the first phase LIFEspan has adopted four new best practices, including an option for clients to have remote appointments through a secure video conferencing platform. The redesign ensures the program more efficiently uses available resources while continuing to deliver a high degree of value.

Trying out new ideas is key to innovation but collaboration also plays a vital role, which is why we are adopting a design-thinking approach to drive initiatives forward. Design-thinking is a human-centred approach to idea creation that asks us to empathize deeply with our clients to develop a service that truly meets their needs. We know young people with disabilities and their families experience a myriad of challenges when they shift from pediatric to adult care. As part of a design-thinking process, our transitions team hosted an “innovation jam” in April where 60 staff, clients, families and community partners came together to brainstorm and prototype ways to make the move to adult services smoother. Now they are working with the Ministry of Health and Long-Term Care’s Business Innovation Office to launch these prototypes this fall so we can start making a difference in the lives of transition-aged youth as soon as possible. What we’re learning from the design-thinking approach is that testing and improving on ideas is part of the

process. A good idea doesn’t need to be perfect for us to get started. By removing perfection from the equation every individual has the freedom to be curious and do things differently, which is further embedding our culture of innovation. Fostering innovation is also about removing unnecessary barriers, which is why we launched a permission-to-contact platform called connect2research in July. The idea for connect2research came from feedback we regularly heard from families, clinicians and researchers that the opportunities for families to learn about research study participation were limited and difficult to access. So, in partnership with clients and families, we co-designed a solution that leverages our health information system to ensure every client and family eligible for a research study is given the opportunity to participate. This high impact change greatly expands access to participate in the transformative research taking place every day in our Bloorview Research Institute. Finally, under the leadership of our Board of Trustees and with our entire leadership team, we reviewed our risk appetite and developed a statement of risk appetite and tolerance reflecting selectively increased risk tolerance where appropriate and impactful, for example in research and in services for new patient populations. Next steps include rolling out that statement across the entire organization as a tool for operations managers and frontline clinicians. By removing barriers and fostering an environment where the entire Holland Bloorview community feels empowered to explore their ideas together and then quickly transform them into reality we are truly evolving to a culture of innovation at Holland Bloorview. And not surprisingly, we see that H the benefits far outweigh the risks. ■

Julia Hanigsberg is President and CEO, Holland Bloorview Kids Rehabilitation Hospital. www.hospitalnews.com

AUGUST 2018 HOSPITAL NEWS 25

PAEDIATRICS

Program that improves health care

experience for children with ASD looking to expand By Ben Maycock group of IWK Health Centre researchers, clinicians, administrators and families is changing the way care is being provided to youth with autism spectrum disorder (ASD). Building Alliances for Autism Needs in Clinical Encounters (BALANCE) is an interactive online program which teaches healthcare providers about ASD and ways they can effectively tailor care to meet the individual needs of each child and family. Launched at the IWK’s Day Surgery Unit in December 2016, the program’s success is now leading it to expand to other sites. “Youth with ASD have unique sensory, emotional and communication

YOUTH WITH ASD HAVE UNIQUE SENSORY, EMOTIONAL AND COMMUNICATION NEEDS THAT CAN MAKE HEALTH-CARE EXPERIENCES CHALLENGING. needs that can make health-care experiences challenging,” says Dr. Jill Chorney, the study supervisor. “Because these experiences are challenging, families of youth with ASD may delay or avoid seeking healthcare until problems are more complex or serious.” IWK staff, physicians and families developed BALANCE to ensure healthcare professionals have the knowledge, skills and support to feel

comfortable caring for youth with ASD and their families. For example, a child with hyper-sensory issues may be provided sunglasses or noise-cancelling headphones, while a child who is a linear thinker may be walked through what they can expect using a set of visual cue cards. “Using BALANCE we take a few minutes to slow down and understand that child – not the text-book disorder,

but the child,” says Dr. Stuart Wright, an anesthesiologist at the IWK, and a parent of a child with autism. “The whole team then works together to care for the child and communicate with the family in a way that works best for them.” BALANCE delivers much of its content through videos featuring children with ASD, their families, healthcare providers and researchers. The program is now regularly used in the IWK’s Day Surgery, and has recently been expanded to the IWK’s Medical, Surgical and Neurosciences Unit (MSNU) and Pediatric Medical Unit (PMU). Modifications will also allow implementation in other areas such as emergency rooms, H ambulatory and dentistry clinics. ■

