Hospital News June 2019 by Hospital News

Special: Canadian Society of Hospital Pharmacists Inside: From the CEO’s Desk | Evidence Matters | Safe Medication | Nursing Pulse | Long-Term Care

June 2019 Edition

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Contents June 2019 Edition

IN THIS ISSUE:

Canadian medical volunteers

10 ▲ Special focus: Hospital pharmacy

▲ Cover: Gene therapy gives new lease on life

14 ▲ Volunteers offer comfort and compassion

COLUMNS Editorial ............................4

In brief ..........................5,7 Evidence matters ...........16 Nursing pulse ................18 From the CEO’s desk .....32 Ethics .............................33 Long-term care ...............36 Safe medication ........... 44 Careers ...........................47 www.hospitalnews.com

Helping people ple tia with dementia sic through music

▲ Have an innovative idea in aging and brain health?

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Unbefriended

seniors often lack basic daily needs and suffer extreme social isolation By Stephanie A. Chamberlain and Carole A. Estabrooks hat happens when a person grows older and is no longer able to make health and financial decisions for themselves – but also does not have family or friends who can make those decisions on their behalf? Health and social services use a hard-hitting term to describe this growing population: “unbefriended.” “Unbefriended” individuals may have experienced homelessness or mental health issues or substance abuse; they may be estranged from their family, have outlived their family or never had a partner or children. Although the “unbefriended” can be of any age, they are often older adults. “Unbefriended” seniors are the most vulnerable of the most vulnerable – and we need to do more to safeguard their access to basic daily needs, including companionship, and improve their quality of life. There’s actually not much known about this population, which is why we undertook a study – the first of its kind in Canada – examining the quality of care and quality of life for the “unbefriended” across seven long-term care homes in Alberta. Our study found that many of these individuals are low-income, living on limited government-provided pensions. Even though they are living in longterm care facilities where they have food and shel-

ter, few can afford basic personal care items, such as clothing, lotions or denture adhesive. Similarly, uninsured services, such as dental, hearing and eye and foot care services are beyond their financial means. Even those that can afford these basics frequently go without them because they have no one to purchase these items on their behalf or arrange for appointments. Our study found that overworked care aides in long-term care facilities – who themselves often make a basic wage – frequently purchase supplies out of their own pocket to help the “unbefriended.” One care aide reported buying dental adhesive out of her own money so the residents in her care could put in their dentures. Another reported seeing “unbefriended” seniors in worn and thread-bare clothing so scouted out second-hand clothes for them. We also found that “unbefriended” individuals have limited social interaction, especially if they exhibit challenging behaviours due to mental illness or dementia. Little social interaction contributes to a lower quality of life. Those with more financial means could hire a companion for social interaction, but most are unable to afford this luxury or are unable to facilitate hiring someone. Continued on page 5

Stephanie Chamberlain is a doctoral candidate at the University of Alberta. Dr. Carole A. Estabrooks is Scientific Director of the pan-Canadian Translating Research in Elder Care (TREC) and Professor, Faculty of Nursing, at the University of Alberta.

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

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

+ Special Focus: Patient Rooms THANKS TO OUR ADVERTISERS Hospital News is provided at no cost in hospitals. When you visit our advertisers, please mention you saw their ads in Hospital News. 4 HOSPITAL NEWS JUNE 2019

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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IN BRIEF

Quantifying the value of genomics driven health care for children with rare diseases wo million Canadian children are classified as having a rare disease. As these children and their families navigate these complex, life-threatening, or chronically debilitating conditions, their stories are often similar — they spend years experiencing a diagnostic odyssey that includes many hospital and clinic visits, tests and several misdiagnoses before a firm diagnosis is established. Over 80 per cent of rare diseases are thought to have a genetic origin. And while next generation sequencing technologies, such as whole exome and whole genome sequencing, may enable more accurate disease diagnosis and treatment guidance for childhood rare diseases, these technologies are not routinely available in clinical care. There are outstanding questions as to whether these technologies are valued by patients, or an efficient use of healthcare resources, as well as understanding at what point they be-

OVER 80 PER CENT OF RARE DISEASES ARE THOUGHT TO HAVE A GENETIC ORIGIN. come cost-effective. Answering these questions helps inform the adoption of these tools as a standard of clinical care and potentially validates the impact that genomics has on the quality of life for patients. Dr. Dean Regier, a scientist at BC Cancer, focuses his research on improving methods to understand how genes play a role in our personal lives and how patients and the general public value the trade-offs between the benefits and risks when making decisions to undergo genomic testing. He gathers evidence from patients for input into economic models, which evaluate whether these technologies provide value for money. “Genome wide sequencing improves the health and well-being of patients and families with rare diseases. What

is needed in BC and around the world is robust, high quality evidence of the cost effectiveness of these tools as well as the value patients and families place on improved diagnoses. This evidence can aid decision makers in assessing value for money in context to the many competing demands on our scarce healthcare resources,”says Dr. Regier, Over the next two years, a $500,000 project, funded through Genome BC’s Genesolve program and Illumina Inc., will draw upon health care data from BC as well as the 100,000 Genomes Project in the UK to generate evidence for the appropriate and sus-

tainable adoption of whole exome and whole genome sequencing to diagnose and guide treatment for children with rare diseases. This work will be undertaken by Dr. Regier in collaboration with colleagues from the University of Oxford, the University of British Columbia and BC Children’s Hospital and BC Women’s Hospital + Health Centre. “Genomics is already saving lives and improving health outcomes in many areas, including rare disease. However, the validation of these technologies as a cost-effective way to direct clinical management and improve patient outcomes is critical to optimizing the uptake of genomics into the healthcare system,” says Dr. Catalina Lopez-Correa, Chief Scientific Officer and VP, Sectors, Genome British H Columbia. ■

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Unbefriended seniors Continued from page 4 In Canada, “unbefriended” seniors are assigned a government-appointed public guardian to take over decision-making responsibilities on their behalf, such as for their healthcare and living arrangements. But public guardians are not care providers or family members. They do not spend much time with their clients who live in long-term care facilities because they are deemed safe and housed. Many public guardians carry large case loads of well over 50 clients. While they are supposed to visit their clients four times a year, they often struggle to meet this goal. So what can be done to improve the quality of life and access to basic daily living needs for someone deemed “unbefriended”? We could expand the public guardian role to include basic living needs www.hospitalnews.com

beyond just food and shelter, such as quality of life markers and social interaction. Alternatively, governments could fund organizations to work alongside public guardians to systematize such services so that no individual is left neglected or forgotten or relying on the charity of care aides. But first and foremost, we need to simply put the “unbefriended” on the map. We can’t address what we don’t count and measure, and largely, they are the forgotten population in the policy landscape. With the numbers of single households rising dramatically, more and more of us could find ourselves in this position as we age. We owe it those who are at their most vulnerable to provide a life of basic dignity and H security. ■

How do you get a reputation for providing unsurpassed service and value? You earn it. No organization has purchased more radiology equipment than CAPsource. The ability for CAPsource to make each purchasing initiative as customized as the technology being offered and as unique as the hospitals participating means that every hospital is able to make their own decisions for what equipment is best for their patients. That’s how you earn a reputation for providing unsurpassed value in procurement.

sjhs-gpo.ca JUNE 2019 HOSPITAL NEWS 5

NEWS

2019 Hospital Supply Chain Conference By Pippa Wysong his year’s annual HSCN National Healthcare Supply Chain conference had an impressive 29 exhibitors representing a wide range of services and products. The launch of the Healthcare Transportation Network was an announcement at the conference. The Network coordinates multiple transportation providers across the province, and is spearheaded by Voyago, a province-wide transportation service. Chuck Archer of Voyago told Hospital News that the Network will make patient transportation, primarily hospital-to-hospital, more widely available and accessible. Connecting various transportation providers not only increases the number and types of vehicles available, but increases the availability of driving services in smaller communities. It can also reduce the need to phone around for transportation. A key feature offered by the Network are apps which allow hospitals to connect to services, specify the type of vehicle needed (such as if a stretcher or wheelchair capable), specify pick-up and drop-off points, and more. Voyago itself has 150 vehicles on the road for healthcare, but by being part of the Network hospitals have access to an additional 60 stretcher and 15 wheelchair capable vehicles. According to

Archer, the Network is open to more transportation services joining. Anybody working in hospitals will be aware of the vast amounts of potentially reusable items that are sent out as waste. Hope and Healing International provides an alternative by accepting reusable items that they clean and refurbish for use in developing countries. In a program that both helps patients in need and the environment,

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the organization will take everything from wheelchairs, crutches, diagnostic equipment, orthotics, medical furniture, spectacles, surgical instruments and equipment and more. Pharmaceuticals are accepted too but must have at least one year before expiration. Another way to help the environment, save energy and reduce costs is addressing the infrastructure of hospital buildings. Ecosystem is a Quebec-based engineering firm that does retrofit changes to everything from ventilation systems, insulation, electrical and more which all comes with a 7-year warranty. Information from the company shows a renewal project done across three sites of the Quebec City University Hospital Centre lead to a reduction in energy consumption by 30 per cent, leading to $2.9 million in annual savings, and a greenhouse gas emissions reduction of 52 per cent. In Ontario, the company has already done work at St. Michael’s Hospital in Toronto and Lakeridge Hospital. Cornerstone Medical showed off an example of the Silentia folding privacy screens they distribute. The screens

are an alternative to privacy curtains and are mounted either on a wall or free-standing post. The number of panels (overall length) and height are customizable. The screens can be wiped down – a change from sending curtains to dry-cleaners. They are also available in a wide range of colors and can even be ordered with artwork or photographic images on them with – popular themes are sunsets, garden and forest images. A new-to-Canada inventory solution was offered by PAR Excellence which showed off it’s smart shelving and bin system which automatically keeps track of inventory. Each bin, which stores a specific type of item, sits on a weight scale with data sent to a computer. Each time an item is added or removed from a bin, the weight is recorded and calculations are performed which provide users with a tally of how many items are in a bin. The weights are sensitive enough to determine the weight of a single small bandage. Bins are available in different sizes and are already in wide use across H the US. ■

Pippa Wysong is a freelance writer. 6 HOSPITAL NEWS JUNE 2019

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IN BRIEF

Excess Health system failing to meet seniors’ needs, weight expected to

Canadians facing increasing financial burden s the number of aging Canadians grows, so do our worries about being able to get the health care we need. The findings from a recent national Ipsos survey tell a startling tale of Canadians significantly concerned about the state of our health care system. With the youngest Baby Boomers now reaching the age of 55, a significant portion believe they’ll need to delay retirement to afford the health care services they need. Recently, the Canadian Medical Association (CMA) was in Charlottetown, where federal, provincial and territorial ministers responsible for seniors discussed issues affecting older Canadians. The CMA was on-site with provincial medical associations from the region to brief ministers on the state of seniors care in Canada, sharing views from the front lines and a pan-Canadian perspective.

What we know: • The number of seniors is expected to exceed the number of children aged 14 and under for the first time ever in Canada by 2021 (source: Statistics Canada) • Nine in 10 (88%) Canadians say they’re worried about the growing number of seniors requiring more health care (source: Ipsos 2019) • Six in 10 (58%) believe that Canadians will have to delay their retirement to afford their health care; • Baby boomers believe that a failure to improve the health system will result in them having to pay more out-of-pocket for health care and more taxes • In 2018, Canadian caregivers and care receivers had to spend more than $9B out-of-pocket to care for their loved ones, a number that’s expected to continue to rise

• When it comes to how Canadians feel about the future of health care, negative emotions (62%) far outweigh positive (38%), with nervous (22%), afraid (21%) and distressed (18%) topping the list (source: Ipsos 2019) (consider deleting) • Concerns on health care could sway voting behaviour this election, with Canadians 55 and over more likely to say they’ll vote for the party they think has the best plan for the future of health care (source: Ipsos 2019) “Meeting the health care needs of our aging population is a nationwide issue, with seniors across the country having to pay more out of their own pockets for the care they need,” said CMA President Dr. Gigi Osler. “What we’re seeing today reflects the limitations of seniors’ care, and we H can – and must – do better.” ■

Many patients with pancreatic cancer miss out on treatment that may extend survival espite potential for prolonging survival with treatment, one-third of patients with metastatic pancreatic cancer do not see a medical oncologist, and even more do not receive cancer-directed treatment, found new research published in CMAJ. Pancreatic cancer has a high death rate and is often diagnosed in advanced stages. “The data suggest that there are many missed opportunities for important discussions between patients and cancer specialists,” says Dr. Natalie Coburn, an author of the study and a surgical oncologist at Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, Ontario. “We have better chemotherapy drugs than in the past, but those standards of care aren’t reaching patients. Spreading the reach of the standards of care, starting with a consultation with a medical oncologist, would have a big impact.”

