Hospital News September 2019 by Hospital News

Inside: Evidence Matters | Ethics | Nursing Pulse | Long-term Care | Online Education

September 2019 Edition

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Preparing for disaster Page 16

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A shot in the dark. Doug Ford and his government are cutting public health units from 35 to 10, while slashing funding without warning. Despite vocal public opposition, they continue to close their eyes to the impact of their decisions â&#x20AC;&#x201C; the reductions in services and access to care that will put the well-being of our communities at risk. Tell your MPP, the Health Minister, and Doug Ford to stop their misguided approach to public health.

Contents SEPTEMBER 2019 Edition

IN THIS ISSUE:

First Canadian patient treated with MR-Linac

5 ▲ Cover story: Preparing for disaster

▲ World Patient Safety Day

COLUMNS Editor’s Note ....................4 In brief .............................6 Online e ducation ............24 Evidence matters ...........32 Long-term care ...............34 Ethics ............................ 44

AGE-WELL National Impact winners

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Climate change places older adults at greater risk We need to plan better to protect vulnerable seniors from the impact of climate change By John Muscedere and George Heckman n elderly man in Ottawa spent most of last winter snowed in, unable to leave his home, surviving on canned food. Last summer, fifty-four people died as a result of a heat wave in Quebec, many of them older adults. Seniors’ communities were quickly evacuated during floods in Calgary, but evacuated residents sat and slept on crowded chairs and cots for three days. These are not disaster movie scenarios, but recent catastrophic events linked to climate change that have directly imperiled Canadians in their own homes – especially our most vulnerable older citizens. Climate change can affect us directly through natural disasters, such as flooding, poor air quality, forest fires and extreme temperatures, but also indirectly, through changing infectious disease patterns such as West Nile Virus and Lyme disease. Climate change events do not affect every Canadian equally. Those who are older and more vulnerable – or frail – find themselves at increased risk. Canada’s population is aging, and its most rapidly growing segment is that of people over the age of 80 years. This trend will continue for the foreseeable future, in tandem with the increasing frequency

and severity of natural disasters due to climate change. At the same time, in accordance with their preferences, more Canadians, including many with complex health needs, are aging at home, usually supported by community health agencies but often far from their families. But extreme climate and weather events may prevent these services from delivering care, leaving seniors isolated and at-risk. The risk is amplified for those seniors who are frail. Frail individuals are those in whom aging has exacted a toll, and the Canadian Frailty Network characterizes ‘frailty’ as a state of increased vulnerability and functional decline. Individuals with frailty are more likely to have multiple medical problems, take multiple medications, and be limited in their ability to get around and carry out activities of daily living. Now, think about what happens if the power goes out for an extended period. Those using mobility aids like scooters, walkers or canes aren’t easily evacuated if elevators don’t work. Many medical devices, like CPAP machines, nebulizers, or dialysis machines won’t work either. If landlines or the internet are interrupted, and as mobile phones run out of power, how can these physically isolated people let others know they are in danger? Continued on page 6

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Monthly Focus: Patient Safety/ Mental Health and Addiction/ Research/Infection control: Developments in patient-safety practices. New treatment approaches to mental health and addiction. An overview of current research initiatives. Developments in the prevention and treatment of drug-resistant bacteria and control of infectious (rare) diseases. Programs implemented to reduce hospital acquired infections (HAIs).

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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.

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NEWS

Photo credit: Bisi Alawode

Sunnybrookâ&#x20AC;&#x2122;s MR-Linac team treated the first patient in Canada on the new MR-Linac â&#x20AC;&#x201C; Elekta Unity in August. The technology combines radiation and high-resolution magnetic resonance imaging (MRI).

First patient in Canada treated on MR-Linac By Alexis Dobranowski n August 15, members of Sunnybrook Health Sciences Centreâ&#x20AC;&#x2122;s radiation team treated the first patient in Canada on the new MR-Linac â&#x20AC;&#x201C; the Elekta Unity. This technology is the first machine in the world to combine radiation and high-resolution magnetic resonance imaging (MRI), and will let the team at the Odette Cancer Centre target tumours and monitor their response to radiation with unprecedented precision â&#x20AC;&#x201C; even as a tumour moves inside the body â&#x20AC;&#x201C; thanks to the machineâ&#x20AC;&#x2122;s real-time MRI guidance. The team watched on MRI as a beam of radiation hit a glioblastoma. Seeing the radiation hit the target means the team can ensure exceptional precision, spare healthy tissue, and adjust the radiation target if needed. As a founding member of the Elekta MR-Linac consortium and the first Canadian centre to install an MR-Linac, Sunnybrookâ&#x20AC;&#x2122;s team made significant contributions to the development and implementation of this technology, beginning with an imaging research study and now embarking on a clinical trial called MOMENTUM (The Multiple Outcome Evaluation of Radiotherapy Using the MR-Linac).

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â&#x20AC;&#x153;We are so excited that our efforts can now benefit patients,â&#x20AC;? said Dr. Arjun Sahgal, radiation oncologist and head of Odette Cancer Centreâ&#x20AC;&#x2122;s Cancer Ablation Therapy Program. â&#x20AC;&#x153;The Elekta Unity will help us target tumours more precisely, sparing the healthy surrounding tissue. â&#x20AC;? Sunnybrook is one of seven centres participating in the MOMENTUM study, the next phase in the clinical implementation of the MR-Linac. The data collected through MOMENTUM will help inform future novel treatment approaches on the machine. Images will be taken on each day of a patientâ&#x20AC;&#x2122;s treatment, and radiation delivery will be adapted based on the image to target the tumour, even as the tumour moves inside the body. This optimal radiation treatment approach aims to improve patientsâ&#x20AC;&#x2122; survival while also reducing damage to the surrounding healthy tissue. Patients enrolled in MOMENTUM will be asked if they are willing to share their de-identified information about their treatment experience, including their MR images and quality-of-life information. At Sunnybrook, the team of radiation oncologists will identify patients to be treated on the MR-Linac, based

on indications that they believe are well-suited for this technology. At Sunnybrook, MOMENTUM will focus initially on glioblastoma and prostate cancer, followed by pancreatic, head and neck, and cervical cancers. Additional cancer sites will be rolled out in a controlled and systematic way, to ensure we are delivering safe, effective treatments on this new device. The implementation of the MR-Linac technology and start of the MOMENTUM at Sunnybrook has been

made possible by a large team of dedicated staff, including radiation oncologists, medical physicists, radiation therapists, researchers, MRI scientists and more. â&#x20AC;&#x153;Through MOMENTUM, we will collect and contribute to data that will help researchers and oncologists here and around the world come up with the best ways of ablating tumours using this technology,â&#x20AC;? said Dr. Sahgal. â&#x20AC;&#x153;This kind of work is so important for improving H patient outcomes and experience.â&#x20AC;? â&#x2013;

Alexis Dobranowski is a communications advisor at Sunnybrook Health Sciences Centre.

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IN BRIEF

Shingles vaccination of older adults cost-effective in Canada

accinating older adults against shingles in Canada is likely cost-effective, according to a study in CMAJ (Canadian Medical Association Journal), and the Shingrix vaccine appears to provide better protection than the Zostavax vaccine. Herpes zoster, or shingles, affects about one in every three adults, causing a painful rash that can result in long-term pain in eight to 27 per cent of people. The study used a model to compare the effectiveness and cost-effectiveness of the recombinant subunit

(RZV, Shingrix) and live attenuated zoster (LZV, Zostavax) vaccines in adults aged 50 years and older in Canada. The LZV vaccine has been available in Canada since 2008, and RZV was approved in 2017. The number of people needed to be vaccinated to prevent one case of shingles was lower for RZV (Shingrix) than for LZV (Zostavax) for all ages. For example, in people aged 60 years, the number needed to vaccinate was 18 for RZV and 78 for LZV. “Our model predicted that the recombinant subunit zoster vaccine is likely cost-effective in Canada for

adults 60 years or older and that it provides greater health benefits than the live attenuated zoster vaccine for all age groups,” writes Dr. Marc Brisson, Centre de research du Centre hospitalier de l’Université de Québec and the Université Laval, Québec, Quebec, with coauthors. The study results are consistent with other economic evaluations in the United States and the Netherlands. “Effectiveness and cost-effectiveness of vaccination against herpes zoster in Canada: a modelling study” H was published August 26, 2019. ■

Seeking Canadian small businesses able to offer innovative solutions to three health challenges s the single largest purchaser of goods and services, the federal government is using procurement to help Canadian small businesses succeed. Through the Innovative Solutions Canada program, government departments are inviting small businesses to propose a new innovative solution that addresses a specific challenge they face. Successful small businesses may receive

up to $150,000 to refine their research and development and could, if accepted into Phase 2, receive up to $1 million to develop a working prototype. The government can then act as a first customer, which helps small businesses to commercialize their innovations, scale up their business and create good middle-class jobs across Canada. Recently, the Honourable Navdeep Bains, Minister of Innovation, Science and Economic Development, and the

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Honourable Mary Ng, Minister of Small Business and Export Promotion, announced the launch of three new challenges from Health Canada. Health Canada is calling on Canadian innovators and small businesses to: 1. Develop an easy-to-use and affordable tool to help medical professionals rapidly diagnose an infection and identify whether it stems from a virus or bacteria. This new development would help fight infections that are increasingly resistant to treatment and ensure patients receive appropriate care. 2. Create a tool that would use artificial intelligence and deep learning to help specialists quickly and effectively match organ donors and compatible recipients, thus improving the success of organ donations and transplants. 3. Find a cost-effective way to test mixtures containing micro-organisms to determine the risks they may pose to human health and the environment. Innovative Solutions Canada is a key component of the government’s Innovation and Skills Plan, a multiyear plan to make Canada a global innovation leader and prepare Canadians to succeed in tomorrow’s H economy. ■

Canadians eager for health care to catch up to the online world ew findings released in a Canadian Medical Association (CMA) report show more and more Canadians believe that connecting data, technology and innovation can help cure their ailing health care system. The report, entitled The future of connected health care, explores Canadians’ perspectives on health care today and the advance of technology such as AI, virtual care and patient platforms.” Within the next 10 years, Canadians expect the health care system to catch up to other industries in offering an online experience. From tracking appointments online (79% think this is likely to happen), to being able to access and share complete medical history with any doctor or health professional at any time (77%) and even booking medical appointments through a robot (72%), Canadians believe that by 2029, health care will be more accessible and will have a more positive impact on their lives. However, they remain concerned about Canada’s ability to adopt virtual care, believing that governments, physicians and patients have been slow to embrace readily available methods.

AMONG THE REPORT’S KEY FINDINGS: • Canadians are ready for an Amazon-like online experience in health care: • 84% are interested in the ability to access all their health information from one platform and 77% agree access to their complete medical history and the ability to share it with any doctor at anytime is likely to happen within 10 years. • Nine in 10 believe they should have full ownership of their health data and 95% believe they should be the ones approving who gets access. • 69% believe having their information in one electronic platform will reduce the chances of medical errors. • Almost half (46%) of Canadians indicated being willing to input their personal health data into a program like Alexa, Siri or Fitbit and 44% would allow the program to Continued on page 7 www.hospitalnews.com

IN BRIEF Continued from page 6 monitor their health and report any issue with a health professional. Patients are ready for virtual care but worry about opening the door to private health care: Roughly two-thirds of Canadians are interested in consulting with various health care providers through a virtual platform. While younger Canadians show greater interest, six in 10 of those 55+ are also highly interested. • Half of Canadians believe virtual care is a step in the right direction, but a majority (77%) worry about the loss of human connection and compassion or opening the door to private health care (71%). To pay or to be paid? • At the same time, 43% of Canadians agree they would pay a subscription fee to have 24/7 access to a family physician, while 34% would pay to have an expanded array of health professionals available at their convenience. • Six in 10 Canadians also believe they should be compensated for sharing H their personal health data. ■

Climate change and older adults Continued from page 4

Canadian seniors take an average of seven different drugs, with one-quarter taking over 10. Any lapse in access to medication can be life-threatening. Frail seniors also have challenges regulating their body temperatures during extremes of heat or cold. They’re also more susceptible to dehydration, infections, and respiratory and cardiac problems from weather events and pollution. And ice and snowstorms result in more falls and fractures. The mental health consequences can also be severe, ranging from depression and anxiety due to social isolation, to PTSD from the experience of a severe weather event. For a frail senior, such mental health

problems lead to further disability and even premature death. These are not worst-case scenarios. These events and their consequences are happening now, and they are increasingly common. Notwithstanding the need for our governments to address the root causes of climate change, a strategy to protect vulnerable seniors from climate change is also required now. Every senior needs an emergency preparedness plan, developed with families, friends and neighbours, and home care agencies. But government agencies and disaster management agencies must also consider and take into account the unique needs of frail Canadians.