Ben Maycock works in communications at IWK Health Centre. 26 HOSPITAL NEWS AUGUST 2018

www.hospitalnews.com

PAEDIATRICS

Our earliest memories may be forgotten but not lost By Jessamine Luck hen asked to think of their earliest memory, most would think of a time when they were four or five years old. The period from birth to Kindergarten appears to be forgotten. Since the late 1800s, this phenomenon has been called “infantile amnesia” and debate on why we can’t remember our earliest years has persisted to this day: Are these memories gone or are they just difficult to access? A new study from The Hospital for Sick Children (SickKids) shows these early memories in mice are not missing and can be brought back by directly stimulating different clusters of neurons that represent individual infantile memories in the brain. The results, published in Current Biology, provide deeper insight into the complexities of forgetting. Dr. Paul Frankland, Senior Scientist in Neurosciences & Mental Health at the SickKids Research Institute, and his team trained infant mice to associate a specific place with a particular memory. This training engages the hippocampus, which plays a role in processing memories tied to a particular situation or context. The resulting memory of the place was forgotten within approximately one week. Next, they conducted the training again with different mice but this time they identified and tagged the specific neurons that were active in the hippocampus to keep track of them for the next phase of the study. Weeks later, when the place had long been forgotten, the researchers stimulated the tagged clusters and found the mice behaved as if they recognized the place once again. “The memory recall was remarkable,” says Frankland, who is also an Associate Professor in the Department of Psychology at the University of Toronto. Continued on page 30

AboutKidsHealth.ca

reboots their child health website

By Alexandra Theodorakidis growing number of Canadians now access health or medical information online before consulting a health-care professional. However, it can be difficult to know which online health sources are reliable, especially when it comes to paediatric care. In 2004 the Hospital for Sick Children (SickKids) launched AboutKidsHealth, a family-education portal. Articles cover every day topics including fever, colds and nutrition. AboutKidsHealth also features more in depth content on complex conditions such as diabetes, epilepsy and mental health. “AboutKidsHealth empowers families by giving them up-to-date, evidence-based and relevant information about their child’s health,” says Shawna Silver, Chief Medical Editor at AboutKidsHealth, and a Staff Paediatrician at SickKids. Over the past 13 years, website visits to AboutKidsHealth have grown to exceed visits to SickKids homepage; the website now sees millions of visits each month. With articles available in up to 10 languages, visits to AboutKidsHealth come from all over the globe. Recenty, AboutKidsHealth launched a redesigned website. The updated website has a new layout, improved search functions and all content is now mobile friendly.

“Our primary vehicle to share the information created by AboutKidsHealth is our website. By upgrading the website to a more current design and user-friendly interface instills even more trust in the information our users seek from SickKids,” says Sean Schurr, Director of AboutKidsHealth. The process to update AboutKidsHealth began more than two years ago. With more than 3,500 articles and 5,000 medical illustrations, animations and videos, the old AboutKidsHealth website design and platform struggled to keep up with the needs of patients, families and health-care providers. The biggest area that needed improvement was the ability to use the website on mobile devices. Over the past five years, AboutKidsHealth has seen an increase in the number of users visiting the site from mobile devices, including smartphones and tablets. In 2012, 20 per cent of AboutKidsHealth users accessed the website from their phone. In 2017 that percentage had grown to 72 per cent of users. With the relaunch, the website can be accessed from anywhere via smartphone, tablet or personal computer. “There are multiple different online health resources available, but they vary in trust, relevance and accessibility,” says Schurr. “AboutKidsHealth covers all three areas, given our part-

Alexandra Theodorakidis is a Writer/Editor for AboutKidsHealth. www.hospitalnews.com

nership with the expertise of SickKids doctors, nurses and health specialists who develop our content.” Another major update to AboutKidsHealth focused on the navigation of the website. It is now easier for users to search for articles, as they can filter by body system, body part and health category. The layout of each article page has been simplified, and banners and additional information have been removed from the left and right sides of the webpage because research shows that people are better able to consume content online when they don’t have distractions. Each article has also been organized in an accordion structure to allow users to go directly to the information they are looking for, such as “Signs and symptoms” or “When to seek medical attention” without needing to read the full article. Having information that is easy to find is particularly important to the clinicians who use AboutKidsHealth as a family-education tool. “Although clinicians spend significant time performing patient education, the retention and understanding of information is modest,” says Silver. “Providing patient education and information to families improves the understanding of their child’s care.” H Learn more at AboutKidsHealth.ca ■