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The study looked at data on 10, 881 patients with a new diagnosis of advanced pancreatic cancer in Ontario from 2005 to 2016, and examined how many people saw a medical oncologist and how many received treatment after consultation. About 65 per cent of patients had a consultation with a medical oncologist, and 38 per cent of all patients received cancer-directed treatment. More than half of patients who did not receive cancer-directed treatment did not have a medical oncology consult. By contrast, about 80 to 90 per cent of patients with colorectal cancer see a medical oncologist and undergo treatment for the disease. The study aims to raise awareness of this issue for pancreas and other high-fatality cancers. “We want to debunk the idea that it’s ‘not worth treating’ pancreas cancer. We want more people to

access a medical oncologist so that they can have informed discussions about treatment options, symptom management and palliative care,” says coauthor Dr. Julie Hallet, a surgical oncologist at Sunnybrook Health Sciences Centre and the University of Toronto. “We could achieve better results by getting more people to an oncologist and better access to best practice treatments right now than with new and often expensive experimental drugs in the future.” The authors suggest that changes to health policies are necessary to ensure all patients have equal opportunities for assessment and treatment. “Low rates of specialized cancer consultation and cancer-directed therapy for incurable pancreatic adenocarcinoma: a population-based analysis” was published May 27, H 2019. ■

become 2nd leading preventable cause of cancer

Canadian Cancer Society (CCS)-funded study has found that, unless Canada makes changes, excess weight will become the second leading preventable cause of cancer, following tobacco. The Canadian Population Attributable Risk of Cancer (ComPARe) study estimated that by 2042, the number of cancer cases due to excess weight will nearly triple, from 7,200 to 21,200. Currently, more than one in two Canadian adults have excess weight, putting them at increased risk for at least 13 different types of cancer, including breast, colorectal, endometrial and esophageal cancers.

BY 2042, THE NUMBER OF CANCER CASES DUE TO EXCESS WEIGHT WILL NEARLY TRIPLE, FROM 7,200 TO 21,200. Published in Preventive Medicine, the ComPARe study is the first study of its kind in Canada and estimates the current and future burden of more than 30 different cancer types due to more than 20 different modifiable cancer risk factors. The ComPARe study revealed that as many as four in 10 cancer cases can be prevented. In addition, the ComPARe study also showed that currently the top five leading preventable causes of cancer are smoking tobacco, followed by physical inactivity, excess weight, low fruit, and sun. The ComPARe study also estimates that if we don’t act now, by 2042 almost 60 per cent more cancer cases will be due to preventable causes. For example, if more Canadians had a healthy body weight, about 110,600 cases of cancer could be prevented by H 2042. ■ JUNE 2019 HOSPITAL NEWS 7

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More than 200,000 patients get infections every year while receiving healthcare in Canada, and more than 8,000 die as a result. 3,4 Not surprisingly, treatment is more costly than prevention, totaling an estimated $129 million in 2010 alone.4 Swapping out dilutable products for ready-to-use disinfectants may help hospitals achieve consistent, compliant use for terminal disinfection.

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References: 1. Wiemken T L, et al. The value of ready-to-use disinfectant wipes: Compliance, employee time, and costs. Am J Infect Control 2014;42:329-30. 2. Weinstein RA. Epidemiology and control of nosocomial infections in adult intensive care units. Am J Med 1991;09:179S. 3. Government of Canada. The Chief Public Health Officer’s Report on the State of Public Health in Canada 2013 – Healthcare-associated infections – Due diligence. 2013. https://bit.ly/2AVgHs4. Accessed September 28, 2018. 4. Canadian Patient Safety Institute. Healthcare associated infections (HAI). https://bit.ly/2ecb77j. Accessed September 28, 2018. 5. Sifuentes LY, et al. Microbial contamination of hospital reusable cleaning towels. Am J Infect Control 2013;41:912-5. 6. O’Neill C, et al. Quality control is indispensable for automated dilution systems with accelerated hydrogen peroxide. Can J Infect Control 2009;24:226-8. 7. Engelbrecht K, et. al. Decreased activity of commercially available disinfectants containing quaternary ammonium compounds when exposed to cotton towels. Am J Infect Control 2013:41:908-11. 8. Smith DL, et al. Assessing the efficacy of different microfibre cloths at removing surface micro-organisms associated with healthcare-associated infections. J Hosp Infect 2011;78:182-6. 9. The Clorox Company. Environmental sustainability. https://bit.ly/2Rplqqq. Accessed October 3, 2018.

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NEWS

(Above) One of Mercy Ships hospital ships. (Inset) Aissata pictured here with mom Hassanatou after the 7-month-old received cleft-lip surgery.

Canadian medical volunteers

help give 100,000 free surgical procedures in West Africa he Canadian office of international nonprofit Mercy Ships celebrates a major milestone: a baby born with a debilitating cleft lip in Guinea has received free surgery from Mercy Ships volunteers, marking the charity’s 100,000th surgical procedure onboard its hospital ships. Aissata (EYE-sat-ah), a 7-monthold child, travelled with her mother nearly 200 miles to receive the surgery on the hospital ship Africa Mercy, which has provided free surgeries to more than 2,100 people in Guinea since arriving in August. For Mercy Ships, the milestone represents an important point in the charity’s 40-year legacy. For Aissata, the free surgery changed the course of her life.

10 HOSPITAL NEWS JUNE 2019

“I have always been very worried about her future and what would happen to her if I didn’t get her the surgery she needs,” says Aissata’s mother, Hassanatou (Ha–SANA–tu). “But now that she has come here to the ship, I am no longer worried.” Their family is among the world’s estimated five billion people who do not have access to safe, affordable, timely surgery. In sub-Saharan Africa specifically, 93 per cent of the population can’t get the surgery it needs. Mercy Ships addresses this global surgery crisis within Africa by sending hospital ships staffed by volunteers to the places where surgeons are needed most. These surgeons also train local medical professionals who will stay in their home countries, effecting change long after Mercy Ships departs. Mercy

Ships has touched more than 2.7 million lives since 1978. “Seeing Aissata’s new smile after her surgery is an image of the hope and healing we are working to provide for thousands of people in Africa who are without access to surgical care,” Mercy Ships Canada CEO Jamie McIntosh says. Canada currently has a number of volunteers who were onboard the Africa Mercy when the 100,000th surgery was performed. Over 70 Canadians will serve on the ship this year, donating time and a wide range of skills as nurses, surgeons, anesthesiologists, sterilizing technicians, dentists, teachers, engineers, electricians and more. Some volunteers serve for long periods onboard the Africa Mercy,

some even living with their families onboard. Others, like Canadian OR Nurse Kim Marlatt, serve in shorter periods. Marlatt just returned from Conakry, Guinea earlier this year after spending her two-week vacation volunteering with the Mercy Ships Ophthalmic Program. “It was such a life-changing experience for me. One of the weeks I was there, I was doing cataracts on five-month-old babies who were born blind,” she says. “We were giving the gift of sight. The next day, I’d go see the babies in this ward and they were reaching for your face and seeing their moms for the first time,” says Marlatt. The medical volunteers who work with Mercy Ships come from a range of specialties, and help provide surgeries in the Women’s Health, www.hospitalnews.com

NEWS Medical volunteers assess a patient onboard the hospital.

Plastic Reconstructive, PalliativeCare, Orthopaedic, Maxillofacial, Dental, Ophthalmic and General Surgery Programs. “Our surgical programs change the entire course of our patients’ lives,” says McIntosh. “And by forming partnerships with African nations, together we are building a powerful legacy of hope and healing that’s contributing to the overall development of West and Central Africa.” After Mercy Ships completes its fourth surgical visit in Guinea in June, the Africa Mercy will sail for Senegal in August. Currently the 2019-20 field service in Senegal has openings for nurses (team leads, OR, ICU, IPC), sterile processing technicians, surgeons and more. To learn more and apply visit https://mercyships.ca/become-a-volunteer/ or email crew.coorH dinator@mercyships.ca. ■

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Revolutionary gene therapy gives new lease on life Clinical Trials Unit performs first-in-Canada procedure at Foothills Medical Centre By Blain Fairbairn roundbreaking research is offering new hope to people living with serious illness thanks to a joint AHS and University of Calgary Cumming School of Medicine (CSM) initiative in the new Clinical Trials Unit (CTU) at the Foothills Medical Centre (FMC). The CTU’s first study participant, Josh McQuillin of Prince George, B.C., is the first Canadian in history to receive gene replacement therapy by a direct intravenous injection to treat a genetic disease. Only three other people in the world have undergone similar treatment. “I lived a normal life up until I was 12 and then got really, really sick,” says the 30-year-old. “The doctors had no idea what was wrong with me, but they say I almost died.” McQuillin was diagnosed with a Urea Cycle Disorder (UCD), a genetic disease that causes ammonia to build up in the body, and can lead to brain damage or death. Ammonia is naturally produced as the body metabolizes protein, but for those with a UCD the process of converting ammonia to urea (the harmless substance giving urine its yellow colour) doesn’t work properly. The condition required McQuillin to take up to 36 pills a day, adhere to a strict diet and limit travel and activities so he was always close to a hospital. Simple things like missing a meal or eating too much protein could result in a life-threatening scenario and lengthy hospital stays. McQuillin received experimental gene replacement therapy at the CTU. It gave him a working copy of the gene he needed, sending it directly to his liver via intravenous injection. His liver can now process ammonia effectively, which has given McQuillin a new lease on life.

Photo credit: Riley Brandt, University of Calgary

Study participant Josh McQuillin, left, celebrates his amazing progress with Dr. Chip Doig, centre, a medical director at the Foothills Medical Centre’s (FMC) intensive care unit, and Josh’s physician and study lead Dr. Aneal Khan at the new Clinical Trial Unit. “It’s like night and day,” he says. “My exercise has changed, my sleep patterns have changed, my diet has changed — it’s really incredible.” Dr. Aneal Khan, the study lead and an associate professor in the departments of Medical Genetics and Paediatrics at the CSM, says gene therapy holds tremendous promise as an effective treatment for a number of disorders, and offers significant benefits to patients and the healthcare system. “With gene therapy we use modified viruses to add new genes to a patient’s

cells so that they have a working copy of the gene,” says Khan, who’s also a member of the CSM’s Alberta Children’s Hospital Research Institute. “This is highly personalized, precision medicine that can drastically improve the quality of life for people born with a genetic abnormality.” Many patients with genetic disorders like McQuillin must take expensive medications every day for the rest of their lives and require frequent hospitalization with numerous complications, Khan adds. The estimated cost

of treating UCD is about $1 million per year per patient. The CTU is a self-sustaining entity funded through research programs with industry and government sponsors. It is unique in that it’s housed in the Foothills Medical Centre’s Intensive Care Unit (ICU), and managed by the hospital’s critical care team. This allows patients with rare or serious disorders who may require immediate medical attention to safely participate in research. Dr. Christopher (Chip) Doig, a medical director in intensive care for Alberta Health Services’ Calgary Zone, says the CTU is powerful example of how academic and clinical partnerships open up new options for patients and opportunities for researchers to investigate new therapies for a broad spectrum of disorders. “As a hospital ICU, we’re not going out and actively looking for studies,” he says. “What we’re doing is making the opportunities available to worldclass researchers like Dr. Khan and his team to benefit patients. Although the CTU is new, many researchers in a number of areas have expressed interest and excitement about its potential. “Our hope is to see more trials that could involve gene therapy and personalized medicine in everything from cardiac disease to cancer.” Following his treatment, McQuillin is off his medication and no longer needs to think about what, or when, he has to eat — or where he can go to ensure a hospital is nearby. “I was told not to travel to the developing world because I couldn’t be sure I’d get the treatment I’d need if I got sick,” he says. “Even camping for a couple days was an issue because I might be too far from a hospital. “Now I can do whatever I want without worrying about ‘maybe I’ll feel okay’, or ‘maybe I won’t’. I feel like I’m back to H normal.” ■