A good place to start would be with primary care and community support agencies, where existing standardized assessments could support the creation of a registry of individuals who would require more help during disaster. Knowing where these vulnerable seniors live would help planners know where to deploy community services such as cooling shelters for extreme heat or Snow Angel programs to help clear snow and ice. Through the recognition of the increased vulnerability of our aging and frail population and better planning, Canada can ensure they are as protected and prepared for emergencies as any other group as we face climate H change together. ■

John Muscedere is the Scientific Director of the Canadian Frailty Network, and a Professor of Critical Care Medicine at Queen’s University and George Heckman is the Schlegel Research Chair in Geriatric Medicine and an associate professor at the University of Waterloo, an assistant clinical professor of Medicine at McMaster University, and a researcher with Canadian Frailty Network.

NEWS

World Patient Safety Day designated by the WHO By Sandi Kossey very second of every day, someone in the world suffers an avoidable harm – or has the risk of being harmed – while receiving healthcare. Avoidable harm occurs in all healthcare settings and no one is immune. Patient safety incidents impact all people – patients and their families, healthcare providers and leaders, policymakers – and all of society experiences the tragic consequences. Yet despite the best efforts to address the ongoing toll and effects of preventable harm, the epidemic magnitude of this public health crisis remains largely unrecognized. The burden of injuries and other harm to patients from adverse events is likely one of the top 10 causes of death and disability in the world, comparable to that of tuberculosis and malaria. The available evidence suggests that most of this burden falls on low- and middle-income countries, where 134 million healthcare-associated adverse events occur annually in hospitals, due to unsafe care, contributing to 2.6 million deaths. According to a RiskAnalytica study (2017) that was commissioned by the Canadian Patient Safety Institute, in Canada, patient safety incidents are ranked the third highest cause of mortality, behind cancer and heart disease. In hospitals and home care settings across the country, preventable harm occurs every one minute and 18 seconds, and someone dies from a patient safety incident every 13 minutes and 14 seconds. That is nearly 28,000 people per year. Many countries have prioritized patient safety and observe a national or international patient safety day or week, such as Canadian Patient Safety Week, held annually across the country. This year, for the first time, Canada will join countries around the world to recognize World Patient Safety Day to promote all aspects of patient safety. World Patient Safety Day aims to

Participants of the World Patient Safety Day planning session.

THE BURDEN OF INJURIES AND OTHER HARM TO PATIENTS FROM ADVERSE EVENTS IS LIKELY ONE OF THE TOP 10 CAUSES OF DEATH AND DISABILITY IN THE WORLD. inspire global action for safer systems, services, procedures and practices in healthcare to eliminate avoidable harm, and manage and mitigate risks of harm to people in all care settings. The 72nd World Health Assembly (WHA) recognized patient safety as a global health priority and the 144th Session of the WHO Executive Board adopted the WHA Resolution (WHA72.6), ‘Global action on patient safety’. The resolution endorses the establishment of the first annual World Patient Safety Day, September 17, 2019. Globally, this landmark milestone represents a major achievement in the patient safety movement

after more than 17 long years, and is the 11th campaign mandated by the WHO, joining the ranks of other notable public health priorities such as World Cancer Day and World AIDS Day. In recognition of longstanding contributions to patient safety improvement in Canada and globally, with the support of the Government of Canada, and on the invitation of the WHO Director General, the Canadian Patient Safety Institute was designated as a WHO Collaborating Centre on Patient Safety and Patient Engagement in 2017. We have been actively involved in the events and planning leading up

to the resolution and the global campaign, and are excited to coordinate World Patient Safety Day efforts in Canada. The theme selected for the inaugural World Patient Safety Day is “Speak up for patient safety”. WHO member states/countries from all WHO regions around the world are coordinating memorable and significant events for scaling up patient safety in a national context that create awareness, excitement, involvement, and draw out emotion and compassion. To learn more, visit www.who.int/campaigns/worldpatient-safety-day To recognize the first World Patient Safety Day in Canada, the Canadian Patient Safety Institute, Health Standards Organization (HSO), and CAE Healthcare are hosting a screening of To Err is Human in Ottawa on September 17, 2019. This in-depth documentary addresses this silent epidemic and offers profound insights from those working behind the scenes to fix it. To Err is Human was produced by the family of the late Dr. John M. Eisenberg, a pioneer in patient safety as a past Director of the Agency for Healthcare Research and Quality (AHRQ) in the US, as a tribute to continue the legacy of his important mission. The film showcases solutions, easy to implement, to dramatically and immediately improve the quality and safety of healthcare. The film presentation will be followed by provocative panel discussion including Chris Power, CEO, Canadian Patient Safety Institute, Leslee Thompson, President & CEO, HSO & Accreditation Canada, and Dr. Robert Amyot, Chief Strategic Advisor, CAE Healthcare. We invite you to join us in marking the first World Patient Safety Day. To learn how you can get involved, visit www.patientsafetyinstitute.ca or follow the Canadian Patient Safety Institute H on social media. ■

Sandi Kossey is Senior Director of Strategic Partnerships and Priorities and Director/Head of the WHO Collaborating Centre for Patient Safety and Patient Engagement for the Canadian Patient Safety Institute. Engage with Sandi on Twitter @ptsafety_sandi 8 HOSPITAL NEWS SEPTEMBER 2019

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NEWS

Dispensing Naloxone in emergency department receives positive response By Selma Al-Samarrai ast fall, the Emergency Departments (ED) at St. Michael’s Hospital and St. Joseph’s Health Centre began dispensing Naloxone kits, a drug that helps reverse opioid overdoses. Anyone seeking care in the ED because of opioid use has access to a free kit that has lifesaving results. Fast forward and ED Registered Nurse Krystal Fox says the team has experienced a largely positive reaction from patients and family members who take a Naloxone kit with them after treatment. “Often you feel a bit helpless dealing with patients who are living with addictions. They come into our ED with an overdose, we treat them, they leave and then that’s our only interaction with them,” says Fox. “But with the Naloxone kits, we get a chance to sit with patients in a non-judgmental space and offer them help and advice not only on the dangers of using opioids, but on how to prevent overdose, and the safest way to use opioids which is in the presence of other people. I find it often leaves them with a positive experience with our ED.” When patients’ overdoses are treated at either of Unity Health Toronto’s EDs, their care team sits down with the patient and their loved ones to discuss addictions resources that are available to them in their community. They also go through the kit using a checklist to make sure they know when and how to use it. Patients can’t use the kit for themselves but they can help save a friend and families can help safe a family member. “Patients and their families have been very grateful for the kits,” says Fox, recalling a recent encounter she had with a family of a patient who was admitted because of an opioid overdose. “I was able to sit with and teach the family members and the patient

Kate MacWilliams, clinical nurse specialist for the ED (left) and ED Registered Nurse Krystal Fox are holding the Naloxone kits dispensed to patients and family members at Unity Health Toronto’s two emergency departments. how to use the kit and what to do in case of an overdose, and it felt like the conversation really empowered them. They were so thankful that they’d have an opportunity to save their loved one’s life in case an overdose happens again,” explains Fox. Kate MacWilliams, clinical nurse specialist for the ED, was part of the team involved in setting up the Naloxone program at St. Michael’s ED and in other mental health services areas. The implementation of the Naloxone program involved external consultations with substance users in the community.

“As health care providers, it’s easy to make assumptions about what you perceive the needs of your patients to be, but you don’t really know unless you ask them,” explains MacWilliams. The lines of communication remain open as the team continues to collect feedback to enhance the program after its implementation. The most recent input from the local community shows that some prefer the injectable form of Naloxone to the nasal spray because the spray contains a larger dose that can cause stronger withdrawal symptoms. However, the

nasal spray limits risk to the person administering the medication because the injectable form of Naloxone creates the risk for a needle stick injury. Because of this particular consultation feedback, the St. Michael’s ED now carries Naloxone in both forms. “Providing exceptional care can only be achieved if you include the valuable perspectives of patients and families. In this particular project, the perspectives we received were so important because they came from marginalized community members whose voices are often not heard,” explains H MacWilliams. ■

Selma Al-Samarrai works in communications at Unity Health Toronto. 10 HOSPITAL NEWS SEPTEMBER 2019

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NEWS

Electronic triage support tool

continues to grow, support consistency By Sayurie Naidoo riage nurses are typically the first clinician that people see when they arrive at an emergency department (ED). These nurses must be able to assess and act quickly, and have excellent communication and observational skills. They also need thorough knowledge and understanding of the Canadian Triage Acuity Scale (CTAS). Using CTAS, triage nurses prioritize patient care on a five-point scale, ensuring the sickest and highest risk patients are seen first. But to calculate a CTAS score, triage nurses must consider thousands of possible combinations of the 169 presenting complaints and more than 400 modifiers that refine the severity of the patient’s vital signs and symptoms. In September 2016, Hospital News reported that an electronic version of CTAS (eCTAS) would launch to improve emergency room triage accuracy for better patient care in Ontario. eCTAS is a decision-support tool that recommends a triage score based on information that nurses enter into the system, in alignment with the CTAS guidelines. Developed by CCO (which, in time, will be Ontario Health), eCTAS has expanded across Ontario and shown a proven improvement in triage consistency. As of August 2019, 107 hospitals in Ontario are using the nurse-designed eCTAS system. As a result, 85 per cent of all patients in Ontario EDs are triaged with this innovative electronic tool. “eCTAS has become a welcome and valuable electronic decision-support tool for use by Ontario’s highly educated and experienced triage nurses,” says Janice L. Spivey, a board member of the Emergency Nurses Association of Ontario. Post-implementation audits confirm the program is supporting triage nurses in making accurate decisions in

AS OF AUGUST 2019, 107 HOSPITALS IN ONTARIO ARE USING THE NURSE-DESIGNED ECTAS SYSTEM.

the assignment of the CTAS score for emergency patients. Research showed a 17 per cent improvement in triage accuracy for hospitals using eCTAS, effecting approximately one in six patients with minimal impact to triage time. Improved accuracy means fewer patients are under-triaged, improving patient safety in EDs across Ontario. The research findings will be published in an upcoming issue of the American College of Emergency Physicians journal, Annals of Emergency Medicine. The electronic tool was designed with input from a 90-member working group of triage nurses and ED educators and administrators. Based on their design inputs, eCTAS displays all the information needed by triage nurses on a single screen. “This is an easy-to-use, one-stop shop solution that meets the needs of frontline professionals. In a single view, they can triage, document assessments, enter vital signs and get the right CTAS score for their patients,” says Joy McCarron, Clinical Lead for eCTAS.

The program is supported by key national and provincial partners, including the Canadian Association of Emergency Physicians and the CTAS National Working Group. McCarron emphasizes that the CTAS National Working Group is responsible for determining the content of the guidelines. “CCO can’t change the modifiers or the way the scores are developed, but we can share insights with the CTAS National Working Group for future enhancements,” she says. The eCTAS database now contains more than four million patient visits, making it the largest triage database of its kind in Canada. The robust dataset allows CCO to evaluate and monitor for trends and identify areas for improvement. For example, triage nurses may flag through eCTAS that modifiers are missing for certain conditions. CCO would then share this information with the CTAS National Working Group to consider when updating the guidelines. Hospitals can also use their local data to iden-

tify educational needs (e.g., if there is consistently high overrides of recommended CTAS scores). Another key feature of eCTAS is a visual alert that conveys updates about infection risks from around the world. “This feature is so important, as infection risks can travel quickly from anywhere in the world to Canada,” says McCarron. She gives a recent example involving a new antibiotic-resistant strain of typhoid from Pakistan. Within two hours of receiving the information about the risk from Public Health Ontario, CCO had embedded the update in eCTAS. If a triage nurse entered “Pakistan” in the travel history field, an alert appeared on the screen along with instructions on how to control the risk. “It is exciting to see this program grow,” says McCarron. “Now other provinces are looking at eCTAS and exploring how they can emulate the program to improve the safety and consistency of triage across H Canada.” ■

Sayurie Naidoo is a Communications Advisor at Cancer Care Ontario. 12 HOSPITAL NEWS SEPTEMBER 2019

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NEWS

Ontario paediatric emergency departments order fewer low-value imaging tests than US counterparts L

ower use of imaging tests in Ontario paediatric emergency departments (EDs) was not associated with higher rates of poor outcomes, suggesting that use may be safely reduced in the United States, according to a new study by researchers at ICES and The Hospital for Sick Children (SickKids). Choosing Wisely, a campaign targeting overuse of care that provides little benefit, was launched in 2012. Diagnostic imaging (e.g. MRIs, ultrasounds and x-rays) overuse in children seen in EDs accounts for three of the first five of the American Academy of Pediatrics Choosing Wisely recom-

mendations and six of the 10 Choosing Wisely recommendations for emergency medicine in Canada. The study, published June 3rd in JAMA Pediatrics, compared the use of low-value diagnostic imaging rates from four paediatric EDs in Ontario to 26 in the United States from 2006 to 2016. The researchers looked at data for children 18 years and younger who were discharged from the ED during the study period with a diagnosis for which routine use of diagnostic imaging may not be necessary, like asthma or constipation. “This finding was most pronounced for diagnostic imaging associated with radiation exposure such as plain radio-

graphs and CT scans for concussion and gastrointestinal complaints like constipation and abdominal pain. Although not commonly used in either country, abdominal CT scan use was approximately 10-fold lower in Canada than the US for both constipation and abdominal pain,” says Dr. Eyal Cohen, lead author of the study, co-founder of the complex care program and interim head of the Child Health Evaluative Sciences program at SickKids, and adjunct scientist at ICES. The researchers found lower imaging rates in Canada were not associated with future hospitalization, intensive care unit admissions, surgery, or death.