AUGUST 2018 HOSPITAL NEWS 27

PAEDIATRICS

Creating a

portable tracheotomy kit By Ellie Stutsman t was a healthy pregnancy with no signs of trouble. Then, a premature birth followed by a visit to McMaster Children’s Hospital (MCH) where a Paris, Ontario, family learned their daughter, Mara, had an absent pulmonary valve. This is a rare anomaly of the heart where blood does not flow efficiently, causing low amounts of oxygen. It was a shocking experience for Mara’s father, Christian, in what should be one of the most joyful periods in a parent’s lifetime. The experience, though, ultimately led to an important and innovative opportunity for hospital staff to use themselves and improve patient safety. “I remember being in the room and first hearing her diagnosis,” says Christian. “My jaw hit the floor when I first saw diagrams comparing her heart to a healthy one. I didn’t know if I was going to make it.” After their daughter underwent cardiac surgery, the family spent more time at MCH where they later discovered the child needed a tracheotomy

– a surgical procedure that makes an incision in a person’s neck to clear the airway. Shortly after Mara got the tracheotomy, she was ready to be discharged. When a family is ready to leave the hospital, they visit with hospital staff to review some routine procedures to care for the patient at home. Christian needed to learn how to manage Mara’s tracheotomy, including how to troubleshoot any problems with the ventilator. If it ever became inoperative, he needed to figure out how to fix it in the moment. During the training he and his family received, the team went through a few hypothetical scenarios. Christian pointed out one scenario where he would need instant access to all the tools to perform a safe operation. It was at this moment he came up with the idea to create an emergency “tackle box” kit that is easily retrievable. “I started thinking, rather than spending time looking for different tools I need, I should have some sort of kit that’s ready to go with everything I need inside it,” says Christian.

“Nothing would make my anxiety increase more than having to look for all this equipment while Mara is suffering.” The process-driven father of two took his creation to Cindy Brennan, a respiratory care coordinator at MCH, who embraced it immediately. “Christian’s kit changed the way we set up our rooms for tracheotomy patients,” says Cindy. “Families are the experts in their child’s care. It’s important to hear their perspectives and allow them to bring new ideas to us.”

The result delivered an improvement opportunity as part of the Continuous Quality Improvement (CQI) initiative, a new management system at HHS that enables staff to solve problems at the unit level. Many improvements aim to improve the patient experience or offer savings of time and resources. It also showed how patients and families are involved in improving the way we provide care. Christian agrees. “There’s always been a commitment from staff to hear everyone out to make H things better.” ■

Ellie Stutsman works in communications at Hamilton Health Sciences Centre.

New data about medical cannabis, Lyme disease, Zika and eating disorders he Canadian Paediatric Surveillance Program (CPSP) recently released new data about the use of cannabis for medical purposes and the incidence of Lyme disease, Zika-associated viruses and eating disorders in children and youth. 2017 data from surveillance studies and one-time surveys show: • 38% of Canada’s paediatricians who responded to a survey on medical cannabis use reported being asked by a parent or adolescent patient in the past year to prescribe cannabis for medical purposes.

28 HOSPITAL NEWS AUGUST 2018

• With tick populations spreading further into parts of southern Canada, the burden of Lyme disease among children and youth is expected to increase. Over the three years of reporting, the majority of cases identified were located in Ontario and Nova Scotia. • Complications associated with Zika virus, including microcephaly, are rare in Canada. Continued data collection into 2019 will help researchers better understand and monitor the impact of Zika in Canada. • Eating disorders are affecting Canadian children as young as five years old, and one type in particular, known as avoidant/restrictive food

intake disorder or ARFID, has little to do with self-image. Children with ARFID have significant eating disturbances due to lack of appetite, aversive reactions to texture, smell, or appearance of food, or fears related to eating, such as choking. The CPSP is a network of 2,700 Canadian paediatricians and paediatric subspecialists. It is a partnership between the Public Health Agency of Canada and the Canadian Paediatric Society. Through disease surveillance, the program generates valuable new knowledge to inform clinical research, practice and policy related to important rare conditions and evolving child

health threats. Along with knowledge translation tools, including monthly tips on adverse drug reactions, the CPSP provides timely information to researchers, doctors, and health policy makers on both emerging and persisting health conditions affecting children and youth. “Lack of information on rare diseases or severe complications is challenging for children and their families,” says Jonathon Maguire, CPSP Chair. “Being able to offer knowledge gained through our surveillance helps families to better understand these conditions and provides evidence for doctors on appropriH ate evaluation and treatment.” ■ www.hospitalnews.com