Blain Fairbairn is a Senior Communications Advisor at Alberta Health Services. 14 HOSPITAL NEWS JUNE 2019

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NEWS

COPD decision tool

helps keep patients safe By Amelia Buchanan atients with chronic obstructive pulmonary disease (COPD) often come to the Emergency Department gasping for breath. These flareups can usually be treated safely in the ED, but sometimes they can lead to serious complications. Thatâ&#x20AC;&#x2122;s why Dr. Ian Stiell created a decision tool to help doctors accurately predict which patients were the most likely to suffer complications. A recent study published in CMAJ found that The Ottawa COPD Risk Scale is better than current practice at predicting these short-term risks. Now this made-in-Ottawa tool can be used by doctors around the world to help choose the best care for their patients with COPD. â&#x20AC;&#x153;Before this tool, there was no way to know if a patient who came to the Emergency Department with a COPD flare-up was going to have serious complications,â&#x20AC;? says Dr. Stiell, also a senior scientist at The Ottawa Hospital and distinguished professor at the University of Ottawa. â&#x20AC;&#x153;This new information can help doctors decide whether to admit a patient or send them home.â&#x20AC;? COPD is a group of diseases that block airways and affects 11 per cent of Canadians over age 35. Flare-ups of the disease make it harder to breathe and can lead to complications like

needing a breathing machine, or having a heart attack or death. However, identifying which patients will experience these complications is challenging. Dr. Stiellâ&#x20AC;&#x2122;s team previously found that about half of patients with COPD who suffer adverse events in Canada do so after being sent home. Until now, there has been little evidence to help prevent this. â&#x20AC;&#x153;This tool will improve care for patients with COPD by helping ensure that those at high risk of dangerous complications are admitted to hospital, and those at low risk are sent home,â&#x20AC;? says Dr. Stiell. Dr. Stiell noted that doctors consider many factors when deciding whether to admit a patient, including how much support they have at home and whether they can see a doctor within a week of their visit. The Ottawa COPD Risk Scale does not replace these considerations, but provides additional information to help doctors make a decision. Dr. Stiellâ&#x20AC;&#x2122;s research team developed the tool based on data from 945 patients from Canadian hospitals. The 10-point scale includes elements from a patientâ&#x20AC;&#x2122;s history, examination or tests conducted during their visit. These risk factors are easy to determine and do not need expensive further testing.

Dr. Ian Stiell is known around the world for creating decision rules that improve patient care, such as the Ottawa Ankle Rules, the Canadian C-Spine Rule, and now The Ottawa COPD Risk Scale. A validation study with 1,415 more patients showed that using the risk scale is better than current practice. If used, it will likely increase COPD admissions for higher-risk patients while decreasing admissions of low-risk patients. Researchers donâ&#x20AC;&#x2122;t expect this tool to cause a net increase in COPD admissions overall. â&#x20AC;&#x153;Thereâ&#x20AC;&#x2122;s no question that this tool can be used today,â&#x20AC;? says Dr. Stiell. â&#x20AC;&#x153;While designed for emergency physicians, it could also help others who serve patients with COPD, including

respirologists, general internists and family doctors.â&#x20AC;? Dr. Stiell is known around the world for creating decision rules that improve patient care, such as the Ottawa Ankle Rules and the Canadian C-Spine Rule. These rules are now available on a mobile app. This study was funded by the Canadian Institutes of Health Research. Research like this is possible because of generous support for research to improve patient care at The Ottawa H Hospital. â&#x2013;

Amelia Buchanan is the Senior Communications Specialist at The Ottawa Hospital

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JUNE 2019 HOSPITAL NEWS 15

EVIDENCE MATTERS

Cervical cancer screening: Is it time for a new test? By Michael Raj he incidence of cervical cancer has been decreasing over the past three decades, largely due to routine screening. When screening leads to the detection of pre-cancerous lesions, they can easily be treated, and cancer can be avoided; and when screening finds cancer at an early stage, it can usually be treated successfully. Nevertheless, in 2017, it is estimated that there were 1,550 cervical cancer cases diagnosed and 380 deaths in Canada. Current guidelines recommend screening every two to three years using a cytology-based test starting at age 21 through to ages 65 to 70, depending on the jurisdiction. The cytology test can be either a conventional Pap test (or Pap smear) or the newer liquid-based cytology test. Because both tests are commonly referred to as Pap tests, this term is used in this article to refer to both types of cytology. During a Pap test, a health care provider takes a swab of cells from the surface of the cervix, which is then examined un-

der microscope for abnormalities. If a screening test comes back positive, the patient will then undergo a colposcopy to examine the cervix and determine if cancer is present. Another test – the HPV or human papillomavirus test – can also be used for cervical cancer screening. Rather than looking for cell abnormalities, this test examines the cells for the presence of the DNA of high-risk (cancer-causing) types of the HPV virus. HPV is the most common viral infection of the reproductive tract and is the major risk factor for the development of cervical cancer. Almost all cervical cancers are caused by HPV. While there’s currently no cure for HPV infection, it can be prevented with vaccination. School-based programs have been implemented in all Canadian provinces and territories with different starting ages and dosing schedules. Most sexually active people will have an HPV infection at some point in their lives, and in most cases, the

infection will clear on its own. But a persistent HPV infection can lead to changes in the cervical cells, which can develop into cancer. It could take as long as 10 to 15 years for these cells to become cancerous. It’s therefore important to find these cell changes early through regular screening. This strong link between HPV infection and cervical cancer has caused many experts to suggest that HPVbased screening replace the Pap test as the primary screening test for cervical cancer. It’s thought that the HPV test might be better at correctly identifying those who are at risk of developing cervical cancer compared with the Pap test. Further, cell samples for HPV tests can also be collected by patients themselves, whereas Pap test samples can be collected only by clinicians. This may be particularly important for those who find the screening process embarrassing or invasive, or who don’t screen for other reasons. Despite these potential advantages, HPV testing hasn’t been implemented in any Canadian provinces or territo-

ries yet, although a few are working on it. Should the Pap test be replaced by the HPV test? What does the evidence say? To help guide decision-making, policy makers and the health care community turned to CADTH – an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures – to find out what the evidence says. CADTH undertook a health technology assessment to help answer questions about whether the HPV test should replace the Pap test in Canadian jurisdictions as the primary screening tool for cervical cancer. The CADTH review found that there would be both benefits and drawbacks to the broad adoption of either type of test. Because the HPV test is very effective for detecting the types of HPV that put an individual at a high risk for cervical cancer, it may be able to identify a greater number of at-risk patients and, ultimately, result in fewer cases of cervical cancer being missed. Continued on page 18

Michael Raj, BSc MHSA is a Knowledge Mobilization Consultant for CADTH’s Implementation Support and Knowledge Mobilization program. 16 HOSPITAL NEWS JUNE 2019

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NEWS

Hospital fresh market

improves healthy eating By Katherine Mayer he seasonally popular Fresh Market located at Thunder Bay Regional Health Sciences Centre is returning in June for the seventh year. The Fresh Market is a farmers’ market hosted on the Hospital grounds throughout the summer and early fall months, featuring several local farmers and vendors and their fresh produce and products, and plays an important role in health promotion. Adults in Northwestern Ontario consume lower levels of fruits and vegetables than the rest of the province, and access to local, fresh and healthy produce and products is limited. “Our onsite Fresh Market improves community health and well-being by making fresh, healthy and local food to be more accessible to our staff, patients, visitors, and volunteers,” says Kelly-Jo Gillis, Manager of Preventive Health Services at our Hospital. “Reducing barriers to accessing healthy food is a goal that the Fresh Market constantly achieves.”

ADULTS IN NORTHWESTERN ONTARIO CONSUME LOWER LEVELS OF FRUITS AND VEGETABLES THAN THE REST OF THE PROVINCE, AND ACCESS TO LOCAL, FRESH AND HEALTHY PRODUCE AND PRODUCTS IS LIMITED. With more than 3,000 visitors annually from June to October each year, organizers strive to improve the Fresh Market’s impact on health by expanding produce and products,

The Hospital fresh market is a farmers’ market hosted at Thunder Bay Regional Health Sciences in an effort to improve healthy eating. working with new vendors, and engaging with customers and vendors alike to evaluate its success. “We focus on encouraging individuals to learn more about their food, where it’s coming from, and how to cook homemade meals with the ingredients they purchased,” explains Gillis. “Dietitian-approved recipes are provided and partnerships with our Hospital’s cafeteria allow us to provide food samples, food demos, and showcase local food on our cafeteria menus. And unlike a grocery store, Fresh Market attendees are able to ask questions directly to farmers and vendors and learn more about the items they are purchasing.” The Fresh Market is one of the most successful health promotion initiatives at our Hospital. Gillis continues, “The Fresh Market offers more health education than just healthy eating. Partnerships with our internal Hospital departments, local Health Unit and environmental programs have provided opportunities to learn about more aspects of health, including stroke prevention, sun safety, environmental health and exposures.” The notion of the Hospital promoting healthy eating onsite sends a

positive message to our community. “Even though we are an acute care hospital, we have a key role to play in the prevention and management of chronic disease in our region,” says Gillis. “We need to role model healthy lifestyles, and the Fresh Market is a great way to do that.”

Our Hospital’s Fresh Market is open to all staff, patients, volunteers, and the public every Wednesday from June 19 until October 9, 2019 between 11:00 am and 1:00 pm in the cafeteria courtyard. For more information on other health promotion initiatives at our Hospital, H visit www.tbrhsc.net/prevention. ■

Katherine Mayer is the Health Promotion and Communication Planner at Thunder Bay Regional Health Sciences Centre.

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JUNE 2019 HOSPITAL NEWS 17

NURSING PULSE

A path to wellness Support for nurses who struggle with mental illness or substance use disorders By Jonathan Sher n an intensive care unit where nursing staff and doctors try to stop or stall death, an Ontario RN engages in a more private fight, keeping secret an addiction that she knows compromises the quality of her care. Kathy* worked hard to earn a plum assignment in 2007 at a teaching hospital, and did so hiding her addiction, she says. While she never used alcohol or narcotics while working, by the oneyear mark in the ICU, she knew her conduct away from work was hampering her ability to look after patients. “Everything was spiraling downwards,” she says. “I was less than my best.” Kathy hid her addiction for another two years, unwilling to be exposed to public shame and professional disaster. That’s why she is thrilled that four Ontario nursing organizations, including the Registered Nurses’ Association of Ontario (RNAO), have joined forces to create a path for nurses who need support for mental illness and/or substance use disorders. It is a path that focuses on recovery, not shaming and punishment. Launched in January 2019, the Nurses’ Health Program (NHP) provides nurses a way to seek help outside the glare that comes when they are reported to the College of Nurses of Ontario (CNO), referred to the Fitness to Practice Committee, and have restrictions or conditions placed on a public register. Similar programs exist for other health professionals in the province, including pharmacists, physicians and veterinarians. The new program is run independently of CNO, which provides two of the eight members of NHP’s board, the other six split evenly among RNAO, Ontario Nurses’ Association

(ONA), and the Registered Practical Nurses Association of Ontario (RPNAO). “RNAO is delighted to partner with CNO, ONA and RPNAO in developing this program. Nurses who are dealing with issues of mental illness and addiction need support to overcome their challenges,” RNAO CEO Doris Grinspun explains. “NHP offers them a new avenue. We take great pride in being able to offer a program like this.” Nurses have two avenues to NHP. They can contact the program and seek help on their own, or, if they are reported to CNO, they may be given a choice to enrol in NHP as an alternative to a possible health inquiry process, so long as they comply with their treatment and monitoring plan, including any limits placed on them. At no time will their health disorder be publicly disclosed. This anonymity will not shield nurses from public accountability. Those who can’t practise safely won’t be allowed to do so. And nurses who too often fail to follow through on treatment and monitoring commitments can be removed from NHP and referred to CNO. “This program is a huge step forward. It will help nurses to get the specialized treatment and support they need, so they can work towards healthy recovery to be able to continue in their dedication to high-quality patient care,” ONA President Vicki McKenna says. Indeed, NHP strikes the right balance between protecting the public from harm and providing timely and confidential support for nurses who need it. “There is significant research showing that voluntary and confidential professional health programs are highly effective both in supporting recovery and protecting the public,” says Anne Coghlan, CNO’s chief executive officer.