Minimizing care that provides little benefit to patients has become an important focus to decrease health care costs and improve the quality of care delivery. Diagnostic imaging in children is a common focus for campaigns designed to reduce overuse both in Canada and the US. “There may be opportunities to safely reduce low-value imaging in pediatric emergency departments in the United States to better align resource use with high-quality care delivery,” adds Cohen. The study “Low-value diagnostic imaging use in the pediatric emergency department in the United States and Canada,” was published in the June 3 H issue of JAMA Pediatrics. ■

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This course is cosponsored by the Institute for Natural Resources (INR). This program is approved by the National Association of Social Workers (Provider #886502971-4888) for 6 Clinical Social Work continuing education contact hours. The Institute for Natural Resources, Provider #1356, is approved as a provider for social work education by the Association of Social Work Boards (ASWB) www.aswb.org, through the Approved Continuing Education (ACE) program. The Institute for Natural Resources maintains responsibility for the program. ASWB Approval Period: 02/28/2019 â&#x20AC;&#x201C; 02/28/2022. Social workers should contact their regulatory board to determine course approval. Social workers participating in this course will receive 6 clinical continuing education hours.

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at the door if space remains. CREDIT CARDS: Most credit-card charges will be processed in Canadian dollars. Some charges will be in U.S. dollars at the prevailing exchange rate. The tuition includes all applicable Canadian taxes. At the seminar, participants will receive a complete course syllabus. Tuition payment receipt will also be available at the seminar.

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COVER

Preparing for disaster By Jeffrey Tochkin, Caroline Nolan and Sarah Hartwick ospitals are experts in emergencies. Staff train for years to respond effectively and save lives daily. But, when an emergency exceeds capacity and becomes a disaster â&#x20AC;&#x201C; whether a flood, tornado, shooting or major

collision â&#x20AC;&#x201C; it requires a more coordinated response. Disaster events in our communities are on the rise, and they regularly test hospitals throughout the country. As the Regional Trauma Centre for eastern Ontario, preparing for disaster

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16 HOSPITAL NEWS SEPTEMBER 2019

has become a part of the culture at The Ottawa Hospital. In 2019, this paid off when the hospital declared a Code Orange for the first time in five years.

PRACTICING FOR A DISASTER Over the past few years, in collaboration with departments from across the hospital, The Ottawa Hospitalâ&#x20AC;&#x2122;s Emergency Management team has revamped its corporate Code Orange Plan and has run regular training exercises to test it. Following a number of incidents in the Greater Toronto Area in mid2018, the hospital decided to run a major exercise to field-test its Code Orange Plan. â&#x20AC;&#x153;Practice makes perfect,â&#x20AC;? said Dr. Andrew Willmore, the hospitalâ&#x20AC;&#x2122;s Medical Director for Emergency Management. â&#x20AC;&#x153;We spend a lot of time thinking about what the best response to a Code Orange will be, and we leverage academic literature and experiences from other institutions. Once we have our policy, we have to test it. If it doesnâ&#x20AC;&#x2122;t work on the front lines to improve our response, we need to make changes.â&#x20AC;? After six months of planning, in November 2018, the Emergency Management team ran the hospitalâ&#x20AC;&#x2122;s largest-ever exercise: a simulated active shooter. The exercise designers developed a scenario involving a shooter at a local convention centre. Over the 75 minutes, 20 casualties arrived at the

hospitalâ&#x20AC;&#x2122;s Civic Campus Emergency Department. The primary goals for the day were to evaluate how patients were triaged, how patients moved through the department, and command post communication in the Emergency Department. The exercise included dozens of departments and services from the hospital, with the majority from the Emergency Department, the Trauma Team and the Surgical Suites. To avoid putting any strain on regular operations in the Emergency Department, staff came in specifically to take part in the exercise. Controllers and Evaluators watched and recorded the activity. Staff from the hospital and from partners across the city, including Canadian Armed Forces Personnel, came to observe. Realism was key in setting the scene for health-care providers taking part in the exercise. Volunteer medical students were in full â&#x20AC;&#x153;moulageâ&#x20AC;? casualty make-up, and a simulation mannequin gave the team a life-like experience.

BEHIND THE SCENES: PLANNING THE EXERCISE Designing such a large exercise takes expertise and attention to detail. In this case, the design team chose an in-situ simulation for the exercise, but has previously used tabletop exercises, drills, seminars and workshops with good results. www.hospitalnews.com

COVER The Code Orange exercise in November, 2018 was one of The Ottawa Hospital’s largestever simulated responses. It tested how well the hospital’s plans would translate into a real-life response to mass casualties.

Over the course of the 75-minute exercise, 20 patients came through the doors, most of them medical students from the University of Ottawa.

The in-situ and simulation was planned for a Friday morning before flu season was in full force, when the Emergency Department likely wouldn’t be over-capacity. Its aspects led to a collaborative effort between Emergency Department leadership, Simulation Centre Faculty and Staff, and Emergency Management staff. Ahead of the exercise, regular planning meetings kept the design on track and prepared the participants for their roles. A “go/no-go” decision was held just before the start of the exercise to allow for last-minute flexibility and ensure real patients in the department wouldn’t be affected.

partment to receive trauma patients. In all, 13 patients from the collision went to the Civic Campus, while six went to the hospital’s General Campus. The response was fast, effective and undoubtedly saved lives. Many of the staff members involved that day credit the November exercise with preparing them and improving the hospital’s response at exactly the right time. “It was important to have had [the simulation] fresh in back of your mind. That really helped,” said Dr. Adnan Sheikh, head of Emergency Radiology, in the days following the event. “That was the preparatory course, and Friday H was the exam.” ■

REAL-LIFE DISASTER: CODE ORANGE AT THE OTTAWA HOSPITAL Two months after the exercise, the lessons learned paid off when the hospital had to declare a Code Orange. On a Friday afternoon in January 2019, a

double-decker city bus collided with a bus shelter at Ottawa’s Westboro transit station. Within minutes of the news breaking, the hospital quickly activated the Trauma Team and declared a Code Orange. Response teams from all over the hospital converged on the Emergency De-

Jeffrey Tochkin and Caroline Nolan are Emergency Management Coordinators at The Ottawa Hospital, and led the design of hospital’s largest-ever Code Orange exercise. Sarah Hartwick is a Communications Officer at The Ottawa Hospital.

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SEPTEMBER 2019 HOSPITAL NEWS 17

NEWS

Jeya Nadesalingam is a phlebotomist at St. Joseph’s Health Centre.

Faster, better

ED care By Amber Daughtery

ost patients probably don’t think twice about who’s drawing their blood or starting their IV in the hospital. But in the Emergency Department at St. Joseph’s Health Centre, it’s because of who’s doing this that patients are receiving care faster. An innovative collaboration has placed St. Joseph’s phlebotomists (also known as medical lab technicians, or MLAs) – who traditionally work behind the scenes and in outpatient clinics – right in the heart of the busiest area, helping relieve pressure on nurses and physicians.

EDS ARE BUSY PLACES AND ST. JOSEPH’S IS BUSIER THAN MOST, WITH MORE THAN 100,000 PEOPLE COMING THROUGH EACH YEAR.

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18 HOSPITAL NEWS SEPTEMBER 2019

Two years ago, MLAs started drawing blood in the ED, performing the task that would typically take nurses away from other pressing priorities. As an added benefit, because the MLAs are specially trained in blood collection, there were fewer errors related to the samples and labeling, preventing patients from having to have blood drawn multiple times. Taking it one step further, MLAs have now had their roles expanded to be able to start intravenous (IV) lines, again speeding up care and freeing up capacity in other providers.

“In this situation, we had to rewrite their job description,” said Chief Technologist Yvette Williams. “We had to ensure that the current medical directives in the ED were revised to include permission for MLAs to start the IV lines. What was really great was that most of our MLAs were already trained in this area and they were excited to be able to do it.” “I love the Emergency Department environment,” said Jeya Nadesalingam, a phlebotomist. “I did a trial placement here and loved it so much I didn’t want to leave. It’s lively and active and it lets me constantly interact with patients which is very rewarding.” EDs are busy places and St. Joseph’s is busier than most, with more than 100,000 people coming through each year. When MLAs were only able to draw blood, patients still had to wait for a nurse to do an IV insertion. Having MLAs able to do both means there’s less waiting for patients. “They’re taking on more of an active role in what is really a teambased environment,” said laboratory manager Adnan Khan, “We’ve heard positive feedback from everyone – both the MLAs and nurses are learning from one another and appreciating what the other is doing.” Because of the success at St. Joseph’s, a similar model is being implemented at St. Michael’s Hospital. “Our main goal is always to do what’s best for our patients,” said Williams. “And having specialized MLAs supporting other providers in the ED means patients are having fewer samples taken, there’s a lower risk of error and patients can move through as H quickly as possible.” ■

Amber Daughtery works in communications at Unity Health Toronto. www.hospitalnews.com

NEWS

Surgeons insert 3D ankle bone into BC man’s ankle By Ann Gibbon n June 2017, White Rock, British Columbia resident John Jefferson and his wife Shannon were in eastern Washington State, doing what they loved – riding their motorcycles, enjoying the wind and the open road. Then in one quick moment, his life changed and a health nightmare began. A deer abruptly jumped into his path. Jefferson, 71, struck it and hit a guardrail. A key bone in his ankle, the talus, burst right out of his right foot – it was “extruded,” he says. Wife Shannon had the presence of mind to grab the bone in the hopes it could be reinserted, her husband was airlifted to a Seattle hospital and doctors there surgically put it back into place.

But back in White Rock, the wound got severely infected and he required regular intravenous antibiotics. Things improved somewhat, but then by spring 2018, the ankle got so bad that doctors were considering amputating his foot. Last August, his dead talus bone was removed. Jefferson refused to even consider an amputation, vowing to find a way to walk again. Instead he began researching 3D talus bone replacement. He found that Duke University was using technology to make 3D-printed bones. Then he found a Texas company that made the bone but the cost of getting the surgery in the US was prohibitive, about $100,000. The 3D-printed bone itself cost $12,000.

Enter Dr. Alastair Younger, a St. Paul’s Hospital orthopedic surgeon. Dr. Younger wanted to try the surgery in Canada but the cost of the replacement bone wasn’t covered by Health Canada, which deemed the surgery experimental. The two kept the pressure on, and then finally on May 24, Dr. Younger and his team conducted the first 3D-printed talus bone surgery and total ankle replacement in Western Canada. A 17-ounce cobalt-chrome talus bone now sits in John’s ankle. He also has a model of it on his living room table. (The Texas bone maker sent three sizes of bones as options). After two years in a wheelchair, he is starting to walk again, just short distances – 100 metres or so at a time. He’s driving, too.

John Jefferson with a 3D talus bone replacement. Dr. Younger says John’s story of perseverance is inspiring, and he’s been approached by others to get the 3D surgery. He says the benefits are endless. The 3D bone is cheaper than a prosthetic and the outcome for patients – the ability to walk again – is H priceless. ■

Ann Gibbon is a Senior Communications Specialist at Providence Health Care in British Columbia.

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NEWS

Journey toward Trauma Distinction Accreditation By Niall Emmott f you were to experience a traumatic and complex injury such as a major burn, a gunshot wound or a brain injury in Alberta, you’ll be accessing a consistent, gold standard of care, thanks to a provincial system for trauma care services. A trauma system connects different facilities and services that care for patients with complex and life-threatening conditions. Alberta is one of two provinces – the other is B.C. – that have established a provincial system.

TRACKING DATA ACROSS THE PROVINCE BENEFITS OUR CARE TEAMS AND, ULTIMATELY, OUR PATIENTS.

“A provincial system enables us to apply best practices and make improvements across the system, instead of being limited to a zone or a type of setting, like a bigger city,” says Christine Vis, manager of Trauma Services at the Foothills Medical Centre. “No matter where patients are, our goal is to provide a gold standard of care and help them return to their homes and communities, healthy and happy.” Taking a provincial approach to trauma services is unique to Alberta, but it isn’t new. The provincial trauma services team came together in 1999 with 10 sites in five zones and were already working together prior to Alberta Health Services being established. Since then, they have standardized practices and care so every patient receives the same high standards of care, regardless of where they live.