PAEDIATRICS

Study explores challenging behaviours and emotions in

young children By Ellie Stutsman n 2015 Sonja Baker’s family grew from three to five when she gave birth to twin girls. Even as newborns the twins, August and Violet, had very different personalities, but both were outgoing, happy little girls. “Of course all three of our girls have their own unique personalities, but it’s amazing how much you see the differences with the twins,” says Sonja. But, when the twins approached age two, Sonja became concerned about some of the differences between them. Violet was cooperative, easy going and learning quickly, while August started to become less vocal and have more temper tantrums.

The study is exploring whether a program called the Family Check-Up can help decrease challenging behaviours and emotions in young children. “When you have two that are going in opposite directions,” says Sonja. “It can be challenging to figure out how to get both to respond positively. I was starting to feel like I needed some help.” That’s when Sonja learned about a research study in Hamilton called “Making the Race Fair”. The study is exploring whether a program called the Family Check-Up can help decrease challenging behaviours and emotions in young children. The Family Check-Up program has proven to be successful in the United States, and this is the first time it’s being tested in Canada.

“Sometimes challenging behaviours can lead to greater problems as children get older,” says Dr. Terry Bennett, child psychiatrist at Hamilton Health Sciences and lead investigator of the study. “The idea of ‘Making the Race Fair’ comes from the concept that, as healthcare professionals, can we influence kids towards a more positive path in development to set them up for success as early as we can.” Dr. Terry Bennett and her team at the Offord Centre for Child Studies of McMaster Children’s Hospital and University and McMaster University, have set out to enroll 280 families like Sonja’s who have kids between the age of two and four and are struggling “beyond the terrible two’s”. The Family Check-Up program works with parents on setting family goals and developing the path to achieve them. The study team follows up with families at six and 12 months to gauge their progress. “Ultimately, we hope to follow the participants longer to see if early intervention benefits the kids well into their school age years,” says Dr. Bennett. “We know that early parenting practices influence kids’ ability to learn emotional self-regulation. If we’ve been able to assist in this area by the time they’re entering kindergarten, it should have spillover effects as they progress in to their youth.” Any parent will agree that some days are more challenging than others. Dr. Bennett and her team hope that their work will help those kids who struggle more than others to be able to flourish just the same. “Even if I have to guide my girls differently, I want to ensure they have the same opportunities in life,” says Sonja. “I want to see them grow up together H as equals, as best friends.” ■

Dr. Terry Bennett and her team are running the research study.

Ellie Stutsman works in communications at Hamilton Health Sciences Centre. www.hospitalnews.com

AUGUST 2018 HOSPITAL NEWS 29

PAEDIATRICS

Teen patients got dressed to the nine(tie)s for a prom-inspired after hours event By Krista Pereira t was a blast to the past at The Hospital for Sick Children (SickKids) on Friday, July 13 for the annual prom-inspired after-hours teen event. The event’s vintage vibes brought back memories of the 90s with crazy shapes, neon colours, CDs and Slinkies! The 90s-inspired night was a celebration for teen patients who may not have attended their own high school proms due to health issues. Dedicated SickKids Child Life staff and the Children’s Council make it possible for patients to experience this teen milestone at the hospital every year. This year, around 40 teens showed up for an unforgettable evening of dancing, laughing and making memories. One group of friends made a particularly special memory this year when Jenn Wilton, a 17-year-old SickKids

30 HOSPITAL NEWS AUGUST 2018

patient, made a heartfelt ‘promposal’ to her friends, Carolyn and Vanessa. The three of them have become close friends since getting to know each other at last year’s event. Jenn surprised Carolyn and Vanessa in a beautifully decorated Marnie’s Studio, where she played the piano and sang them her version of “Perfect” by Ed Sheeran. They happily agreed to go to the event with her! Makeup artists and hair stylists arrived early in Marnie’s Studio to help patients and friends get dressed up for the night. The studio was buzzing with excited teens and their families, laughing, chatting and taking pictures together. Teens were also given accessories to spice up their look like hats, sunglasses and jewellery – even choker necklaces to stay true to the night’s 90s theme.