From a nurse’s perspective, the NHP approach is far better for everyone, Kathy says, because a strictly punitive approach drives nurses to hide illness and addiction, something that places them and their patients at risk. After years of treatment and monitoring that included twice weekly urine tests, CNO’s Fitness to Practice Committee removed restrictions on Kathy’s license, and she began her search for a nursing position. She estimates more than 200 employers turned her away. The few that offered interviews did so having not read Find a Nurse, the public register. When she volunteered the information on the register – which she believed she was obligated to do – she was quickly shown the door. NHP assigns a case manager to each nurse, which is critical, Kathy says. “It’s so helpful to have a human face and voice you can talk to. Otherwise, the self-hate and self-loathing (can be) overwhelming,” she says. “I had suicidal thoughts. You know you let your profession down, yourself down, your family down.” Nurses place so much focus on helping others, they too often neglect themselves, says RPNAO CEO Dianne Martin. “I’m proud that this evidence-based program will help tackle the stigma and support nurses to come forward and get the help they need.” Now clean for nine years, Kathy is enjoying work and life. She’s worked hard for clarity and peace, and thinks that NHP could have provided a far speedier and less traumatic path to recovery. “(Nurses) always envied doctors because they had a program that offered (confidentiality). This is such a great step.” *A pseudonym has been used to H protect privacy. ■

Jonathan Sher is senior writer for RNAO, the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario. This article was originally published in the January/February 2019 issue of Registered Nurse Journal. 18 HOSPITAL NEWS JUNE 2019

Cervical cancer testing Continued from page 16 However, because not all patients with high-risk HPV will go on to develop cervical cancer, the test would likely result in an increase in patients undergoing additional, more invasive testing only to find out that they don’t have the disease. It should be noted that CADTH found few long-term clinical studies comparing the HPV and Pap test, so it’s unclear if identifying more at-risk patients would, over time, lead to fewer deaths from cervical cancer.

HPV TESTING HASN’T BEEN IMPLEMENTED IN ANY CANADIAN PROVINCES OR TERRITORIES YET, ALTHOUGH A FEW ARE WORKING ON IT. Decision-makers thinking about a switch from Pap testing to an HPVbased screening program need to balance a wide range of considerations. The CADTH review assesses not only the comparative accuracy and clinical utility of the two screening tests but also their safety and cost-effectiveness, and it also explores the experiences and perspectives of patients as well as ethical and implementation issues. The reports produced from the review are freely accessible at www.cadth. ca/hpv-testing-primary-cervical-cancer-screening. If you’d like to learn more about CADTH, visit www.cadth.ca, follow us on Twitter @CADTH_ACMTS, or speak to our Liaison Officer in your region: www.cadth.ca/contact-us/liaiH son-officers. ■ www.hospitalnews.com

Canadian Society of Hospital Pharmacists

Joint Venture Partnership supports

CANADIAN SOCIETY OF HOSPITAL PHARMACISTS

implementation of Vanessa’s Law with educational material By Ellen Gardner and Valentina Jelincic dverse drug reactions (ADRs) and medical device incidents (MDIs) occur in hospitals, including emergency departments, and in people’s homes – but such events are significantly underreported. The Protecting Canadians from Unsafe Drugs Act, also known as Vanessa’s Law, honours the memory of Vanessa Young, who died at the age of 15 due to a heart problem after being prescribed cisapride. Vanessa’s Law is intended to increase medication and device safety in Canada by strengthening Health Canada’s ability to collect information and take quick and appropriate action when a serious health risk is identified. The Law includes a mandatory requirement for hospitals to report serious ADRs and MDIs. This provision of the law comes into effect later this year.

serious ADR and MDI reporting. “The Joint Venture partnership leverages the strengths of our organizations, in collaboration with Health Canada, to support provinces and territories, hospitals and healthcare providers in preparing for implementation of the Vanessa’s Law mandatory reporting requirements,” says ISMP Canada CEO Carolyn Hoffman. “We are extremely proud to be working with Health Canada in partnership with ISMP and CPSI to address serious gaps in safety reporting in hospitals,” says Leslee Thompson, CEO of HSO.

MAKING THE CONTENT RELEVANT AND USEFUL One of the principles guiding the Joint Venture is that the best people to communicate information about mandatory serious ADR and MDI reporting are those closest to their audience.

Education Modules – A Helpful Approach? Response

# of Pilot Respondents Proportion of Respondents

3.9%

Yes

240

94.1%

(blank)

2.0%

Total

255

100.0%

Figure 1: 94% of respondents to the Pilot questionnaire indicated that the approach to education about Vanessa’s Law mandatory requirements is helpful. Three organizations – the Institute for Safe Medication Practices Canada (ISMP Canada), the Health Standards Organization (HSO), and the Canadian Patient Safety Institute (CPSI) – are working in a joint venture to assist Health Canada with outreach, education, and feedback to encourage 20 HOSPITAL NEWS JUNE 2019

Therefore, hospitals, educational organizations, and accrediting bodies are encouraged to use the educational material in a way that is most useful and relevant to their stakeholders. The educational content is contained in five PowerPoint modules, which include one concise overview module.

“The educational modules are designed to be ’building blocks’ for healthcare providers to integrate into their own learning or to incorporate into orientation, continuing education, and other education activities,” says Sylvia Hyland, Vice President and Chief Operating Officer at ISMP Canada. The Joint Venture partners suggest the materials be used in the following ways to raise awareness of Vanessa’s Law and to support reporting and learning: • Hospitals can include some, or all, of the educational slides in their orientation programs. • Educators can use the content in presentations or as part of a curriculum. • Professional associations, colleges, and societies can use the content to create accredited courses or certification programs for continuing education. • Patient and consumer organizations can use the materials to increase awareness and knowledge among their members.

MODULES CONTRIBUTE TO UNDERSTANDING OF VANESSA’S LAW A pilot test of the educational material was held for three weeks in March and April. Stakeholders were invited to review the modules and provide feedback by responding to a questionnaire. The Vanessa’s Law Questionnaire was completed by 255 unique respondents from across Canada, both individuals and organizations. The largest numbers of respondents were pharmacists and hospitals. From the questionnaire, it was learned that respondents reviewed

one, some, or all of the educational modules. The majority (83.1%) of respondents had reviewed all five modules. Results from the pilot include: • Over 89% of respondents reported they had a good or strong understanding of Vanessa’s Law after reviewing the educational modules. • 94% of respondents indicated that use of the slides/modules in communication about Vanessa’s Law will be a helpful approach. • 91% of respondents indicated that they will be using the slides to communicate about Vanessa’s Law mandatory reporting requirements. • Many respondents provided helpful suggestions for additional information to be included in the final PowerPoint slides. • Respondents also provided suggestions for additional educational formats that could be considered in future for additional knowledge dissemination/translation. “These results are very encouraging in that they reveal a high level of interest in using the educational material in communicating about Vanessa’s Law,” says Sylvia Hyland. The Joint Venture partners will be incorporating the feedback to produce the final education modules, scheduled for release in July 2019. “Vanessa’s Law is essential to Canada’s healthcare system,” says Chris Power, CEO of the Canadian Patient Safety Institute. “We can’t improve what we don’t measure. These new reporting requirements will help contribute to improving the safety of drugs and medical devices. Everyone in Canada deserves safe healthcare.” Learn more about Vanessa’s Law on H the Health Canada website. ■ www.hospitalnews.com

CANADIAN SOCIETY OF HOSPITAL PHARMACISTS

CSHP’s new CEO Jody Ciufo aims to amplify the voice of hospital pharmacists across Canada n December, 2018 the Canadian Society of Hospital Pharmacists (CSHP) announced the appointment of Jody Ciufo as its new Chief Executive Officer. Since then, the Society has been on a path towards elevating the profile of hospital pharmacists. With full support of the CSHP Board of Directors, Ciufo is applying effective leadership strategies honed over her lengthy career in association management. Her mandate is to grow the membership, engage the hospital pharmacy community, and amplify the association’s collective voice. Relying on her experience and successful track record in turning things around for associations, the CSHP Board of Directors is changing the game at CSHP. “The Society has an incredible opportunity to leverage the shifting landscape within the association world,” says CSHP Board President, Douglas Doucette. “Our members want us to build on our past successes – not rest on them. People

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today have more membership options to choose from than ever-before. We want to ensure they rely on CSHP for a better member experience, enhanced programs, more educational opportunities and generally new initiatives for diverse needs.” “As a member-driven organization, we approach our mandate as a community working together to ensure our practice is always evolving into something better,” adds Ciufo. Applying this philosophy, Ciufo is underscoring the value of a national voice. “Our collective expression can be felt in things such as our advocacy work,” she says. CSHP recently responded to Health Canada’s intent to amend the Narcotic Control Regulations, the Benzodiazepines and Other Targeted Substances Regulations, and the Food and Drug Regulations - Part G, as they pertain to pharmacists. “On behalf of CSHP members, we requested the regulations reflect contemporary pharmacy practices, close regulatory gaps, remove barriers to practice, and

remove inconsistencies between the regulations,” says Ciufo. Another planned evolution for CSHP is to expand its community of members to include pharmacy technicians. “Pharmacy technicians are such an integral component of the hospital pharmacy world,” says Doucette. “We can’t call ourselves leaders in hospital pharmacy practice without recognizing the value pharmacy technicians add to our community,” he says. “That’s why we offer programs and content for pharmacy technicians such as access to professional liability insurance, pharmacy specialty networks (PSNs) and other resources,” he says. “The next natural step is to strengthen our bond by including pharmacy technicians as full members,” says Doucette, “The (CSHP) Board chose Jody Ciufo based on her experience steering big ships to lead this exciting initiative.” Indeed, bold changes are not new to Ciufo. During the last federal election, as the Executive Director of the Canadian Housing and Renewal Associa-

tion, Ciufo initiated the award-winning Housing For All advocacy campaign that was a key factor in the federal government’s $40 billion commitment to affordable housing in 2016. “I work with a vision of serving the public good, and applying strategies that drive necessary systemic changes,” she says. “The Canadian Society of Hospital Pharmacists is a perfect next-step for that as our work is integral to the best possible patient care through the advancement of safe, effective medication use in hospitals and beyond. I’m inspired by what the Society has achieved and honoured to be chosen to lead this respected organization.” To learn more about Jody Ciufo and H the CSHP please visit www.cshp.ca ■

JUNE 2019 HOSPITAL NEWS 21

CANADIAN SOCIETY OF HOSPITAL PHARMACISTS

Taking a deep breath – there’s a pharmacist to help By Negar Golbar hronic Obstructive Pulmonary Disease (COPD) is a respiratory disorder affecting the lungs. Symptoms include shortness of breath, a cough with mucus, lung infections, feeling tired, and wheezing. A common misconception is that these symptoms are a natural part of the aging process. COPD is a slowly progressive disease which means that it will not go away with time and there is no cure. Approximately 500,000 Canadians over the age of 35 have been diagnosed with COPD, and it is estimated that an almost equal number of middle-aged individuals may be suffering from undiagnosed COPD. COPD is the fourth leading cause of death in Canada. It significantly impacts a patient’s quality of life and leads to multiple hospitalizations. In addition to the already harrowing consequences to the patients and their families, annual COPD related health care costs are estimated to be almost $2000 per patient. The annual indirect costs associated with time off work can amount to approximately $1000 per patient. In 2010, the total costs related to COPD in Canada were $4 billion annually and this is expected to increase. Appropriate and prompt medical treatment is nec-