The provincial trauma services team came together in 1999 with 10 sites in five zones and were already working together prior to Alberta Health Services being established. Another unique feature is Alberta’s Trauma Registry. The registry captures data from every patient who goes through the system, from ambulance to rehabilitation. As a result, healthcare workers have unprecedented access to information and data, which is then measured to continually improve processes and performance. “Tracking data across the province benefits our care teams and, ultimately, our patients,” says Rosmin Esmail, provincial trauma epidemiologist. “We review data for quality, perfor-

mance, and benchmarks, which then enables us to improve in all levels of care and standardize our practices. Because we measure it, we can improve it.” Trauma teams in Foothills Medical Centre, the University of Alberta Hospital and the Royal Alexandra Hospital also participate in the American College of Surgeon’s Trauma Quality Improvement Program (TQIP). Doing so allows Alberta to benchmark against seven leading centres in Canada and 800 centres in the U.S.

This work is leading toward Alberta Trauma Services’ application to secure Trauma Distinction from Accreditation Canada. If achieved, it will be the first time a provincial system has received this distinction. “We’ve standardized protocols and policies across Alberta and continue to identify where there may be gaps in service and areas in order to continually improve,” says Esmail. “Over the years, Alberta’s trauma system has evolved to become the leader for trauma services in Canada. Our H province is setting the gold standard.” ■

Niall Emmott is a Communications Advisor, Provincial Programs at Alberta Health Services. 20 HOSPITAL NEWS SEPTEMBER 2019

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Brian’s all in.

Brian Cameron likes to win. Be it in the courtroom, or playing poker in his downtime, this hardworking lawyer knows how to keep his cards close to his chest, which may be one reason why he’s at the top of his profession. As a personal injury litigator, Brian gets satisfaction from the opportunity to make a difference in the quality of his clients’ lives, especially when they may not yet be aware of the hand that they’ve been dealt. What makes him a good poker player also helps him win cases. “I see myself as a storyteller. I share my client’s life story with the jury so they can see how drastically the defendant has changed their life … and I have a good poker face when I need one.” Brian excels at breaking down legal complexities to their simplest form for his clients. He treats them with a level of dignity and compassion that has contributed to his being recognized as a certified litigation specialist. That kind of passion, commitment and dedication means that Brian’s all in when it counts the most.

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NEWS

From the ICU to prom:

Intensive care team makes a dream come true By Julie Dowdie t’s late afternoon on May 23rd and Elena Papapetrou looks radiant as she sits smiling in a beautiful pastel pink gown ready for her prom. Family and friends are equally exuberant as group photos and selfies are taken and final preparations are made for the evening’s festivities. Although this may seem like your average pre-senior prom scenario, it’s unique in that Elena is leaving for the event not from a house or a beauty salon, but from the Intensive Care Unit at Markham Stouffville Hospital (MSH). “My friends and I have been talking about going to prom ever since grade nine, so it was really upsetting for me when I had to go into the hospital,” says Elena, who was admitted to MSH’s Markham site with an infection on May 10. Elena’s infection required her to have emergency surgery in the early hours of May 11 by general surgeon Dr. Jennifer Li and be transferred to the ICU for monitoring. “As she was wheeled in for surgery and every day after that as she recovered, all Elena kept asking was ‘am I still going to prom?’” says Elena’s mother Sev. At first, Elena’s care team had their doubts about whether she would be able to leave the hospital in time for her prom, but “the amazing doctors and staff at MSH took such good care of her and worked so hard to try and figure out a way for her go,” explains Sev. The final confirmation came following another surgery by plastic surgeon Dr. Tara Teshima to close her wound just a day before the big event. “Dr. Teshima told me everything went fantastic with the surgery and asked me when her prom was,” says Sev.

Elena Papapetrou with the team who helped her get to prom. “When I told her it was the next day, she says ‘I think she can go’.” Elena received the good news the day of prom at lunch time. From that point on, Elena’s room turned into a whirlwind of excitement and preparation. “The staff were so accommodating and helpful,” says Sev. “A staff member who used to be a make-up artist did her make-up. Her nurse who had nail polish with her did Elena’s nails.

A physiotherapist brought two different cushions for her wheelchair to see which one would be most comfortable for Elena with her dress. We totally didn’t expect it.” Dr. Atul Bansal was the ICU physician who cared for Elena. He describes the experience as “absolutely incredible.” “I’m so glad that we could help this patient realize her dream of going to prom. As much as we strive to deliv-

er leading-edge medical care, we also strive to deliver an outstanding patient experience. Elena’s care journey is a testament to the holistic care provided by all members of our hospital family to everyone in the community that we are fortunate to serve,” Dr. Bansal says. “The amazing teamwork is one of the reasons why I love working in the ICU,” adds Jennifer Wirch, the physiotherapist who cared for Elena.

Julie Dowdie is a Senior Communications Specialist at Markham Stouffville Hospital. 22 HOSPITAL NEWS SEPTEMBER 2019

www.hospitalnews.com

NEWS A nurse does Elena’s make-up in preparation for the prom.

“From her Wound Care Nurse Practitioner, to the Pain Service Advanced Practice Nurse, the Orthopaedic Patient Navigator who did her make-up, Drs. Li, Teshima and Bansal, as well as Elena’s nurse, everyone did their part to make her prom day a great success.” Cece Pastor, the charge nurse on duty in the ICU that day, echoes these comments. “Even before we knew for sure that Elena could go to prom, we wanted to help get her as ready as possible so she might be able to participate by video conference,” she says. “But once it was confirmed, it was so special to be a part of this ‘behind the scenes’ effort. When Elena came out of her room to leave for prom, many of the staff – especially those of us who are parents – teared up, she looked so beautiful.” After spending about two hours with her friends and boyfriend at the prom, Elena returned to the hospital

as tired as she was happy to continue her recovery from surgery. “We are so grateful for everything the staff and doctors at MSH did for Elena,” says Sev. “It was remarkable how everyone came together for her, not just that day, but throughout her stay at the hospital.” Sev points out that “MSH has always been our family’s hospital. We live just five minutes from the Markham site, both Elena and her younger sister were born there and our family has received care there. But if we were familiar with the hospital before, the compassionate and thoughtful care we received for Elena is something we will now never forget.” Elena was discharged from MSH just four days after her prom and is doing well at home. Her thoughts on being able to attend her prom are simple: “It was a hectic and crazy day, but H also a perfect day.” ■

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Youngsters help student researchers make the grade By Alexis Dobranowski group of enthusiastic 5th graders took some time out of their summer vacations to visit Sunnybrook for a special contest. As part of the Sunnybrook Research Institute 407 ETR Summer Student Research Day, Sunnybrook’s summer students were invited to submit a simple summary of their work in a way the public – even kids – would understand. More than 70 projects were submitted. Five finalists competed for a cash prize. Fifteen youngsters took part in judging the finalists, who presented complicated research about using virtual reality to help detect Alzheimer’s disease, Ontario’s platelet transfusion

rates, teaching spinal surgery, using focused ultrasound to get drugs into the spinal cord, and how high temperatures might affect doctor’s performance – all using simple language. “My study is trying to research the ways to make it safer for doctors and nurses to treat patients with Ebola. At the Toronto military base, we have a temperature chamber that can be set to both hot and cold conditions,” explains Sarah Mullin, who worked this summer with Dr. Rob Fowler. “During the study, the doctors have to put on full protective gear and perform medical procedures on mannequins inside the temperature chamber. Continued on page 26

Mohawk College creates Perioperative Pocket Guide

orking with instructors, Jeff Blunt and Mindy Colburn, Mohawk College has created two new pocketbook guides; one highlights the skills required in the operating room, the other outlines the common general surgery instruments. Their 26 years of operating room experience in front-line nursing, education and institutional leadership has provided the opportunity to identify the learning needs of novice perioperative professionals. Currently, the only time to memorize these instruments is in the operating room, during surgical procedures. The pocketbooks will provide students with more confidence in an operating room setting. These pocketbooks will offer nurses and other healthcare professionals the opportunity to review operating skills and instruments prior to a case, or possibly intraoperatively. With this new resource, we believe Mohawk College has provided graduates of their program an advantage in the operating room by reducing the pressure for memorization.

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24 HOSPITAL NEWS SEPTEMBER 2019

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ONLINE EDUCATION

5th graders visited Sunnybrook in August to judge a competition where summer research students use plain language to explain their research to make it accessible to the public. Photos by Kevin Van Paassen

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ONLINE EDUCATION

Youngsters help student researchers Continued from page 25 Researchers watch the doctors from a window outside the hot chamber and use a checklist to grade their performance on these tasks.” The young students listened carefully and asked questions to make sure they understood the presentations. Miles Jonson, a student at University College Dublin, was awarded first place for his presentation called: Can 3D Video Games Help Detect Alzheimer’s Disease? “Have you ever gotten lost on your way to the kitchen to find ice cream? That might sound silly. How can you get lost in your own house? For most people, finding their way around their home, their neighbourhood and their school is easy. But for people with some types of brain disease, like Alzheimer’s Disease, it can make remembering

where the ice cream is, and even getting around places you know, like your home, really hard,” Miles explained.

Positioned for success

Kristin is evidence that the online Master of Health Management (MHM) Program positions students for success, and enhances their career growth. She believes “the MHM Program teaches leaders crucial translational knowledge that can impact and elevate a student’s personal and professional life, as well as the quality of healthcare in Canada.” When she embarked on her MHM journey, Kristin was Operations Manager of a Neurosurgery & Stroke at a large hospital in Windsor, Ontario. Here, her greatest accomplishment was the establishment of a 16-bed acute stroke unit. In her second year of the Program, she was promoted to the position of Director of Critical Care & Cardiology. And most recently, Kristin was the successful candidate for Vice President of Patient Services & Chief Nurse Executive at Erie Shores Healthcare. “Without the foundational learnings of the MHM Program I know that I would not have had such a swift trajectory in this part of my career. As I have overseen the development of quality initiatives and a standard model of care I have leveraged the theory of each class as a source of reference and opportunity”, she says. 26 HOSPITAL NEWS SEPTEMBER 2019

Miles spent his summer with supervisor Dr. Fahad Alam, working on a 3D virtual reality maze that may help doctors detect and eventually treat Alzheimer’s Disease. Miles said participating in the 5th Grader Day was a lot of fun. “The kids were really engaged and asked really great questions,” Miles says. “Events like this are important for the kids because it gives them an opportunity to learn about new and innovative science at a level geared towards their understanding.”

In addition to the presentations, the young students tried their hands at pipetting with scientist Jarkko Ylanko and checked out some very realistic mannequins and equipment in the Sunnybrook Canadian Simulation Centre with educator Susan De Sousa and simulation specialist Roman Tymchal. The Tell it to a 5th Grader Research Day is part of Sunnybrook’s ongoing effort to involve the community in all aspects of the health-care setting and bring research to the public. Congratulations to Miles and the

THE TELL IT TO A 5TH GRADER RESEARCH DAY IS PART OF SUNNYBROOK’S ONGOING EFFORT TO INVOLVE THE COMMUNITY IN ALL ASPECTS OF THE HEALTH-CARE SETTING AND BRING RESEARCH TO THE PUBLIC. And, he adds, it’s just as important for the researchers. “It ensures that we truly understand our own work to a depth that we can explain it to anyone. In a medical context, this is important to help explain issues and concepts to patients.”

other finalists: Sarah Mullin, MaryJane Hill-Strathy, Daniel Sherman and Christina Ding. A big thank you to all our judges: Adnan, Ari’i, Christopher, Emilija, Emma, Hazel, Jacob, Jordyn, Mateo, Olivia, Rose, Samantha, Sam, Stephen H and Sydney. ■

Alexis Dobranowski is a communications advisor at Sunnybrook Health Sciences Centre. www.hospitalnews.com

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Surgery simulators are key to assessment of trainees achine learning-guided virtual reality simulators can help neurosurgeons develop the skills they need before they step in the operating room, according to a new study. Research from the Neurosurgical Simulation and Artificial Intelligence Learning Centre at the Montreal Neurological Institute and Hospital (The Neuro) and McGill University shows that machine learning algorithms can accurately assess the capabilities of neurosurgeons during virtual surgery, demonstrating that virtual reality simulators using artificial intelligence can be powerful tools in surgeon training. Fifty participants were recruited from four stages of neurosurgical

training; neurosurgeons, fellows and senior residents, junior residents, and medical students. They performed 250 complex tumour resections using NeuroVR, a virtual reality surgical simulator developed by the National Research Council of Canada and distributed by CAE, which recorded all

Photo credit: Helmut Bernhard/The Neuro

Machine learning-guided virtual reality simulators can help neurosurgeons develop the skills they need before they step in the operating room.