“I like the way I look and feel with or without my hair and makeup done, but it’s nice to get dressed up once in a while. I like seeing all these familiar fac-

es in one place looking so fancy!” says Alexandra, who has been a SickKids patient since she was born. “It’s like we all get to forget our worries for a night.” www.hospitalnews.com

PAEDIATRICS Far Left: Jenn (middle) asked Vanessa (left) and Carolyn to go to SickKids prom with her. Right: DJ Skinnzy played music for guests at the pre-prom. Bottom Left: Guests dancing with an On the Floor Dance Crew member. Before walking the red carpet into the event, teens were invited to a preprom in Marnie’s Lounge. Activities included pool, air hockey, appetizers, and music by DJ Skinnzy, a former SickKids patient. “I spent a lot of time here when I was younger, so it’s nice to be here giving back to the hospital,” says Alex Salmon, A.K.A DJ Skinnzy. As teens entered the prom, they were each given some 90s swag including a neon fanny pack and glow sticks. The rotunda’s decorations stayed true to the theme too. The space was decorated with colourful inflated motifs, Slinkies, and CD disks. There was a spread of delicious food including 90s-themed cake pops and mock-champagne glasses. “Some of the teens here are at SickKids when their proms are going on and some of them are too sick to attend,” says Carolynn Darrell,

SickKids Child Life Specialist. “We really like to provide the opportunity to patients to have this comingof-age experience and to really have fun.” On the Floor Dance Crew got everyone dancing while the DJ played classic 90s throwback hits. Toronto FC soccer players joined in on the

Our earliest memories Continued from page 27 “These results suggest our earliest experiences are not completely forgotten or erased from the brain. Instead, we can bring them back through direct stimulation.” The team used a precise method called optogenetics to selectively stimulate the clusters of neurons that corresponded with the infantile memory. When the researchers tagged the relevant clusters of neurons during training, they inserted a gene to make them responsive to light. Then, the researchers activated the tagged neurons by delivering light into the brain. “The optogenetic strategy we used was crucial to achieve the level of precision needed to test whether we could bring these memories back,” explains Frankland. “We were able to target specific clusters of neurons for specific periods of time to recreate very specific memories.” www.hospitalnews.com

The study’s results point to retrieval failure – difficulty with accessing memories – as only part of the problems contributing to infantile amnesia. Although the adult mice showed evidence of remembering early memories with direct stimulation, the recovery was incomplete, indicating there may be problems with storing these early memories as well. These findings give greater insight into how the brain stores and forgets memories. This research was supported by the Canadian Institute of Health Research (CIHR), the Human Frontiers Science Program (HFSP), the Spanish Ministry of Economy and Enterprise and the SickKids Foundation. It is an example of how SickKids is making Ontario healthier, wealthier and smarter (www. H healthierwealthiersmarter.ca). ■

fun and goofed around with patients on the dance floor and in the photo booth. The After Hours Exclusive Teen Event is made possible through the Dream Delivery program at SickKids.

Thanks to the generosity of the Turning Dreams Into Memories – Ann Storfer Endowment Fund, the program provides unique opportunities for chronic and long-term patients at H SickKids. ■

NOW HIRING!

RN, RPN, PSW & Therapists for Full time and Part time Virtual, hospital and community roles across Canada SE Health (Saint Elizabeth Health Care) is a social enterprise applying our knowledge, vision and drive to forever impact how people live and age at home, today and into the future. As a not-for-profit organization with Canadian roots and 110 years of expertise, we bring quality excellence and innovation to home care, seniors lifestyle and family caregiving. Through our team of 9,000 Leaders of Impact, we deliver 20,000 care exchanges daily, totaling 50 million in the last decade alone.

If you join our team you will become a part of a distinguished Canadian, not-for-profit organization with a century of experience. • You will have access to a total rewards program which includes group benefits and pension plan • You may be eligible for our education bursaries and tuition assistance program • You may have flexible working hours

PLEASE APPLY ONLINE

• You will be provided with an extensive paid orientation and preceptorship program • You will be eligible for subsidized RNAO/RPNAO JOIN OUR memberships HEALTH CARE TEAM TODAY!

www.sehc.com AUGUST 2018 HOSPITAL NEWS 31

KEEPING HOSPITALS SAFE. FIGHTING CANCER. Cobalt-60 from Bruce Power’s reactors helps sterilize 40% of the world’s single-use medical devices, and powers the Gamma Knife, which helps cure brain cancer.

BrucePowerNGS

brucepower4you

@Bruce_Power

@brucepowerngs

LEARN MORE AT WWW.CLEANNUCLEARPOWERSAFEHOSPITALS.COM