22 HOSPITAL NEWS JUNE 2019

essary to improve quality of life and decrease both personal and health care related costs. COPD does not have a cure, but there are medications that can help. Medical management of COPD is generally done with inhalers that can improve shortness of breath, improve lung function, and help patients stay out of the hospital. Inhaled therapies can help patients return to their normal, active lifestyles and overall, feel better. In recent years, several new inhalers have emerged on the market to help manage COPD. The inhalers come with a variety of medicinal ingredients, combination of ingredients, and devices. Several considerations need to be made when deciding what medication would fit best for the patient. Pharmacists can be helpful in this regard when it comes to tailoring and personalizing therapy. Pharmacists can help select the best, most effective medications for patients while considering factors such as cost, drug coverage, ease of inhaler use, and use of combination therapy so patients have fewer devices to navigate. Pharmacists can also teach patients how to use their inhalers and provide education to help patients understand what their inhalers do. The community pharmacist is often the easiest health

care provider to access for patients; usually there is no appointment needed and short wait times relative to walk-in clinics or emergency rooms. Patients can therefore engage with their community pharmacist regularly and conveniently to discuss their therapy, receive education, refine inhaler technique, and receive coaching on medication adherence. Pharmacists are helpful in COPD management not only in traditional community pharmacies, but within the hospital as well. Many patient care areas of the hospital will have a pharmacist who can help with managing therapy and providing education. Improving outcomes for patients admitted with COPD related illnesses is a major initiative that Alberta Health Services (AHS) Calgary Zone has undertaken. AHS Calgary Zone has implemented the COPD/Heart Failure (HF) Outcomes Improvement Initiative which serves to offer the best care by using the most recent treatment guidelines and providing education to patients. Front line staff such as nurses and pharmacists have taken on the role of educating each patient who is hospitalized because of their COPD in an effort to reduce the rate of readmission. Like in community, the ward pharmacist brings value to the team

by helping select appropriate therapy, being considerate of the cost to the patient, providing education and assessing inhaler technique, discussing COPD action plans, and liaising with the community pharmacy so there are no gaps in therapy. Additionally, if the patient shows any interest in quitting smoking, the ward pharmacist can create a smoking cessation plan that can start in the hospital and continue once the patient is discharged. Although there is no cure for COPD, it can be successfully managed and even prevented with the right education. Approximately 80-90 per cent of all COPD cases are caused by smoking; therefore, quitting smoking is the most effective way to prevent COPD from happening and to slow disease progression if already diagnosed. Early cessation of smoking is optimal; however, it is never too late to quit. Pharmacists both in community and in hospital can play an important role in helping patients quit smoking. Pharmacists can help create quit plans, monitor and encourage, provide options to help combat cravings, and help patients navigate all the nicotine replacement options. Depending on the province, the pharmacist may even be able to prescribe medications H to help patients quit. ■ www.hospitalnews.com

ñʁŘ˾ǔ Fill ™

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ă˿ʁǔȭǷƬ ǞǚǚǔȭǷ ȧŘƞƬ ƬŘʊ˿Ǌ PraxiFill™ is an automated syringe

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ă˿ʁǔȭǷƬ ǚŘŽƬǚǚǔȭǷ ȧŘƞƬ ƬŘʊ˿Ǌ

PraxiLabel™ is a semi-automatic tabletop syringe labeler intended to increase labeling productivity as it

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movements involved in the syringe labeling operation. Simple and fast change over between diǏerent sizes www.praximedsystem.com

A day in the life of a pharmacist on a surgical unit By Nathaniel Morin start my day in the same way as many of my pharmacist colleagues across the hospital, reviewing my unit for new patients, orders, and triaging medication-related issues that need my attention. Before morning interdisciplinary rounds, I review charts and assess what I can do to make the biggest impact for the people admitted to my unit. In orthopedic surgery, we have a mix of elective and emergency surgeries. This means that the unit might look completely different than when I left the day before. We also have a high turnover, so prioritizing and efficiency is important. Today, we have eight new admissions – six elective hip or knee replacements, one hip fracture, and one septic arthritis – and my patients’ most urgent medication-related problems seem to be anticoagulation and diabetes control.

can apply for Additional Prescribing Authorization (APA). I have APA, so after I help John make his decision, I fill out and submit the Alberta Blue Cross special authorization forms, write a prescription for John myself, and start him on the anticoagulant in hospital, rather than asking a physician to do it for me. I find that using my APA allows me to use my abilities as the resident medication expert, to help lighten the workload for surgeons, physicians and nurse practitioners. Next I meet with Jane. Jane’s diabetes medication were held before her surgery, as is common practice to avoid hypoglycemia (low blood sugars) while fasting. When I saw her about a month ago in the pre-admission clinic, I was worried her blood sugars would be elevated at admission, and we made a plan to place a correction scale of insulin into her

BEFORE MORNING INTERDISCIPLINARY ROUNDS, I REVIEW CHARTS AND ASSESS WHAT I CAN DO TO MAKE THE BIGGEST IMPACT FOR THE PEOPLE ADMITTED TO MY UNIT. During our morning rounds, I meet with the orthopedic surgery hospitalist, the charge nurse, the patient’s nurse, the physiotherapist, and the occupational therapist. We discuss each patient on the unit and determine everyone’s needs. I bring forward medication-related problems that I prioritized earlier and make plans to resolve them with our hospitalist. After rounds today, I’ll meet with two of our patients: John and Jane. John has a low-burden pulmonary embolism provoked by his hip replacement surgery, and needs an anticoagulant. When I meet with John, we discuss the risks and benefits of different anticoagulants, his preferences, and together we select a treatment. We then discuss what symptoms should prompt a return to our Emergency Department. In Alberta, pharmacists 24 HOSPITAL NEWS JUNE 2019

chart for pre-operative use. Thankfully, Jane didn’t need insulin before surgery, but I’ll make sure she has another correction scale of insulin available for ongoing use because the body’s stress response after joint replacement can raise blood sugar levels to a point where it puts Jane at risk for post-operative infection. After meeting with John and Jane, I follow up with other patients, bring any concerns to the team, document my assessments and recommendations in patients’ charts, and answer questions from patients and the team. Then I’ll do my best to prepare for tomorrow – we have 12 new patients being admitted for elective surgery – but I’ll be ready for whatever comes my way, knowing my patients and my H team are relying on me. ■

CANADIAN SOCIETY OF HOSPITAL PHARMACISTS

In the Emergency Department:

The integral role of the pharmacy t By Angela von Chorus and Miranda Markle wo years ago, the Chinook Regional Hospital in Lethbridge, Alberta introduced clinically deployed pharmacy technicians to the Emergency Department. As clinically deployed pharmacy technicians we are often the first point of pharmacy contact for patients in the emergency department who are waiting to be transferred to an inpatient unit. As such, we are in an optimal position to gather comprehensive information about the medications a patient is actually taking (that information makes up the patient’s Best Possible Medication History, also known as a BPMH). A BPMH helps ensure that accurate and complete medication information for a patient is communicated consistently regardless of where care is given and who is providing it. Studies have shown that pharmacy technicians ob-

tain a medication history with as much accuracy and completeness as pharmacists or nurses. By optimizing workload assignments, with respect to pharmacy services in the emergency department, pharmacists and pharmacy technicians, along with nurses and physicians, can each perform the tasks suited to each profession for the benefit of the patient. What this means for pharmacy personnel is that pharmacists can provide their clinical expertise while the pharmacy technicians gather information to create a BPMH. The BPMH interview is the first opportunity to identify potential drug-related problems. Pharmacy technicians look for signs of duplicate therapy, wrong doses being taken, and other problems such as side effects, how well the patient understands information about their medications and how to

Interprofessional e Building a foundation for t

By Kathleen MacMillan, Gaithre Kalainathan and Carl Ko atient care improves with interprofessional collaboration. But did you know that so does learning improve when students participate in interprofessional health education (IPHE)? IPHE has increased student awareness of different professions and their scopes of practice within health care, and has improved their understanding of how our professions can be better integrated into the overall health care team. As an example, hospital pharmacists are able to work with physicians and nurse practitioners under collaborative practice agreements, wherein the pharmacist can use their expertise to the fullest through an expanded scope. This awareness of how different profes-

sions can be leveraged to create more positive healthcare outcomes, is likely to contribute to us seeking out interprofessional collaborative opportunities during our future practice.

IPHE FOR HEALTH PROFESSION STUDENTS From our perspective as students, we see the benefits of IPHE first hand. For us, we have learned the challenges and barriers that other professions face through our peers, and are better able to empathize with them. In the professional world, we can take this knowledge and be better prepared to work with our colleagues from different disciplines, fostering a more psychologically www.hospitalnews.com

CANADIAN SOCIETY OF HOSPITAL PHARMACISTS

e y technician take them, or whether financial constraints affect their ability to properly take the medication. Information about identified problems is then given to the pharmacist or other appropriate member of the interdisciplinary team for assessment and management. The BPMH interview also presents an ideal opportunity to educate the patient on the importance of creating a medication list and to discuss strategies for keeping it up to date. Pharmacy technicians are drug distribution experts and therefore have an understanding of which drugs are included on the hospital formulary, which drugs are currently available, and which ones have therapeutic interchanges: all of this helps patients have a seamless transition in care. Our knowledge of the hospitalâ&#x20AC;&#x2122;s drug inventory also allows us to expedite

drug procurement by recognizing what is ward stock and what needs to be sent from the dispensary. The Clinically Deployed Pharmacy Technicianâ&#x20AC;&#x2122;s knowledge of different dosage forms and routes of administration allows us to work with nurses and physicians to enhance medication delivery. The clinically deployed pharmacy technicianâ&#x20AC;&#x2122;s role also promotes interdisciplinary collaboration. This can involve educating staff on the BPMH process, on the use pharmacy resources, and on drug shortage information and therapeutic interchanges. Pharmacy technicians help to facilitate interdepartmental collaboration by attending emergency department interdisciplinary meetings to address pharmacy-related issues. Although our primary focus is to work with patients in the emergency department who are

waiting to be moved to an inpatient care unit we often find opportunities to work with patients who do not need to be admitted to hospital. Some of what we do involves communicating with the patientâ&#x20AC;&#x2122;s community pharmacy, educating patients, and referring patients to other services. Having the opportunity to work as part of an interdisciplinary team to provide direct patient care has thus far

been the most rewarding experience for us as regulated pharmacy technicians. Our role in the emergency department positively impacts the patientâ&#x20AC;&#x2122;s journey through the healthcare system by delivering safe and effective care. As pharmacy technicians develop and expand their scope of practice, future opportunities will present themselves and we, as regulated professionals, need to be H ready. â&#x2013;

l education:

or the future Carl Kooka

safe environment for all. We believe that IPHE allows students to become better problem solvers, as we are able to look at problems from multiple perspectives, consult our peers as well as faculty members from other disciplines, and collaborate to come up with system-level solutions.

DEVELOP BETTER LEADERS Student leadership on IPHE not only improves oneâ&#x20AC;&#x2122;s ability to work on a team but also promotes collaboration among future health professionals. Any profession can and should be able to take a leading role on the interprofessional team when the situation warrants their expertise and guidance. In this way, the www.hospitalnews.com

patient will receive the best possible care, as everyoneâ&#x20AC;&#x2122;s knowledge will be utilized to the fullest. Working on an interprofessional collaborative team has provided us with several advantages as we enter the workforce. The three authors of this article were fortunate to partake in a variety of IPHE initiatives during our time in university. Through these, we met a variety of students and faculty members in various disciplines. We are excited to take what we have learned and implement it into our practice, spreading the culture of interprofessional collaboration. We believe that all healthcare students should be exposed to IPHE during H their education. â&#x2013;

TELEHEALTH

! " !

JUNE 2019 HOSPITAL NEWS 25

CANADIAN SOCIETY OF HOSPITAL PHARMACISTS

Pharmacist prescribing: Opportunities to optimize patient care through appropriate medication therapy By Shirin Abadi ith the aging population and high demands for the use of limited healthcare dollars, healthcare professionals need to work at the top of their license to truly make a positive difference for patients. Because pharmacists are not able to independently prescribe in most provinces in Canada, they are required to contact the prescriber for a revised prescription, if there needs to be a change in the medication type, dose, route, frequency and duration of therapy, as well as for discontinuation of medications. The problem with this approach is that it can be very time-consuming and costly

to the healthcare system. With more than 10 per cent of emergency department visits in Canada being due to medication-related issues, particularly in the elderly, and with the shortage of family physicians in some regions of Canada, enabling pharmacist prescribing to ease some of the pressures in the healthcare system would make perfect sense. Pharmacists learn more about medication therapy than any other healthcare professional, so it would seem logical for them to be able to prescribe, particularly if they feel confident in their knowledge, skills, and experience in prescribing medications,

How Will Pharmacist Prescribing Help You at Your Hospital and Clinic Visit? Medications affect everyone

Pharmacists are the medication experts

1 in 15

Pharmacists have at least 5 years of university training

Canadians use at least 5 medications1

Prescribing will allow pharmacists to help you...