How to Harness On-Demand Learning Shannon Hunt

Director, Multichannel Content Delivery Public Services Health & Safety Association On-Demand Learning is one of the latest trends in eLearning. On-Demand Learning refers to accessing the information you need when you need it. This can be compared to searching online for a short video tutorial when looking for instructions on something specific, such as a cooking technique or how to clean an appliance. The use of platforms and the generation of content covering numerous areas of interest is what facilitates this type of learning. Massive Open Online Courses (MOOC) are comprised of various course elements, such as videos, interactions or knowledge checks, which can be called up on demand and completed individually. We are also seeing platforms emerge that are searchable and can pull results from several MOOCs, courses or other content, allowing for a custom learning experience that is specific to exactly what is needed at that moment. This can be particularly useful when the learner is looking for a quick review or to verify information. On-Demand Learning is coupled with the trend of MobileReady Learning. We are also seeing the use of gamification that can be used to incentivize and reward learners for completing modules, certain learning elements or an entire curriculum. These online leaning trends are influencing how learners access and consume content, and shaping the way organizations are building digital learning solutions for their workplaces. Public Services Health & Safety Association has an in-house eLearning team with experience in on-demand learning and expertise creating exceptional digital learning experiences.

28 HOSPITAL NEWS SEPTEMBER 2019

instrument movements in 20 millisecond intervals. Using this raw data, a machine learning algorithm developed performance measures such as instrument position and force applied, as well as outcomes such as amount of tumour removed and blood loss, which could predict the level of expertise of each participant with 90 per-cent accuracy. The top performing algorithm could classify participants using just six performance measures. This research, published in the Journal of the American Medical Association on Aug. 2, 2019, shows that the fusion of AI and VR neurosurgical simulators can accurately and efficiently assess the performance of surgeon trainees. This means that AI-assisted mentoring systems can be developed that focus on improving patient safety by guiding trainees through complex surgical procedures. These systems can determine areas that need improvement and how the trainee can develop these import-

ant skills before surgeons operate on real patients. “Physician educators are facing increased time pressure to balance their commitment to both patients and learners,” says Dr. Rolando Del Maestro, the lead author of the study. “Our study proves that we can design systems that deliver on-demand surgical assessments at the convenience of the learner and with less input from instructors. It may also lead to better patient safety by reducing the chance for human error both while assessing surgeons and in the operating room.” Research funding for this study was provided by Franco Di Giovanni Foundation, the Montreal English School Board, the McGill Department of Orthopedics, the Fonds de recherche du Québec – Santé (FRQS), and a Robert Maudsley Fellowship for Studies in Medical Education from the Royal College of Physicians and H Surgeons of Canada. ■

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NEWS

Preventing workplace violence:

Majority of health professionals lack necessary training By Susan Driscoll ccording to a recent study, workers in health occupations in Canada had the highest probability of reporting workplace violence and harassment on the job over the previous year. Last year, Canada’s Ministry of Labour established a program to specifically address workplace safety. The most common form of workplace abuse among Canadian women and men is verbal abuse – with women more likely to report abuse than men. It is a growing problem that can no longer be ignored. Recent research by the Crisis Prevention Institute Inc. (CPI), the leading international workplace violence prevention trainer, indicates healthcare workplace violence prevention training needs are increasing and going unmet. Healthcare professionals predict training needs will increase

by 20 per cent or more over the next three years driven by regulatory pressures, employee demand and increasing risk exposure.

To address these concerns, CPI has created its new Verbal Intervention ™ Training. The program features verbal and non-verbal de-escalation tech-

niques blending online and in-person learning to provide an impactful and cost-efficient approach. One component of the program includes scenario videos which allow employees to visually see and hear the best ways to handle situations verbally. CPI has more information available at crisisprevention.com/verbal-intervention. The program builds learner competency while minimizing time off the workplace floor. The training was developed specifically for healthcare staff who need the confidence and skills to identify and productively respond to disruptive behaviors. This evidence-based program is rooted in CPI’s proven philosophy of Care, Welfare, Safety and Security for staff, patients and caregivers to ensure a culture of safety for everyone. Providing workers with the skills to address potential workplace violence early on will help reduce the number and severity of workplace violence incidents.

Hospital harms total $1 billion for healthcare system in Ontario in fiscal year 2015/16 xperiencing harm in hospital significantly increases the length of stay, length of recovery after discharge and health system costs, which amounted to more than $1 billion in Ontario in fiscal year 2015/16, according to new research in CMAJ (Canadian Medical Association Journal). “We were able to estimate, for the first time, the total health system impact of hospital harm in Ontario,” says Lauren Tessier, PhD student, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario. “This amounted to more than $1 billion in 2017 Canadian dollars and 407,696 acute hospital days – equivalent to

a 1117-bed hospital operating at 100 per cent capacity every day for a year.” Using new hospital harm methodology developed by the Canadian Institute for Health Information (CIHI) to measure adverse events, the study provides useful information on the total cost to the health care system from a harm experienced in hospital as well as subsequent health care usage. Researchers used person-centred episodes of care (PCEs) to look at the entire use of health care services, from the adverse event in hospital through all related hospital and post-discharge care until an individual had returned to the community and was stabilized for 30 days without any further admissions. They looked at harm in four

30 HOSPITAL NEWS SEPTEMBER 2019

categories: health care/medication, infection, patient accidents and hospital procedures. “The PCE methodology enables all acute and post-acute care, including hospital, physician, pharmacy and home care readmissions, to be captured in the episode of care – an important advance, as many studies on the costs of adverse events have treated readmissions as initial admissions, leading to bias,” says Tessier. The study included 610 979 patients aged 18 to 105 years in Ontario who had an acute hospital admission between April 2015 and March 2016. Of all patients in the study, 36,004 (6%) experienced a harm during their first hospital admission during that period. The most common harm was in the

health care/medication-associated conditions category, making up half (50%) of all harms. The additional length of stay for patients who experienced hospital harm ranged from 0.4 days (pregnancy PCE) to 24 days (mental health PCE). Costs ranged from $800 (pregnancy PCE) to $51,067 for an unplanned surgical PCE. “Our finding that hospital harm significantly increases length of PCE is a novel contribution to the literature, as the PCE methodology has only recently been developed,” says Tessier. In a linked commentary, Drs. Lauren Lapointe-Shaw and Chaim Bell, internal medicine specialists, University of Toronto, Toronto, Ontario, write, “The linked study will benefit policy-makers in several ways: the auwww.hospitalnews.com

NEWS

Hospitals, clinics and others know that the cost of workplace violence directly impacts employee morale and turnover, contributes to worker’s compensation claims and increases exposure for legal and reputational damage. The goal of CPI’s Verbal Intervention ™ Training is to reduce exposure to the growing concerns many healthcare organizations are facing today. The program is forward-thinking, using a “train-the-trainer” model so the trainer can then teach the techniques to other professionals in their workplace. Verbal de-escalation training helps to quickly mitigate and decrease risk before situaH tions get out of control. ■ Susan Driscoll is the president of Crisis Prevention Institute, an international training organization committed to competency-based learning and safe behavior management methods that focus on prevention. Founded in 1980, CPI’s mission is to reduce the likelihood and severity of workplace violence incidents. Over 17,000 facilities, 37,000 Certified Instructors, and 15 million trained professionals trust CPI to help create more confident and productive employees. Learn more at crisisprevention.com.

thors have clarified the costs of adverse events in Canada, provided a baseline from which to assess changes over time, quantified the investment that could be justified to prevent adverse events and offered estimates to be used in economic evaluations of future interventions. Because most interventions target a particular condition, costing by type of adverse event would be a valuable addition. The substantial costs of adverse events are far-reaching and cannot be ignored. An improved understanding of their overall impact can only reinforce our efforts at preventing them.” “The impact of hospital harm on length of stay, costs of care and length of person-centred episodes of care: a retrospective cohort study” is published AuH gust 12, 2019. ■ www.hospitalnews.com

Niagara Heath NICU Registered Nurses, from left, April Minda, Kirsten Prinsen, Karey Adamek, Kendra Briggs and Sheila McDonell with some of the new equipment.

Significant advancement for infant care in Niagara iagara’s tiniest patients will have care closer to home thanks to the addition of five new beds on Niagara Health’s Neonatal Intensive Care Unit (NICU). The NICU can now care for sicker babies after Niagara Health received Ontario government support for the beds, supporting resources and equipment. The unit, at Niagara Health’s St. Catharines Site, will be able to provide care to infants with more complex health problems, including: • Premature babies born at 30 weeks gestation or more (previously it was 32 weeks or more). • Babies requiring ventilation. • Babies needing advanced intravenous therapy. Previously they had to travel outside of Niagara for care.

The new beds, a first for Niagara, also increased nursing staff on the unit and enabled the creation of a specialized interdisciplinary team, including the addition of a dietitian, respiratory therapist, social worker and occupational therapist. As well, the unit added specialized equipment – ventilators, specialized incubators and a new camera for testing the eyes of premature babies – which will further decrease the need to transport patients to and from McMaster Children’s Hospital in Hamilton. “We’re extremely grateful to the provincial government for providing us this opportunity to keep our patients and families within the region for their care,” says Carol Munro, Clinical Manager of the NICU and Children’s Health Unit. “Having a sick baby is stressful enough, let alone having the other stressors of not be-

ing at home or not being with your support system. This is really important for our families.” “This is a significant advancement for infant care in Niagara,” says Dr. Madan Roy, Niagara Health’s Chief of Paediatrics. “Being able to provide a more intensive level of care is another example of how we are elevating healthcare in the region. Our NICU team is very passionate about the care we provide babies, and it’s wonderful more of these patients and their families can stay in the region for care.” The NICU level has been upgraded from a 2B to a 2C care centre. The five beds bring the total number of beds in the unit to 17. The healthcare team is receiving extensive training on the enhanced level of care and new equipment in partnership with McMaster ChilH dren’s Hospital. ■

SEPTEMBER 2019 HOSPITAL NEWS 31

EVIDENCE MATTERS

Managing crystal meth withdrawal:

It’s not crystal clear By Sarah Garland peed. Meth. Crank. Ice. Crystal meth. They’re all names for methamphetamine – a harmful class of illicit drug that can be made from inexpensive medicines commonly found in drug stores. Consuming methamphetamine, by smoking, injecting, or snorting, can cause feelings of euphoria. However, other short-term effects include elevated heart rate and blood pressure, weight loss, headache, dizziness, vomiting, and increased body temperature. Those who use methamphetamine long-term may experience severe dental decay (i.e., “meth mouth”), psychosis, paranoia, and the feeling that bugs are under their skin.

In recent years, the medical community has been grappling with the severity and scale of the opioid crisis, which remains problematic still. Yet there are other drugs on the scene that contribute to the picture of addiction in Canada. According to the Canadian Centre on Substance Use and Addiction (CCSA), methamphetamine use remains relatively rare – at less than one per cent of the population (though estimates vary and reporting on use is not very reliable). However, there has been a 590 per cent increase in methamphetamine possession incidents from 2010 to 2017. This suggests that methamphetamine may now be more easily accessible. Unlike opioids, there

32 HOSPITAL NEWS SEPTEMBER 2019

is no legal use for methamphetamine, and there is no legal alternative. Managing medical issues around methamphetamine use, such as the drug’s potential impact on pregnant persons, is challenging. Methamphetamine withdrawal is a particular challenge, as people who are coming down from methamphetamine-related highs typically have higher rates of non-compliance, aggression, and violence when they are seen in emergency departments or acute care settings. When it comes to questions of evidence and best practice, health care decision-makers can turn to CADTH – an independent agency that finds, assesses, and summarizes the re-

search on drugs and medical devices. CADTH’s Rapid Response program responds to health care provider and decision-maker requests for timely and up-to-date evidence reviews tailored to meet their specific needs. Since December 2018, CADTH conducted several Rapid Response reviews on the treatment of crystal methamphetamine withdrawal. One looked for evidence on drug interventions for managing acute withdrawal in adults who misuse methamphetamine. Two randomized controlled trials were identified – one found pexacerfront to be effective for managing methamphetamine cravings during withdrawal, and the other found buwww.hospitalnews.com