Pharmacists are part of your healthcare team

Adjust doses

They collaborate with doctors, nurses, and other providers

to reach your goals 1 in 4 seniors take at least

10 medications2

Stop medications Research shows pharmacists, with the right tools, improve patient health5

that are not working or are no longer needed

Hospital and clinic pharmacists review medical chart and lab values to recommend best treatments for your care

1 in 9 emergency department visits are due to medication harm3

There are already over

1000 pharmacists Canadians spend

$2.6 billion

working with doctors and nurses in BC hospitals

Pharmacists improve patient safety and access to healthcare

Provide you with treatment options when you need them

on preventable medicationrelated hospitalizations4 And BC is hiring

more pharmacists Pharmacist prescribing reduces harm and costs associated with medications

to work in medical clinics with family doctors to improve your care

Watch

If pharmacists can collaborate with doctors to prescribe, everyone will beneďŹ t.

for serious side effects and prevent them where possible

https://cshp-bc.com/

1 Rotermann M et al (Statistics Canada). Prescription medication use by Canadians aged 6 to 79. Health Reports 2014; 25: 3-9. Available at: www.statcan.gc.ca/pub/82-003-x/2014006/article/14032-eng.htm 2 Canadian Institute for Health Information. Drug use among seniors in Canada, 2016. Available at: https://www.cihi.ca/sites/default/files/document/drug-use-among-seniors-2016-en-web.pdf. 3 Zed PJ, Abu-Laban RB, Balen RM, et al. Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study. CMAJ 2008; 178(12):1563-9. 4 Doran DM, Hirdes JP, Blais R et al. Adverse events among Ontario home care clients associated with emergency room visit or hospitalization: a retrospective cohort study. BMC Health Serv Res 2013; 13:227. 5 Canadian Pharmacists Association. A review of pharmacy services in Canada and the health and economic evidence. Feb 2016. https://www.pharmacists.ca/cpha-ca/assets/File/cpha-on-the-issues/Pharmacy%20Services%20Report%201.pdf

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26 HOSPITAL NEWS JUNE 2019

and are supported by the healthcare team, members of the public, and local and provincial governments to do so. There are numerous daily examples of how pharmacists identify and resolve drug therapy problems in a variety of settings, including hospitals, primary care clinics, outpatient pharmacies, and others. In Alberta, pharmacists have been able to prescribe prescription drugs (but not controlled substances) and blood products for the past several years and the impact of pharmacist prescribing on patient health outcomes has been very positive, including improvements in blood pressure control, cholesterol control, diabetes control, heart health, asthma, anticoagulation therapy, and more Studies have demonstrated that pharmacists can prescribe to the same standards as medical doctors, while being more adherent to dosing guidelines and protocols. In addition, prescribing by pharmacists has significantly reduced medication errors, thus improving patient safety, while saving healthcare dollars. Currently, in Canada, pharmacists have varying degrees of expanded scope of practice, as governed by the

CSHP BC Branch cshpbc@gmail.com

legislation in the province in which they practice. These may range from limited prescribing rights, such as renewal, adjustment and substitution of prescriptions, to prescribing for minor ailments, to prescribing prescription medications Internationally, pharmacists practicing in other jurisdictions, such as United Kingdom, New Zealand, and the United States have collaborative and/or independent prescribing rights. The Canadian Society of Hospital Pharmacists (CSHP)-BC Branch has been working hard to advocate for improving the care of patients through enabling pharmacist prescribing authority in collaborative settings. The attached infographic, courtesy of CSHP-BC Branch, explains how pharmacist prescribing can assist patients with improving health outcomes, improving medication safety and reducing healthcare costs. It is hoped that with the necessary legislative changes and public support, we can optimize pharmacistsâ&#x20AC;&#x2122; abilities to make a positive impact on patient care, through enabling prescribing to overcome some of the challenges that our healthcare system is currently facH ing and continues to struggle with. â&#x2013; www.hospitalnews.com

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New approaches

to clinical training of students atients and staff in hospitals often see or meet many people in the hospital. Among the mix are students who need the experience of real-life practice to apply what theyâ&#x20AC;&#x2122;ve learned in school, and to continue their learning outside the classroom or lab. The people who instruct, train, supervise, and mentor the students are preceptors. In pharmacy, most preceptors work in areas where they provide care to patients, such as hospitals, community pharmacies, and ambulatory clinics. They can also work in other settings, for example, managers, drug information centers and universities. Precepting a student allows pharmacists and pharmacy technicians to promote the pharmacy profession, educate the future workforce, and feel personal satisfaction. Hospital pharmacists and pharmacy technicians are important to introduce and mentor students in providing patient care within the hospital

www.hospitalnews.com

setting. CSHP is committed to supporting preceptors in their precepting role. Precepting in pharmacy generally uses a traditional 1:1 model of one preceptor helping one student at a time. Newer models, like peer assisted learning, near-peer model and co-precepting, are becoming more popular and can offer advantages to students and preceptors. Students who are in either a pharmacy technician or pharmacist program must complete a minimum number of hours of pharmacy practice experiences in community and institutional settings to meet the requirements set by their educational program and to be licensed after graduation. Check out the possibilities! The following infographic walks preceptors through options available to them for precepting. Want to learn more? A series of guidebooks were created and can be found at http://www.afpc.info/ content/novel-models-precepting-preH ceptor-resources â&#x2013; JUNE 2019 HOSPITAL NEWS 27

Exploring the role of

renal transplant pharmacists By Kathryn Peterson work as a pharmacist in the transplant clinic at Health Sciences Centre in Winnipeg, MB. It may surprise you that many days pass during which I do not come into contact with a single pill. If not dispensing medications, what is the purpose of a pharmacist? “Pharmacists are essential to the function of our program. The transplant physician counts on their input for daily rounds and ward visits.” says Dr. David Rush, MD, Director, Transplant Manitoba Adult Kidney Program Literature shows clinical pharmacy services have a significant impact on patient care by improving disease management and providing cost

savings to the healthcare system. In 2008, Transplant Manitoba hired a full-time clinical pharmacist as part of its collaborative care team. This role has evolved and expanded over the past 11 years, and now includes two pharmacists sharing time between the adult and pediatric renal transplant programs. Working within an interdisciplinary team in our renal transplant clinic is an incredibly rewarding and challenging experience that allows me to flex my clinical skills and improve patient care daily. These four key areas highlight the unique role my clinical pharmacy team brings to the renal transplant program:

MEDICATION RECONCILIATION ON ADMISSION & DISCHARGE

24/7 Our pharmacists are

driving innovation to be at the patient’s bedside day and night. For more information about using Sheldon, Hal or Rachel in your hospital, call us:

1-877-733-8111 x6

info@northwesttelepharmacy.ca www.northwesttelepharmacy.ca 28 HOSPITAL NEWS JUNE 2019

EDUCATION AND TEACHING TOOLS Renal transplantation involves an extensive and complex medication regimen in order to prolong transplant survival. Our pharmacists spend at least one hour with newly transplanted patients to discuss the new medications prescribed. We provide simplified teaching sheets and customized dosing calendars to emphasize the importance of adherence and ensure patients understand doses and common side effects of their new medications. This intensive teaching allows patients the opportunity to ask questions and gives them the tools to empower them to succeed. Close follow-up is provided at subsequent patient visits, in partnership with our nurses, in order to ensure full comprehension. We also provide teaching to the nursing staff and inpatient pharmacists on topics specific to transplant.

MEDICATION REVIEWS Pharmacists have the unique ability of viewing the patient through the lens of the medications they take. Each patient’s medication fill record is screened by the clinical pharmacist to ensure adherence and assess the indication for every medication at each clinic visit. This focused approach identifies many opportunities to optimize management of common conditions including: diabetes, hypertension, cardiovascular disease, gout and anticoagulation. We not only look for gaps in care, but also focus on “deprescribing” unnecessary medication to ease the pill burden on patients. In conversation with patients and our physicians, we are usually able to stop or lower the dose of at least one medication. In one extreme case, I was able

reduce a patient’s pill burden by 9 tablets per day. This has a major impact on quality of life for individual patients and is an immensely satisfying part of my job. Medication optimizations and recommendations are discussed daily in our multidisciplinary team rounds. Pharmacists play a key role in public health initiatives by identifying vaccination requirements for our high-risk population and discuss these with patients.

SEAMLESS CARE Transplant patients are frequently admitted and discharged from hospital. Canadian studies show that up to 40 per cent of patients experience unintentional medication discrepancies at discharge. Our clinical pharmacists are involved in all discharge prescriptions from our primary teaching hospital and provide discharge teaching to transplant patients. This facilitates the transfer from hospital to clinic and aids in transitions of care. Pharmacists also discuss medication cost and coverage, in collaboration with our social worker, to avoid gaps in care for our patients.

DEVELOPMENT AND RESEARCH PROTOCOL Standardized protocols are a major aspect to ensure equal care is provided to each patient and pharmacists have contributed to the development, review and revision of many medication-related protocols and order sets. Pharmacists are often known for being detail-oriented and this is definitely an asset in protocols. We are actively involved in several research initiatives through our program including one retrospective review of implementing universal infection prophylaxis in our H patient population. ■ www.hospitalnews.com

CANADIAN SOCIETY OF HOSPITAL PHARMACISTS

Preventing

drug diversion in hospitals By Sarah Jennings pioids and other controlled substances are essential drugs in hospitals. They are used to treat acute and severe pain in our emergency departments, operating rooms, labour and delivery suites, and other areas throughout the hospital. Unfortunately, these drugs are sometimes targets for diversion – transferring a drug from a lawful use to an unlawful use. Patients, visitors, or staff may pilfer these drugs for their own personal use or sometimes for purposes of trafficking. We can’t keep everything locked in the pharmacy vault because health professionals need quick access to these drugs, so we rely on a mix of physical security measures, policies and procedures, and education. The Canadian Society of Hospital Pharmacists (CSHP) recently published Controlled Drugs and Substances in Hospitals and Healthcare Facilities: Guidelines on Secure Management and Diversion Prevention. This guidance document helps hospitals meet their obligations under the law, as well as accreditation standards and professional standards. The guidelines were developed in collaboration with many other groups, including nurses, anesthesiologists, emergency physicians, paramedics, dentists, regulators, and law enforcement.

UNFORTUNATELY, THESE DRUGS ARE SOMETIMES TARGETS FOR DIVERSION – TRANSFERRING A DRUG FROM A LAWFUL USE TO AN UNLAWFUL USE. prevent this at every step. We need to develop a culture of continuous quality improvement. Just as we’ve done with medication errors and medication safety, we need to move away from denying that there’s a problem and pointing fingers when something happens; instead, we need to educate our colleagues on what to watch for and how to report, and we need dedicated interdisciplinary committees that review and act on the reports, with a view to improving the system and making it safer. Drug diversion can be dangerous for patients if their intended treatment is substituted with a less potent drug, a lower dose, or no drug at all; or if an injectable drug is tampered with by a person who has a communicable disease such as hepatitis C or HIV. However, drug diversion can be dangerous for the diverter as well. Most health professionals who divert drugs do so because they have a substance use disorder, and many are only discovered after a fatal overdose. We need staff to be alert to any warning signs from

• Store controlled substances securely, ensure all keys are accounted for at all times and passwords are not shared. • Segregate duties. For example, do not have the same person ordering drugs and receiving drugs. • Keep rigorous records that can be easily audited. Document with

double signatures every time stock changes hands. • Conduct regular and frequent counts of stock on hand in pharmacy and in patient care areas. • Reconcile records against each other; e.g., amount purchased by pharmacy, received by pharmacy, dispensed to patient care area, received by patient care area, administered to patient, wasted or returned, and currently on hand. • Conduct audits. Verify all of the above with frequent and random checks in various parts of the H facility. ■

For more information, access the guidelines at www.cshp.pharmacy/ opioid-guidelines. Together, we’ll have a stronger, safer system.