EVIDENCE MATTERS

UNLIKE OPIOIDS, THERE IS NO LEGAL USE FOR METHAMPHETAMINE, AND THERE IS NO LEGAL ALTERNATIVE. prenorphine to be effective. A systematic review was also identified, which concluded that intravenous lorazepam and droperidol appear to be an effective treatment for patients with methamphetamine-related agitation in the emergency department, and that aripiprazole, haloperidol, and quetiapine may be effective at managing methamphetamine-induced psychosis. The systematic review also suggested that isradipine could be effective at managing methamphetamine-induced high blood pressure. One evidence-based guideline that was identified recommends that benzodiazepines be considered a first-line treatment option for the management of severe agitation, aggressiveness, or psychosis from methamphetamine withdrawal. The CADTH review noted, however, that there is a need for larger, controlled studies and longer-term follow-up of patients once they are discharged back into the community – which can be challenging when working with people experiencing addiction. There are also research gaps when it comes to psychological or physical interventions to manage acute withdrawal symptoms; the CADTH report did not identify any non-pharmacological strategies. Based on these limitations, it is uncertain how these interventions compare to non-pharmacological strategies and what a holistic view of withdrawal management might be. Another CADTH review looked at guidelines for treatment provided immediately after acute detoxification and post-treatment care for patients with methamphetamine addiction. This review identified one evidence-based guideline that recommends psychotherapeutic and pharmacologic treatment options as well as structured exercise programs. The guideline also included weak recommendations for the use

of tranquilizers to manage short-term agitation and the use of antipsychotics as needed. The guideline recommends against the use of sertraline to achieve abstinence because of the side effects associated with it. CADTH has also conducted evidence reviews on safe rooms for patients experiencing crystal methamphetamine-induced psychosis, treatment of neonatal abstinence syndrome, and withdrawal management or treatment of persons who are pregnant and addicted to crystal meth. None of these reviews, however, found any relevant literature. Although there is a need for more information on the treatment of pregnant persons and infants experiencing withdrawal, conducting research on this topic is challenging, given that methamphetamine is an illicit substance. While the CADTH reviews looked at slightly different populations and interventions, it remains clear that there is a need for evidence in this space. The CCSA cites stigma (the negative stereotypes about persons with addictions) as one of the largest barriers to persons seeking and receiving treatment. It can be challenging for persons with addictions to access care, and it appears to be additionally challenging for health care workers to know how best to support persons with methamphetamine addictions. Despite the evidence gaps in this area, there appear to be some evidence-based guidelines to help guide acute withdrawal, acute detoxification, and post-treatment care, and some research on pharmacotherapies that may be effective for patients. To access the reports referred to in this article, see: And if you would like to learn more about CADTH, visit cadth.ca, follow us on Twitter @CADTH_ACMTS, or speak to a Implementation Support team member in your region: https:// H cadth.ca/contact-us/liaison-officers. ■

Sarah Garland is a Knowledge Mobilization Officer at CADTH. www.hospitalnews.com

Runnymede Healthcare Centre and Humber River Hospital announce their new partnership. From left to right: HRH Board Chair, Terry Leon; HRH President & CEO, Barb Collins; Runnymede President & CEO, Connie Dejak; Runnymede Board Chair, Nick Migliore; and Runnymede Chief of Staff, Dr. Fabio Varlese.

Humber River Hospital and Runnymede Healthcare Centre announce

new partnership H

umber River Hospital (HRH) and Runnymede Healthcare Centre (Runnymede) have formed an innovative new partnership to streamline care delivery, put patients at the centre of all interactions, and improve community health outcomes as well as the patient experience. The partnership is anchored in the Government of Ontario’s vision for a connected and sustainable healthcare system. Together, HRH and Runnymede will deliver end-to-end, coordinated care. The partnership between the two hospitals is the perfect opportunity to harness their strengths and create a constellation of care to support patients throughout their healthcare journey. Together, HRH and Runnymede will be able to bridge the gap between acute, rehabilitative, complex continuing, outpatient, and virtual care, making it easier for patients to navigate the system and access the care they need. By championing collaboration, HRH and Runnymede will leverage technology and complementary clinical expertise to create

a model of care that will maximize the healthcare options for patients in their community. “We are committed to working together to deliver innovative and compassionate healthcare in the west Toronto community,” said Barb Collins, President and Chief Executive Officer of Humber River Hospital. “Our teams will collaborate in rehabilitative, complex continuing care and seniors care programs, sharing best practices to deliver end-to-end, comprehensive care. Leveraging our technology and clinical expertise collectively, we will enhance care in the best possible setting for our patients and families.” “Humber River Hospital and Runnymede Healthcare Centre are revolutionizing community healthcare,” said Connie Dejak, President and Chief Executive Officer of Runnymede Healthcare Centre. “Pro-actively bridging the gaps in our healthcare system is the driving force behind this partnership. Through bold leadership, innovation, and imagination, we are taking our organizations to the next level to deliver seamless, paH tient-centred, and connected care.” ■

SEPTEMBER 2019 HOSPITAL NEWS 33

LONG-TERM CARE NEWS

The judges and audience get ready for the Toronto regional pitch competition.

Meet the winners

of the AGE-WELL National Impact Challenge By Annie Webb and Margaret Polanyi or anyone with an interest in technology and aging, the AGE-WELL National Impact Challenge: Startup Edition will be remembered as one of the most exciting pitch competitions in 2019. Launched in May, the competition was all about recognizing top startups and supporting entrepre-

neurship in Canada’s technology and aging sector. Five finalists pitched at each of three regional events held in Montreal, Vancouver and Toronto, explaining how their technology-based solution can support healthy aging. Each winner receives $15,000 in cash plus in-kind prizes. And the winners are…

34 HOSPITAL NEWS SEPTEMBER 2019

WALK-WELL UNIVERSE Walk-Well Universe won the Montreal regional competition with a pitch delivered by Ahmed Abou-Sharkh, a physiotherapist and a PhD candidate at McGill University. Walk-Well Universe is dedicated to developing health technologies that address unsafe walking, which can lead to falls and fall-related injuries like fractures.

Walk-Well Universe is a part of Physio Biometrics Inc. The research team also includes Drs. Nancy Mayo and Kedar Mate, both at McGill University’s School of Physical and Occupational Therapy, and Dr. Edward Hill, a computer engineer. They designed, developed and are currently testing and commercializing their main product, the Heelwww.hospitalnews.com

LONG-TERM CARE NEWS

2Toe sensor. Walk-Well Universe also includes other supporting products to maximize the potential benefit of the sensor. “The sensor goes on the user’s shoe and the auditory feedback that is given for each correct step stimulates neural connections in the brain to make the improved gait and step more permanent,” explains Abou-Sharkh. “The Heel2Toe sensor is designed to make walking more efficient and safer so that once people walk better, they will walk more,” he says. “Walking is the safest and most cost-effective way for people to be physically active. But, people who don’t walk well are unlikely to walk for exercise and recreation, jeopardizing their independence and quality of life.” Winning the AGE-WELL competition is a boost, says Abou-Sharkh. “We need to get the product out there and known. We will benefit from AGE-WELL’s services for our commercialization efforts and to advance the company.”

RIGHT: Walk-Well Universe won the Montreal regional competition

TRUE ANGLE MEDICAL TECHNOLOGIES The winner of the Vancouver competition was True Angle Medical Technologies, based in Edmonton.

The company developed the Mobili-T, a swallowing therapy system for older adults with swallowing difficulties. The pitch in Vancouver was delivered by Dr. Gabi Constantinescu, Chief Prod-

uct Officer and a clinician-researcher with a decade of experience assessing and treating swallowing difficulties. Continued on page 36

LONG-TERM CARE NEWS

ABOVE: Toronto winner Daniel Bordenave of Bisep with Libby Znaimer, host of theZoomer.

AGE-WELL National Impact Challenge Continued from page 34 “The Mobili-T system takes the therapy out of the clinic and into the hands of patients,” she says. Mobili-T is a wireless piece of hardware that is placed under the chin, and an app that provides real-time feedback on a mobile device. “The patient can go home and complete therapy that is very similar if not identical to what is done in clinic. They are being remotely followed by a clinician rather than having to drive to the clinic, look for parking etc.” Dr. Constantinescu’s team includes CEO Dr. Jana Rieger and CTO Dylan Scott, who helped launch the company and develop the system with the involvement of patients and clinicians. The team estimates that their technology will allow clinicians to see seven times as many patients. And there is a pressing need: it is estimated that 20

THE COMPETITION WAS ALL ABOUT RECOGNIZING TOP STARTUPS AND SUPPORTING ENTREPRENEURSHIP IN CANADA’S TECHNOLOGY AND AGING SECTOR. per cent of people over age 55 experience swallowing difficulties. The AGE-WELL award will help to commercialize the Mobili-T system, says Dr. Constantinescu. “The prize money will support the next rounds of testing and studies, as well as the prototypes required for these. There will also be support and mentorship opportunities around commercialization as well as development.” She calls the AGE-WELL competition a “valuable initiative.”

36 HOSPITAL NEWS SEPTEMBER 2019

“There are a lot of ideas and startups out there, but it’s very difficult to move to the next step into a full-blown company. It’s nice to know that Canada is looking to fund innovation beyond research and into commercialization so those in need can access these technologies.”

BISEP Bisep, a Niagara Falls-based startup, won the Toronto competition for a device that attaches an individual’s

wheelchair directly to their walker to assist with ambulation. In his winning pitch, Bisep Founder and President Daniel Bordenave said he was inspired to invent the device while working as a kinesiologist at a long-term care facility. Due to limited staff, funding and equipment, Bordenave couldn’t do daily mobility and ambulation training with the elderly residents. He found this unacceptable, given health risks associated with sedentary behaviour. Bordenave set out to devise a solution. “I got together with my grandfather, who was a tool and die maker, and created a prototype.” The result: the ARMM (Ambulation, Retraining and Mobility Mechanism), which provides lateral and posterior support for a person to transfer from wheelchair to walker, and allows the user to safely practice daily exercises. There’s no www.hospitalnews.com

LONG-TERM CARE NEWS Dr. Gabi Constantinescu of True Angle Medical Technologies won in Vancouver.

need for extra staff to trail behind with a wheelchair at the ready. According to a recent study, nursing home residents who used the ARMM walked faster, further and with more confidence than those who did not use the device. The AGE-WELL prize will help Bordenave manufacture more devices, fill pre-orders, promote and bring the device to market by 2020. “It’s a dream come true,” he told an audience of more than 100 people. The Toronto competition was held at Zoomer Hall and will be the focus of a special episode of theZoomer, hosted by Libby Znaimer, in coming months. AGE-WELL congratulates the winners and welcomes them to the network where their innovations will be

nurtured to have the greatest impact possible. We thank all the finalists, the judges and also the sponsors of

the competition: BC Seniors Living Association, CARP, Fasken, Hacking Health, The Impact Centre at the

University of Toronto, MEDTEQ, Ontario Brain Institute, TELUS VenH tures and YouAreUNLTD. ■

Annie Webb is a freelance writer. Margaret Polanyi is Senior Communications Manager at AGE-WELL, a federally-funded Network of Centres of Excellence. The pan-Canadian network brings together researchers, older adults, caregivers, partner organizations and future leaders to accelerate the delivery of technology-based solutions for healthy aging. For more information, visit www.agewell-nce.ca

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LONG-TERM CARE NEWS

NEXT TO FOOD SAFETY, RESIDENT SATISFACTION THROUGH FOOD PREPARATION AND SERVICE IS THE MOST IMPORTANT GOAL FOR ALL OF THE WORK THAT IS DONE IN THE KITCHEN AND DINING ROOMS.

Continuous Quality Improvement in long-term care food service By Dale Mayerson and Karen Thompson he Food Service Department in a long-term care (LTC) home is a busy place! There are three mandatory deadlines to prepare for and serve delicious and timely breakfasts, lunches and suppers, and additional deadlines for afternoon and evening snacks. Next to food safety, resident satisfaction through food preparation and service is the most important goal for all of the work that is done in the kitchen and dining rooms. Along with the work of preparing the food, there is a detailed focus on providing food that is safe. This means that time and temperature must be

controlled through all stages of food storage and preparation. For safety reasons, hot food that is ready for service must stay hot and cold food must stay cold. All staff adhere to this in order to protect residents from foodborne illness. The entire kitchen and all food handling equipment must be clean and sanitized after each use in order to provide the safest possible food. As well as maintaining a strict focus on food safety, the kitchen and dining rooms must also be a safe environment for staff health and safety. Kitchens are frequently hot and humid, with sharp implements in constant use, staff walking on wet or slippery floors, exposure to

38 HOSPITAL NEWS SEPTEMBER 2019

very cold walk-in freezers and refrigerators, risks of burns, and other hazards. In order to ensure that standards are met every day, the LTC Food Service Department has a CQI program in place that includes both Quality Assurance (QA) and Risk Management (RM). Quality assurance is defined as the process of identifying areas in a department that can be strengthened, and working to make those areas better. Risk Management is the examination of risks in the department and working towards resolution to ensure that those risks do not cause any liability or have any negative consequences. The management team is responsible

to ensure that the environment is checked and is meeting expectations every day. The goals of CQI in the Dietary department are to: • Meet and exceed the continually changing needs and expectations of residents • Take appropriate corrective actions, as required, to prepare and deliver meals and snacks • Prevent, or reduce and control actual or potential risks, to the safety, security, welfare and health of residents, as well as all levels of staff Department management uses audits to track work flow and hazards. www.hospitalnews.com

LONG-TERM CARE NEWS Audits are developed from the standards and goals of the department and break the standards into smaller units that can be tracked and measured; these can be referred to as indicators. Audits can be done as often as needed and can be simple checklists to ensure that the indicators are being met. The question to answer is: Are we doing what we say we are doing? This is not an easy question, since many employees are working every day at different tasks to ensure that residents get the meals and snacks they need and deserve. There are audits for many risk activities of the Food Service Department. These include: temperature checks for fridges, freezers and dish machines, temperature checks for the food as it is prepared and just before it is served, plate audits to ensure plates look appetizing and serving sizes are correct, and plate waste audits to see what food is left over at the end of a meal. Every aspect of the work should be checked through the audit process.

Another important part of CQI is the use of surveys. This goes to the residents, and/or their families, to ask a series of questions to determine how satisfied residents are with the actual meal as well as with the meal time service they receive. The meals refer to the food itself, while the meal service includes the helpfulness of staff, the dining environment, the music, etc. Direct feedback from residents is an important information source and allows the department to fully review their processes and know how well they are meeting the expectations of the residents. Surveys can be long with many questions, asking about serving size, food flavour, food temperature, timeliness, etc., or can be short with just two questions: Did you enjoy your meal? How could it have been improved? Results of both audits and surveys require prompt follow up to improve care and service. Audits are reviewed and each area where the indicator is

“not met” should be followed with an action plan and timeline for correcting the situation. This running record shows where changes are needed and how they will be addressed, before the next audit is completed. Surveys are tallied and results are measured against an acceptable benchmark. As an example, the benchmark may be that 90 per cent of residents say they enjoyed their meal. The actual result of a survey was just 60 per cent. This requires a change, which could include reworking a recipe, changing the menu, changing quality of raw ingredients, speaking with the cook, or adjusting portion size. The Plan-Do-Study-Act (PDSA) model is an efficient way to check that any new methods put into place are working and that the changes are being followed. Following this model, a change is planned, then the new process is put into place in one area or segment of the department. This is an opportunity to monitor, evaluate and

improve the process, before expanding it to the rest of the department. This is a continuous cycle to ensure that the department is continually improving and meeting the changing needs of the residents. Staff education and training are also in part of the CQI program. Front line employees work with minimal supervision, and therefore require education and training frequently on a wide variety of topics. It is management’s responsibility to ensure that all employees are up to date in all areas of their work, including resident satisfaction, customer service, new technologies, new food items, allergens, sanitation and safety, food safety, emergency procedures, and much more. The CQI program is a mandatory part of the day-to-day work in a busy LTC food service department. The program helps to keep residents satisfied with their meals and snacks, and provides a safe enH vironment for staff. ■

Dale Mayerson, BSc, RD, CDE, and Karen Thompson, BA Sc, RD are Registered Dietitians with extensive experience in Long-term care. They are coauthors of “Menu Planning in Long Term Care and Retirement Homes: A Comprehensive Guide” and have participated for many years on the Ontario Long Term Care Action Group, an advocacy group of Dietitians in Canada.

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Improving safety and care for nursing home residents By Marion Zych public inquiry called for by RNAO to honour the lives lost, and address the horrific killings by former nurse Elizabeth Wettlaufer, nearly all of them residents in nursing homes between 2007 and 2016, has provided a detailed plan of improvements needed to overhaul the long-term care sector. Justice Eileen Gillese issued her report listing 91 recommendations that cover measures the Ministry of Health and Long-Term Care (MOHLTC), Home Care Service Providers, the College of Nurses of Ontario and the Office of the Chief Coroner and the Ontario Forensic Pathology Service should adopt. Key among the recommendations (85) is that the MOHLTC increase the number of registered nursing staff in long-term homes by undertaking a study and tabling results in the legislature by July 31, 2020. RNAO is eager to partner with the government and our colleagues at the Ontario Nurses’ Association, the Registered Practical Nurses Association of Ontario and the College of Nurses of Ontario, to bring this study to fruition by the deadline. “We have long urged that regulated staff must be increased in long-term care. RNAO will continue to insist that at least one NP for every 120 residents, 20 per cent RNs, 25 per cent RPNs, and no more than 55 per cent PSWs be funded for nursing homes,” says RNAO CEO, Dr. Doris Grinspun. “This is essential if we want to ensure safe and quality care and reduce costs related to avoidable complications.” Grinspun says any changes to the funding parameters of the nursing and personal care envelope, outlined in recommendation 19 must be based on the evidence presented in the staffing study. This is why the government should not act on this recommendation until this study is completed. “We

A GREY TSUNAMI WILL DOUBLE THE NUMBER OF SENIORS AGED 75 AND OLDER IN THE NEXT 20 YEARS, EXPERTS SAY. have to get this right,” adds Grinspun. Other key recommendations in the inquiry report include: • LTC homes should adopt more robust hiring and screening practices, including background checks • LTC homes must enact measures that will improve training with respect to hiring, management of staff and discipline • Homes should require directors of care to conduct spot checks on evening and weekend shifts • Homes should maintain complete discipline histories for each employee The recommendations expose systemic vulnerabilities that made it possible for Wettlaufer to get hired by an LTC home without management knowing she had been fired years earlier from her first nursing job after steal-

ing narcotics during a shift at a hospital and using them to try to kill herself. RNAO was also pleased to see a recommendation (20) that the Ministry of Health and Long-Term Care “encourage, recognize, and financially reward long-term care homes that have demonstrated improvements in the wellness and quality of life of their residents.” This addresses a major concern of nurses and nursing home operators. The Ontario government must immediately stop cutting funding to longterm care facilities that implement best practices that improve residents’ outcomes. As RNAO has repeatedly advised, LTC homes whose care improves the health of residents must retain all funding to reinvest in additional staffing for residents rather than have some of that funding stripped be-

cause the government wrongly tethers funding to acuity says Angela Cooper Brathwaite, RNAO’s president. We are urging Minister Fullerton to exempt Best Practice Spotlight Organizations (BPSO) from any clawbacks on funding resulting from their improved residents’ health outcomes. RNAO says change must happen quickly. A grey tsunami will double the number of seniors aged 75 and older in the next 20 years, experts say. That growth will further strain a LTC system whose resources badly lag the needs of residents who typically suffer from multiple chronic conditions that leave them cognitively compromised as a result of aging, and at times dangerously aggressive. “While we can’t undo the unimaginable terror Wettlaufer inflicted, we can honour the memory of the victims and the loss of their families by acting now to fix endemic problems in longterm care,” says Cooper Brathwaite. “Every resident deserves to live with dignity and support, and as a society we owe it to residents to take the steps recommended by Justice Gillese.” “The tools are within reach: We have excellent nurses, proven best practice guidelines and, thanks to the inquiry, even more knowledge about where our system falls short,” Cooper Brathwaite says. “We urge the Ford government to quickly adopt the recommendations of the inquiry by working collaboratively with nursing associations and other stakeholders because residents in long-term care and their loved ones deserve no less.” The commission granted RNAO standing at the inquiry, which allowed the association to submit recommendations and question witnesses. RNAO was represented by Christine Mainville, Lauren Binhammer, and Gabriel Edelson of Henein Hutchison H LLP. ■

Marion Zych is the Director of Communications at RNAO. 40 HOSPITAL NEWS SEPTEMBER 2019

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NEWS LEFT: Eve Baird is the therapeutic recreation coordinator at York Care Centre in Frederickton created The Sleep Kit – a toolbox for caregivers. BELOW: The Sleep Kit contains 13 items that caregivers can use with older adults to encourage one-on-one engagement before bedtime.

A better night’s sleep

for older adults living with dementia By Rebecca Ihilchik herapeutic recreation coordinator Eve Baird is on a mission: to help those living with dementia sleep better. Working with long-term care residents at Fredericton’s York Care Centre, she knows firsthand the difference a good night’s sleep can make. “If a resident doesn’t sleep well, they’re less open to being involved in activities throughout the day,” she says. “Their mood is different. Their appetite is affected. You really do see the changes.” Sleep disturbances and night restlessness are unfortunately common for those living with dementia, and there aren’t many tangible solutions that don’t involve medication. But Baird noticed that doing activities to relax and engage her clients before bedtime – like playing card games or giving aromatherapy hand massages – had a

positive effect on their quality of sleep. With support from the Centre for Aging + Brain Health Innovation (CABHI), Baird is taking her homegrown idea to the next level. She’s creating and testing a toolbox for caregivers called The Sleep Kit – an accessible, drug-free solution to the problem of poor-quality sleep. The Kit contains 13 items that caregivers can use with older adults to encourage one-on-one engagement before bedtime. Among them are custom-made dementia-friendly colouring books and markers, chamomile tea, a hair brush, a CD with calming music, and essential oils. “The goal is to improve sleep, but the Kit is also about taking it back to the basics of human connection and how powerful that can be,” Baird says. “When people are experiencing agitation or are anxious, often they just

42 HOSPITAL NEWS SEPTEMBER 2019

need somebody there to spend time with and put them at the centre.” The sleep issue also affects family caregivers, who often don’t get enough rest if they are caring for their agitated loved ones at night. “It’s important for both people,” says Baird. “If someone living with dementia is going to be up all night, you know their caregiver is too, because they’ll be wanting to meet their needs.”

the older adults wore to bed, as well as reports from the caregivers, Baird tracked the quality of sleep on nights the Sleep Kit was used versus nights without it.

REAL-WORLD TESTING YIELDS POSITIVE RESULTS With joint funding from CABHI and the New Brunswick Health Research Foundation, Baird tested the Kit with caregivers in the Fredericton, Moncton, and Saint John areas, including those caring for older adults living at home as well as those living in long-term care. Using data from Fitbits

Her preliminary research found that using the Sleep Kit did in fact improve sleep quality. The Kit was particularly successful for the older adults in long-term care, who on average experienced three less bouts of restlessness each night. www.hospitalnews.com

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Inspection blitz to help prevent workplace violence in health care sector inistry of Labour officials are inspecting long-term care, retirement home and community care workplaces to raise awareness about workplace hazards and promote compliance with the Occupational Health and Safety Act (OHSA), Labour Minister Monte McNaughton announced today. These inspections follow weeks of outreach to workplace parties, providing support for employers to help increase awareness and ensure they are compliant with the law. This compliance support and education will continue to happen concurrently along with the focused inspections blitz. “Health care workers have the right to do their jobs in a safe and healthy workplace, free of violence,” Minister McNaughton says. “That’s why this is critical. Together we can keep our health care workers safe, which is vital not only to them and their families,

but to all our communities as well.” Inspections began August 19 and will run to September 27, 2019. Ministry inspectors will be looking for commitment and support from senior executives and other managers for the internal responsibility system of their health care facilities. Ministry inspectors will also check that: • employers are training workers on their workplace violence policy and program, • employers are completing risk assessments and putting measures and procedures in place to control those risks, • workers can summon immediate assistance when workplace violence occurs, • employers are providing workers with information and instruction related to a risk of workplace violence from a person with a history of violent behaviour,

Caregivers also responded positively. Over 95% of long-term care caregivers reported that the Sleep Kit was a tool that could assist them in being a more effective care partner, and 81 per cent of caregivers in the community said it promoted discussion and helped them engage with their partner. Nurse Lorie Yerxa was one of the caregiver participants. She used the Sleep Kit with a long-term care resident who “90 per cent of the time would yell out if you touched them.” “As a nurse and caregiver, using the Sleep Kit affected my relationship with the resident in a positive way,” Lorie says. “I found that the resident would be more receptive to me throughout the day, compared to before using the Kit.”