ĶǒƬȭ ƋɁȧȧƬʁƋǔŘǚ ɡʁƬǞǚǚƬƞ ʊ˿ʁǔȭǷƬʊ ŘʁƬ ȭɁǜ Ř˸ŘǔǚŘŽǚƬ ǜǒƬ ȭƬ˾ǜ ŽƬʊǜ ɁɡǜǔɁȭ ǔʊ Ęȭǔǜ ƞɁʊƬ ʊ˿ʁǔȭǷƬʊ ɡʁƬɡŘʁƬƞ Ž˿ ǜǒƬ ɡǒŘʁȧŘƋ˿Ɩ

COLLABORATION ACROSS THE HEALTH SYSTEM IS IMPORTANT BECAUSE DRUG DIVERSION IS NOT JUST A “PHARMACY PROBLEM” – IT’S EVERYONE’S RESPONSIBILITY. Collaboration across the health system is important because drug diversion is not just a “pharmacy problem” – it’s everyone’s responsibility. We need to think about all of the points in the system where drugs can go missing, and how we can www.hospitalnews.com

their colleagues and to feel that filing a report will lead to their colleague being helped rather than shamed and blamed. What are some of the fundamental principles of preventing drug diversion in our hospitals?

ñʁŘ˾ǔ ÀƬƞ ʸ ă˿ʁǔȭǷƬ ǞǚǚǔȭǷ ū ǚŘŽƬǚǚǔȭǷ ȧŘƞƬ ƬŘʊ˿Ǌ DĞĚy> ŝŶĐ͘ нϭ͘ϱϭϰ͘ϲϵϱ͘ϳϰϳϰ ͮ ŝŶĨŽƐΛŵĞĚǆů͘ĐŽŵ ͮ ǁǁǁ͘ŵĞĚǆů͘ĐŽŵ JUNE 2019 HOSPITAL NEWS 29

CANADIAN SOCIETY OF HOSPITAL PHARMACISTS

Coordinating a response to a critical drug shortage: How do we do it? By Tania Mysak and Tracey Simpson rug shortages happen every day, for many reasons such as natural disasters, manufacturing problems, business decisions, and so on (see www.drugshortagescanada.ca). Managing them requires a lot of care and consideration because they have been associated with increased errors and patient harm. It therefore should not come as a surprise that hospital pharmacy departments have standard procedures to manage drug shortages. Typically, this involves seeking alternate vendors, tightening stock management, engaging with clinicians to define restrictions for use and identifying alternatives, implementing a broad communication strategy, and increasingly, researching opportunities to compound the product ourselves.

ALTERNATE VENDORS Sometimes an alternate brand of drug is available to mitigate a drug shortage. If the drug is not available from any manufacturers, therapeutic alternatives are identified and any remaining drug supply is conserved for patients who need it most. The situation becomes more difficult to manage if therapeutic alternatives are not available, prompting the pharmacy department to involve the Provincial/Territorial Drug Shortage Task Team. At this point, the Chair of the Task Team and Health Canada’s Drug Shortages Unit work together to iden30 HOSPITAL NEWS JUNE 2019

tify critical shortages and create mitigating strategies. Finding drugs that can be imported into Canada, with the help of Health Canada is one solution that is considered. Such approvals, however, are rare, and pharmacy departments must look to other solutions. In rare cases, procuring stock from community pharmacies may be considered or sharing stock amongst the provinces.

STOCK MANAGEMENT Careful stock management is critical during a drug shortage. Understanding current inventory and usage patterns helps pharmacy departments determine how strictly stock needs to be managed through the shortage. Staff may be asked to sequester wardstock back to the pharmacy department and complete regular stock counts with results tabulated centrally for monitoring. In areas with regionalized or provincial health authorities, the centralized governance structure allows monitoring and potential stock redistribution within the authority to areas of need.

CLINICIAN ENGAGEMENT Whenever a drug shortage occurs, clinicians are consulted for therapeutic alternatives and encouraged to use them where possible. Depending on the severity of the shortage, existing utilization patterns may rapidly deplete stock. In these circumstances, clinicians may also be engaged to

strategize potential restrictions for use of the shorted drug. This may include updating existing protocols and order sets to drive behavior and preserve stock for the most critical needs.

COMMUNICATION STRATEGY Communication strategies are implemented to inform all pharmacy managers, nursing units and other clinical areas, describing the shortage and conservation strategies including the alternatives to be used in lieu of the shorted drugs. Enhanced communications through medical staff networks or on local websites can also be considered depending on the shortage severity. In cases where there is heightened potential for patient harm, a proactive external communications approach can be taken to inform and regularly update government of the shortage and the coordinated efforts being undertaken to mitigate risk.

COMPOUNDING Finally, as a last resort, some pharmacy departments consider the risks of compounding an alternative product for patient use. The success of this response depends on the existence of a validated formulation, availability of pharmaceutical grade ingredients for human use, suitable compounding facilities, qualified personnel, and results of quality control tests. In circumstances where the shorted drug is

required to be sterile, additional testing is required to ensure a safe product.

THE GLASS IS HALF FULL Even though drug shortages require a lot of attention to safely manage them, some good occasionally comes of them. A shortage can create an organizational awareness that commonly used and relatively inexpensive products are at risk for inappropriate use. It can identify safer and more effective alternatives and optimize prescribing practices. A shortage can also highlight the advantages of a centrally coordinated organization at the level of a region or province. Such organizations are able to quickly communicate, recall, and sequester stock from all sites in the organization. Relationships forged in regional networks can be used to engage stakeholders in brainstorming conservation strategies and gaining critical “buy-in” to manage the problem collaboratively. Technical compounding expertise can be leveraged to create and validate processes to compound product at the appropriate sites (with appropriate personnel), and then made available to all sites within the organization. By using the expertise and efforts of a dedicated team to manage the inventory, alternatives, communication, and other elements of managing a shortage, pharmacy departments help sites and staff to continue their daily work of providing quality patient care and avert poH tential harm. ■ www.hospitalnews.com

CANADIAN SOCIETY OF HOSPITAL PHARMACISTS

Hometown

hospital pharmacy By Christina Adams here are almost 600 hospitals in Canada, and more than half have fewer than 50 beds, according to the Canadian Institute for Health Information. This speaks to the vast geographic expanse that is our country, and the reality that many Canadians do not live in dense metropolitan areas with large, tertiary-care teaching hospitals. There is a need to ensure adequate hospital care closer to home, thus the small, rural, hometown community hospital remains. Pharmacy staffing at these hospitals is variable â&#x20AC;&#x201C; some have two to three pharmacists working fulltime onsite, along with a full complement of pharmacy technicians, while others are staffed remotely through contracts with larger hospitals or private companies.

WHATEVER THE METHOD OF STAFFING, THE PHARMACISTS WORKING AT THESE HOSPITALS MUST BE WELL-INFORMED WHEN IT COMES TO GENERAL MEDICINE PHARMACY PRACTICE. Whatever the method of staffing, the pharmacists working at these hospitals must be well-informed when it comes to general medicine pharmacy practice. Specialization isnâ&#x20AC;&#x2122;t an option, because patients are coming in with a variety of medical issues, and these hometown hospitals provide that general care patients need. Working in a hometown hospital has its advantages and disadvantages. There is less staff, so the pharmacist

must often juggle both clinical and administrative responsibilities. On the other hand, there is less staff, and fewer layers of bureaucracy, so thereâ&#x20AC;&#x2122;s often an opportunity to be nimble and to quickly adopt new processes. These hometown hospitals have a smaller catchment area, so the pharmacist can really get to know the patients for whom they are providing care, especially those with chronic conditions that result in repeated hospitalizations.

Regardless of the size of a hospital, pertinent legislative and quality standards must be met. The Canadian Society of Hospital Pharmacists offers peer networking through their Small Hospital Pharmacy Specialty Network, which allows pharmacists working in these smaller hospitals to access and share information amongst themselves. A classic phrase in small hospital practice is â&#x20AC;&#x153;Why reinvent the wheel?â&#x20AC;? Sharing information is vital, because otherwise the workload might be overwhelming. If youâ&#x20AC;&#x2122;ve ever worked in a hometown hospital, youâ&#x20AC;&#x2122;ll know what a pleasure it is to care for the people who live and work in your community, those you might later see at the grocery store or a soccer game. Although these hospitals are small, they are vital and highly valH ued in their communities. â&#x2013;

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JUNE 2019 HOSPITAL NEWS 31

FROM THE CEO’S DESK

The soft side of

integration By Dr. Joshua Tepper ealth care systems across the country and in many places around the world are increasingly turning to integration as the next frontier in health system restructuring and modernization. In Ontario alone, a recent call for expressions of interest to create integrated Ontario Health Teams is rumoured to have had more than 150 respondents representing a few hundred service providers across all sectors (with no sticks or carrots offered to motivate the applicants). It is hoped that a well integrated health system will tick all four boxes of the quadruple aim: improved population health, improved patient experience, improved provider experience and better value.

WE NEED TO MAKE SURE WE SUPPORT EACH OTHER AND LEARN ON THE HARD MOMENTS – NOT CRITICIZE OR GLOSS THEM OVER. The exact structure and vision for integration is variable and what these models are called varies even more widely. In almost all cases, hospitals invariably play a critical role in the design and execution of integrated care models. Much of the attention of integration focuses on big ticket items – founding models, legislative changes, governance structures, information technology platforms and labour relations

issues. Undoubtedly, these are critical parts of the answer and are critically necessary elements to address. But focusing on these larger issues often feels disempowering for those closer to the front lines where local community service providers are trying to move forward. The reality is that while these ‘big ticket’ items need to get addressed as key enablers, those will be necessary but not sufficient factors to bring integration models to fruition. Some of the really critical success factors are actually things that will happen at the community level. Here are a few of the local, ‘softer’, activities that might help integration succeed: • Giving up space – Integrated care models are going to require different sets of players working in different ways and taking on different roles. While the temptation will be for avaricious positioning for more money, power, prestige, market share, etc., in fact what will often be needed is for some groups to give up space, to relinquish historical roles and to allow new voices to be heard. • Starting with the patient voice – Many individual parts of the system have begun the process of patient engagement with patient experience surveys, patient and family advisory committees, and starting board meetings with patient stories. How do we continue that momentum in the process of creating integrated models? How do we identify patients interested and appropriate for this work? How do we prepare them to participate? How do we make sure their involvement is meaningful? • Setting goals and defining success – While many of the macro

Dr. Joshua Tepper goals and accountability frameworks will be set by governments or their agents, there is an opportunity to also define what success looks like locally. It may be about focusing on a particular local health need, establishing certain engagement strategies or creating new communication channels in the community. • Stopping to celebrate success and learn from failure – Creating a truly integrated health system is going to be the work of a decade. Governments will come and go, leaders will change and context will evolve. Its going to be a journey. We will need to manage our expectations – there will be more singles than home runs and plenty of strike outs. There will also be some really wonderful successes. We need to make sure we support each other and learn on the hard moments – not criticize or gloss

them over. We also need to come together and take joy when things go right. • Create the rules of engagement – If things like legislation and funding formulas are creating a sandbox, then locally we need to figure out how we want to play in the sandbox: the values we want to share, the rules we want to follow, the culture we want to see. This is going to vary community by community but it is going to be glue that holds each community together. It is easy to undervalue spending time creating and articulating things like principles and shared values. We need to invest energy thinking about and articulating these things. As a colleague said, these initiatives are going to move at the speed of trust and we need to create an environment H where trust can be built. ■

Dr. Joshua Tepper is the President and CEO of North York General Hospital. 32 HOSPITAL NEWS JUNE 2019

www.hospitalnews.com

ETHICS

A reflection on

advance care planning By Andria Bianchi

ational Advance Care Planning (ACP) day was on April 16, 2019. The purpose of ACP day is to encourage people to have discussions about their values, wishes, and beliefs in relation to their health and personal care. For many, ACP is a difficult (and, perhaps, taboo) topic since it involves having conversations about and/or documenting how a person would like others to make potentially life-altering decisions for them just in case they become incapable of making healthcare decisions for themselves. Given that a person of any age may become unable to make healthcare decisions for various reasons (e.g. temporary cognitive impairment, lack of consciousness, a dementia diagnosis, etc.), ACP is, indeed, important. I have engaged in a few conversations with colleagues, friends, and family members about ACP since April 16th. Perhaps unsurprisingly, most of the people who I spoke with have not yet developed written advance care plans; written plans are not entirely essential, however, and having conversations are, arguably, even more important. The one surprise that I did encounter is that some people are hesitant to develop a plan and/or to have a conversation— I will reflect on this perspective below. One of the reasons that ACP is often seen as important is because it allows people to communicate autonomous decisions about their health and personal care when they are capable of doing so. So, if I value having the opportunity to make an autonomous decision about how I do/do not want to live, then informing others about my choice(s) just in case they become the decision-maker(s)/in case I lose my capacity seems sensible. For instance, an ACP conversation may involve in-