CABHI offers acceleration services that support innovators in areas like business development, marketing and communications, and commercialization. “I knew I wanted to go the commercialization route, but I have no business experience,” she says. “CABHI really helped guide me.” So what’s next? With CABHI’s help, Baird is working on a plan to scale and spread the Kit to market, to reach a wider audience. She recently participated in a social venture accelerator program at the University of New Brunswick to further hone her business development skills. She’s also writing an academic article for publication with Dr. Janet-Durkee Lloyd, professor at St. Thomas University, who collaborated with Baird on the project. With a wider release in the works, Baird’s innovation is on its way to ensuring a good night’s sleep for older adults and their caregivers, in New H Brunswick and beyond. ■

CABHI SUPPORT ACCELERATES POINTOF-CARE INNOVATION Baird says as a clinician she felt empowered by CABHI to drive her solution forward. In addition to funding,

Learn more at www.cabhi.com. This project was also supported by the Centre for Innovation and Research in Aging at York Care Centre. Rebecca Ihilchik is a senior marketing and communications specialist at the Centre for Aging + Brain Health Innovation. www.hospitalnews.com

QUICK FACTS • According to Ontario’s Workplace Safety and Insurance Board, workplace violence accounted for 13% of all lost-time injuries in the health care sector in 2018. • In 2017, workplace violence was the third highest cause of losttime injuries in the health care sector. • From 2013 to 2017, there has been a significant increase in lost-time injuries in community type settings due to workplace violence. • employers have measures and procedures in place on reporting incidents of workplace violence; the measures and procedures should also explain how the employer will investigate and deal with violent incidents, and • employers provide appropriate detail in the written notification of a

workplace injury, including the steps taken to prevent reoccurrence. “There must be zero tolerance for workplace violence – one incident is one too many,” says Minister McNaughton. “Addressing this issue in Ontario’s community care workplaces, long-term care homes and retirement home settings will help create safer environments for our workers and improve patient care.” The Ministry of Labour also issued a health care guide during the blitz period. This new guide will help hospitals, longterm care homes and home care facilities learn about the law and how it applies to preventing workplace violence. The Ministry of Labour is committed to improving health and safety for health care workers by helping employers comply with the Occupational Health and Safety Act (OHSA), including through its Safe At Work H Ontario strategy. ■

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Selecting a behaviour analyst for children with autism:

Empowering families to make informed decisions By Ana Luisa Santo, Aamir Khan, Rosemary Condillac, Andria Bianchi utism Spectrum Disorder (ASD) is a lifelong neurodevelopmental disorder that can impact how a person communicates with and relates to other people. Symptoms of ASD include challenges in social communication and restrictive, repetitive interests and behaviour. While the symptoms, severity, and impact of ASD vary, evidence-based therapies can help to mitigate challenges that people with autism may experience. The most effective therapies are behavioural interventions based on the principles of Applied Behaviour Analysis (ABA), which are designed and supervised by qualified behaviour analysts and delivered by well-trained and supervised therapists. Behaviour analysis is the science of behaviour change. Behaviour analysts provide treatments that change behaviour over time and teach skills to help people with autism meet their potential. So, when a child with autism is missing communication skills, and behaves in a harmful manner, for instance, a behaviour analyst could then use evidence-based approaches to effectively asses the child’s needs and implement an individualized treatment plan to alter the behaviour over time by teaching communication and reducing the harmful behaviour. Through the Ontario Autism Program (OAP), children with ASD were previously able to access the clinically recommended hours and intensity of government-funded behavioural services from Regional Autism Programs or private clinics. In February 2019, the Ministry of Children, Community, and Social Services announced changes to their funding model that would alter the availability of and funding for interventions. The announcement indicated that the previous needs-based program would be replaced by an indi-

vidualized funding model of $5000 or $20,000 per family per year (depending on the age of the child and diagnosis). Within this model, families would be expected to hire their own behavioural services. More recently, the Ministry announced that the new model will involve a needs-based funding system, however currently, the government remains committed to individualized funding that requires parents to purchase their child’s therapy directly. One concern about changes to the OAP is that it may be difficult for families to access the appropriate amount of and/or intensity of behavioural intervention for children with autism. Intensive Behavioural Intervention, which is a comprehensive therapy working across several domains of behaviour, is most effective when delivered from 30-40 hours per week for between two and four years. Some individuals with more complex needs

44 HOSPITAL NEWS SEPTEMBER 2019

may require more than 40 hours. Focused Behavioural Intervention, which targets fewer domains to focus on a particular issue or need, can be effectively delivered in 10-25 hours for between six months and two years depending on the needs of the child. Many families may require additional financial support as this can cost between $25,000 – $100,000 per year. Another concern is that families may be required to find their own behavioural services, including behaviour analysts and direct-care therapists. Some of the benefits of having a certified behaviour analyst include: access to effective interventions and assurance that therapy meets professional standards and adheres to ethical guidelines, and some limited recourse in terms of making complaints regarding services being received. One obstacle for families selecting a behaviour analyst is that unlike

other health professionals, behaviour analysts are not a regulated health profession (in Ontario). Regulation offers public protection, the existence of a minimum standard for entry into practice and use of a particular title (e.g. Psychologist, Nurse), standards of practice and ethical codes, knowledge of relevant legislation (e.g. privacy, confidentiality, consent, etc.), and a mechanism for managing complaints. The lack of regulation for behaviour analysts forces families to make decisions about selecting behavioural services without knowing if a person and/or agency uses best practices. This is ethically significant since families have a right to make an informed decision about their child’s care, yet it is challenging to be fully informed when selecting a behaviour analyst since people without adequate training and expertise could consider themselves to be part of the profession. They may www.hospitalnews.com

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also charge less money and appeal to families who may not be able to afford the amount of treatment that their child needs. The Ontario government has recently indicated that regulation of the profession is forthcoming, though the process will likely take many years. The lack of regulation and transparency about behaviour analysis is especially problematic since purchasing behavioural services from someone who fails to practice in accordance with best practices could be detrimental (or, at least not beneficial) for a child with autism. This is concerning from a bioethics perspective since reducing harm and enabling benefits are two primary bioethics principles in healthcare. Some of the harms that could be experienced by children who work with unand/or minimally trained behaviour analysts are: exposure to dangerous or harmful practices that can make behavioural difficulties worse, exposure to ineffective practices that could minimize the effectiveness of intervention and waste valuable time (e.g. critical developmental periods) and resources, infringement on a childâ&#x20AC;&#x2122;s rights if the practitioner is unfamiliar with relevant legislation (e.g. privacy, confidentiality, consent), being subjected to inconsistent and unfair billing practices, and a lack of effective recourse to make formal complaints to a provincial regulatory body. It is important to ensure that families are empowered to make informed decisions when selecting an analyst for their child. In order to provide families with this ability, we suggest that parents look for certain qualifications, designations, and experiences from behaviour analysts. The following suggestions are meant to enable parents to make informed decisions about behaviour analysts so that their child can access beneficial, evidence-based therapies: 1. The Behavior Analyst Certification Board (BACB) is an internationally recognized certification body for behaviour analysts. Masters level

credentialing as a Board Certified Behavior Analyst (BCBAÂŽ) is recognized as a basic standard for those overseeing behavioural interventions based on applied behaviour analysis. The website www.bacb. com has a list of BCBAs, standards of practice, and the BACB ethical code. It is advisable for anyone seeking behaviour-analytic support to ensure that they ask practitioners about their experience, education, and BACB certification. 2. Typically, a behavioural team for intensive behavioural intervention includes a BCBAÂŽ to assess the child, plan, and supervise the intervention and therapists (including undergraduate or college level direct-care therapists). Focused intervention requires a BCBAÂŽ and may or may not also require direct-care therapists depending on the type/intensity of involvement needed. It is important that in addition to BCBAÂŽ certification, experience in delivering and supervising interventions should be a consideration. 3. Families should feel empowered to ask providers for a current resume, proof of credentials, references, and a vulnerable persons criminal reference check. 4. The Ontario Association for Behaviour Analysis (ONTABA) is the largest professional organization representing practitioners of behaviour analysis in Canada. Their website www.ontaba.org provides material about behaviour analysis as well as information that may assist anyone looking for support. A caregiver summary of their recent review of evidence-based practices for ASD (OSSETT-ASD) is also available. 5. Autism Ontario has hosted a list of providers of ABA services for many years through their website www. autismontario.org. A revised registry of providers for the Ontario Autism Program is in progress, as well as resources for parents who are selecting H intervention providers.â&#x2013;

Ana Luisa Santo, MA, BCBA, is a Senior Behaviour Therapist at Surrey Place; Aamir Khan, M.ADS, BCBA, is a Behaviour Facilitator at Surrey Place; Rosemary Condillac, C.Psych., BCBA-D is an Associate Professor at Brock University; and Andria Bianchi, PhD, is a Bioethicist at the University Health Network. www.hospitalnews.com

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SEPTEMBER 2019 HOSPITAL NEWS 45

NEWS

Where to begin when severe weather strikes: How will you communicate with staff? By Ann Pickren n 2018, Canada’s ice storms, floods, windstorms, and tornadoes damaged homes, persons, and properties, and gained the title of the fourth largest historical accumulated loss to date. The nation’s severe weather patterns make businesses the perfect host for a number of threats; last year alone, severe weather resulted in over 100 deaths and $1.9 billion in damages, according to the Insurance Bureau of Canada. Severe weather is no longer the exception; it’s the rule – and healthcare organizations need to prepare with that reality in mind. Successfully developing a wellthought-out emergency management plan that protects people and property

is critical to ensuring employee safety and business continuity. And a successful plan for severe weather must account for communications that need to occur before, during and after an event. Before the next disaster strikes, plan more effectively with these emergency communications strategies in mind.

notifications, who they will come from and when to expect them so that there is a consistency to the process and baseline expectations exist. By establishing a system to contact appropriate staff, patients’ treating physicians, and other necessary persons in a timely manner, your facilities can ensure continuity of operations and that patient care is not disrupted.

USE THE RIGHT PROCESSES

USE THE RIGHT TOOLS

Severe weather cannot be avoided, but its impact can be mitigated by putting in place the right emergency response team and workforce communications processes before the storm hits. Staff, patients and others should have a clear sense of how they will receive

Hospitals and healthcare organizations are challenged to reach staff, patients and visitors before, during and after severe weather strikes. This is due to the fact that the messages for various groups will vary depending on circumstances (i.e. – essential

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personnel might still need to get to work during a snowstorm while other staff may be exempted). For that reason, healthcare organizations need a reliable, accurate platform for communicating in real-time with all relevant individuals or groups. Evaluate which Emergency Mass Notification System (EMNS) is the best fit for your organization. Key features and capabilities that you should look for in an EMNS include:

GEOGRAPHIC TARGETING Using a system that geo-maps notifications is important, particularly for healthcare organizations responsible for the safety of individuals spread www.hospitalnews.com

NEWS

However, with such rapid outbound capabilities, communications managers often overlook the benefits of receiving feedback from recipients. Having a mass notification system in place that allows emergency managers to ask recipients questions or capture feedback drives accurate analysis and rapid decision-making. This tactic can come in handy for recipients to report how poor conditions are in their area or to ask for clarification on instruction.

AUTOMATION An EMNS system that still places a heavy manual burden on users to configure and manage the system invites errors and delays to the communications process around severe weather event notifications. Look for systems that can automate key processes through predefined rules and event triggers, as this will shrink the time between the occurrence of an event and the resolution of that incident. Successful automation does require having sound processes in place when it comes to who is authorized to send notifications, who should receive them, what the message should say, when it should be delivered and when escalation might be required. Automation will always require a degree of tailoring based on the recipient groups, type of weather event, and other variables.

DONâ&#x20AC;&#x2122;T OVERLOOK THE BASICS across multiple facilities. Weather conditions can vary greatly across a region or country, which means that sending generic messages too broad or narrow to a group invites chaos, puts individuals at risk unnecessarily, and damages quality of care if workers who can work are told not to and vice versa.

TWO-WAY COMMUNICATION One of the key benefits of having an emergency mass notification system in place is the ability to send outbound alerts very rapidly. This tactic is extremely useful, especially when encountering severe weather because conditions can change on a dime. www.hospitalnews.com

As part of the emergency response process, itâ&#x20AC;&#x2122;s important to provide additional safety information that can include: â&#x20AC;˘ Local evacuation procedures â&#x20AC;˘ Power outage updates from local suppliers â&#x20AC;˘ Storm debris updates â&#x20AC;˘ Evacuation and re-entry point information to access hospitals in surrounding neighborhoods â&#x20AC;˘ Restoration efforts to help residents and employees get back home and back to work safely â&#x20AC;˘ Shelter information in cases where employees and visitors are seeking additional safety At the same time, even the most comprehensive weather communi-

cations plan can be undone if you canâ&#x20AC;&#x2122;t reach all stakeholders quickly. For staff, this means having up-todate contact information on hand for your workforce. Employees come and go, and phone numbers change â&#x20AC;&#x201C; as do the human resources and business process systems that organizations use to manage contact information. Build a strategy to capture all key forms of contact information â&#x20AC;&#x201C; from the time a new hire joins the company to periodic update periods. This should include email, text messaging, phone, as well as mobile apps and desktop alerts. Severe weather communications cannot be only outbound in nature. Assume that as conditions worsen, staff and even patientsâ&#x20AC;&#x2122; families and friends my attempt to reach your facil-

ity via the main phone line to find out new information and instruction. This can bog down phone lines, consume already scarce personnel resources and delay information getting to people who need it the most. Consider recipient and shared message boards that respectively, allow individuals to retrieve specific messages that were previously distributed and for posting recorded messages or instructions to a wider audience. Finally, communicating as much in advance of weather events as possible will reduce fear and confusion during an actual weather-related event. The history of weather-related losses have reaffirmed the challenge hospitals face today to protect people and property â&#x20AC;&#x201C; and a sound emergency communications plan is core to meeting that H challenge. â&#x2013;

Ann Pickren is President at Onsolve.

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