ULTIMATELY ADVANCE CARE PLANNING IS USUALLY RECOGNIZED AS AN IMPORTANT STEP TO TAKE IN ORDER FOR A PERSON’S AUTONOMY TO BE RESPECTED AT ALL STAGES OF THEIR LIFE. forming my loved ones about whether I do/do not want to live in a circumstance in which I am not expected to ever breathe or eat on my own, whether I would want to live in a ‘risky’ situation at home instead of being in a hospital facility, etc. ACP may also involve the development of a power of attorney for personal care if I want to assign a particular person(s) to be responsible for making personal care decisions for me. Ultimately, ACP is usually recognized as an important step to take in order for a person’s autonomy to be respected at all stages of their life. Another commonly expressed reason for engaging in ACP discussions is because some people may want to alleviate potential burdens/stresses on family members, which can inevitably result from having to make life-altering decisions for other people. I may

want to engage in an ACP discussion so that my decision-maker(s) can feel more confident about making challenging healthcare decisions just in case I lose the capacity to make them for myself. One of the primary reasons that some people expressed reluctance about having and/or documenting ACP conversations reflects a common philosophical problem about personhood/personal identity. The argument goes something like the following: “It is impossible for me to engage in a meaningful ACP process at the present time because I have no idea what I will/will not want to receive at a future point in time (i.e., when I am incapable).” So, ultimately, the argument is that I will be a different person in the future, and I cannot make an informed decision about my future self right now. I have thought a lot about this ar-

gument against ACP over the last few years. On the one hand, it is true that a person can only make decisions based on their current self/state of mind. And this might lead someone to suggest that ACP is, in fact, not sensible since (1) a person does not know the particular decision(s) that will need to be made at a future point in time and (2) a person does not know if their wishes will change. On the other hand, however, ACP does not have to be a one-time conversation that cannot be revisited. ACP can be an ongoing dialogue, allowing one to revisit and reflect upon their wishes as time progresses. Furthermore, and perhaps to the comfort of some, ACP does not need to involve a person communicating very specific healthcare decisions. Instead, ACP can involve articulating a person’s values and beliefs to help decision-makers make decisions accordingly. So, rather than making very specific healthcare decisions, I might choose to articulate my personal, cultural, and/or religious values and beliefs that could be relevant to healthcare decision-making processes. Then, if I ever lose my decision-making capacity, decision-makers would be responsible for making decisions in relation to my values and beliefs while taking into account the relevant context (which cannot be foreseen at the present time). Articulating personal values and beliefs may seem less daunting to individuals who are unaware of and/ or overwhelmed by the many healthcare decisions that might be relevant to a future point in time. At the same time, it preserves an aspect of autonomous decision-making by allowing people to contribute to future healthcare decisions (or, the decision-making process) just in case they become H incapable. ■

Andria Bianchi PhD, is a Bioethicist at University Health Network. www.hospitalnews.com

JUNE 2019 HOSPITAL NEWS 33

NEWS

“

Second ” Heart could mean second chance for IV drug users By Calyn Pettit or some people in our city, a proposed new project called “Second Heart” will mean getting a second chance at a healthier life. In recent years Dr. Richard Whitlock, cardiac surgeon at Hamilton Health Sciences (HHS) and his team at Hamilton General Hospital have seen an increase in the number of patients needing surgery for a serious heart infection caused by intravenous (IV) drug use. Endocarditis is an infection of the inner lining of the heart valves that can damage the heart and, for some people, requires life-saving surgery. Research estimates that as many as 10 per cent of deaths among people who use IV drugs involve endocarditis. More and more often Dr. Whitlock and his team at Hamilton General Hospital, our region’s hub for heart care, perform surgery to repair damage caused by endocarditis in the hearts of people struggling with IV drug addiction. Too often, they recover from surgery and return to the circumstances that brought them to hospital in the first place, with little support to navigate toward a better path. That’s why Dr. Whitlock has teamed up with other professionals from across the community to form a new initiative aimed at bridging the gaps between hospital and the community for this vulnerable patient population. The “Second Heart” project, currently proposed as a pilot study, would

RESEARCH ESTIMATES THAT AS MANY AS 10 PER CENT OF DEATHS AMONG PEOPLE WHO USE IV DRUGS INVOLVE ENDOCARDITIS. unite healthcare and social service providers to support a better transition home from hospital for patients after their surgery. The goal is to curb drug use and the need for repeat surgery and, ultimately, to prevent death. The Second Heart pilot would involve health system navigators and peer support workers to connect and guide patients to community-based services after their operation, and to help them over some of the socioeconomic hurdles, such as housing, that

may prevent a good recovery from surgery and addiction. Dr. Robin Lennox, co-lead on the project and co-head of inpatient addiction-medicine services at HHS and St. Joseph’s Healthcare Hamilton, says that as many as half of endocarditis patients don’t have a family doctor, which further complicates their ability to navigate services that could help them. “We have to recognize that these patients that are getting these infec-

tions are just as deserving of high quality health care that’s targeted toward their needs,” says Dr. Lennox. Currently, the team is making a proposal for funding that would support a pilot project to study whether increased collaboration between surgical and hospital teams and community providers leads to better outcomes in patients with endocarditis caused by IV drug use. “As healthcare professionals, we always strive to treat the underlying cause of disease,” says Dr. Whitlock. “That’s what we fail to do with these individuals, which is to treat the addiction and put the right supports in place to encourage a healthier future.” “We have a responsibility to help H give our patients a second chance.” ■

Calyn Pettit, is manager, digital communications at Hamilton Health Sciences. 34 HOSPITAL NEWS JUNE 2019

www.hospitalnews.com

NEWS

CEO powers impact through

philanthropy By Dr. Bernard Leduc s president and CEO of Montfort, Ontario’s only Francophone teaching hospital, I wear many hats to ensure my organization is recognized as a Canadian health care leader. With the complexity of patients’ health care needs forever increasing and few additional government dollars being invested in health care, Montfort must rely on volunteers and philanthropy to achieve excellence. But reaching fundraising success requires investments – in time, talent and treasure. The Montfort Foundation’s mission is to support the hospital in the delivery of exemplary patient care. As a volunteer member of the foundation board of trustees, it is my duty to strengthen the bond between both entities. My success lies in fostering clear and open communication with volunteers on both boards and to ensure fundraising activities are continuously aligned with the hospital’s mission, vision and strategic objectives. In addition to sharing our extensive networks with foundation leaders, board volunteers also have a mandate to act as brand champions. By maintaining conversations with them, I benefit from their diverse perspectives, which enables me to better equip them to fulfill their fundraising role. My responsibility as a volunteer administrator also extends to donor relations. By attending fundraising activities, networking and donor recognition events, I contribute to donor stewardship – an integral component of the fundraising journey. Creating and sustaining a philanthropic culture within any organization is no easy feat. In addition to engaged volunteer administrators, it requires an engaged senior leadership team – one who understands philanthropy and believes in the benefits it yields. Achieving this requires more

Drs. Robin Lennox and Richard Whitlock of Hamilton Health Sciences are leading a new initiative that aims to provide better support for patients with IV drug addiction once they leave the hospital.

than ongoing communication. Providing philanthropic training is a great way to engage and train leaders to remain receptive and able to identify charitable opportunities. Positioning a capital campaign as an organizational priority also supports the foundation in reaching its objectives while showcasing leaders as philanthropic role models. Most importantly, a strong philanthropic culture requires an engaged workforce – a commitment from the health care professionals already too busy pursuing the mission and providing exemplary patient care. The only option now is generating emotions. Not unlike the information shared in donor impact reports, engaging frontline staff is about sharing the direct impact contributions have on patients, families and their work environment. It’s about getting them to realize they are providing care using innovative equipment acquired through philanthropy, in facilities modernized as a result of fundraising efforts. Identifying opportunities that allow me to effectively communicate these messages to staff is key. I do it every chance I get, at town hall meetings, unit tours and new employee orientations. Since a collaborative approach is also crucial to building a philanthropic mindset, it is important for the foundation to increase its presence at various hospital non-fundraising activities. Staff needs to see the foundation is not only visible when they are raising money, but all the time, as their partner in living the Montfort mission. What originates as simply visibility eventually turns into relationships that slowly transform into collaborations. Involving the foundation in various committees and initiatives, such as a quality improvement council, also generates positive outcomes.

I have been a Montfort donor for many years. Not only is it important for me to give back to my community, but I am a fervent believer in Montfort’s cause. What keeps me donating year after year is the difference my donations make in the life of patients and their families. Whether we are sharing this information through patient testimonials at donor recognition events or illustrating it in donor impact reports, recognizing and stewarding donors for the difference they make is key to sustaining a vibrant donor community. I have met patients whose lives were saved by the innovative medical equipment we acquired through fundraising campaigns. Nothing is more rewarding than knowing my contributions helped save those lives. This experience is what makes giving purposeful. In my opinion, allocating time for fundraising should be an integral part of a CEO’s job description. I recognize that I am not dedicating as much time as I would like to support fundraising efforts. However, in addition to holding every single soul employed at Montfort accountable for adhering to sound and ethical professional practices, I expect them to act as brand ambassadors and help raise awareness about the outstanding care and services they provide daily. Employees, physicians and volunteers are Montfort’s most precious fundraising resource for they have the power to inspire and mobilize others to support our cause – the provision of exemplary patient care, in both official languages. To find out more about the Montfort Foundation’s philanthropic mission, please contact Marc Villeneuve, vice-president of Philanthropy, at marcvilleneuve@ H montfort.on.ca. ■

Dr. Bernard Leduc is President and CEO of Montfort. www.hospitalnews.com

JUNE 2019 HOSPITAL NEWS 35

LONG-TERM CARE NEWS

Nutrition and skin health in long-term care By Dale Mayerson and Karen Thompson kin breakdown can be a serious issue for residents living in long-term care and sound nutrition is an important tool for prevention and management. Skin can become more dry and fragile as we age due to loss of natural oils and other factors. The connective tissue in the skin can lose its elasticity and strength, and age spots may begin to develop. By the time elderly residents move into long term care, their skin is showing definite signs of aging. Poor diet and lack of exercise, as well as chronic health conditions, can also take a toll on the skin. With less mobility and increased weight loss, frail and elderly seniors can be at risk for skin breakdown. Our skin is considered the largest organ of the body. Our skin helps to regulate body temperature, protects us from outside hazards, acts as a barrier that protects our internal systems, and excretes waste materials through sweat glands.

TYPES OF SKIN BREAKDOWN There are many types of skin conditions that can lead to skin breakdown and open wounds. These include wounds of the legs caused by poor blood circulation that can lead to leg ulcers, as well as skin tears from injuries and falls from chairs and wheelchairs, and incontinence related dermatitis that could lead to open sores. Decubitus ulcers, also called pressure sores or bed sores, are the most common type of skin breakdown These can be the result of pressure, shear or friction, and are seen more in people with poor mobility, incontinence and with malnutrition and dehydration. Poor health and frailty play roles, as do acute and chronic illness. A pressure ulcer is “staged” to determine the level 36 HOSPITAL NEWS JUNE 2019

IN MANY HOMES, A SPECIALIZED TOOL IS USED TO DETERMINE SKIN HEALTH. ONE EXAMPLE IS THE BRADEN SCALE, WHICH IS A POINT-BASED SYSTEM FOR MEASURING PRESSURE SORE RISK. of severity and how open and deep the wound is. A wound can be a shallow area or an open sore through skin and muscle, down to bone. Diabetic foot ulcers are a separate concern caused by worsening circulation in the feet due to nerve damage, as a complication of diabetes. In the worst cases, where healing is limited due to the effects of diabetes, this can lead to lower limb amputation.

SKIN CARE IN LTC When a resident moves into longterm care, an individualized care plan is created and followed, and all care plans are assessed on at least a quarterly basis. According to the Ontario Long Term Care Home Act and regulations, skin condition and altered skin integrity will be included in every resident’s care plan. Treatments and interventions include nursing care, nutrition, physiotherapy and activation. As well, regulations require that every home in Ontario has a formal interdisciplinary skin and wound care program to promote skin integrity, prevent the development of wounds and pressure ulcers, and provide effective skin and wound care interventions. The regulations also specify that skin and wound care is included as a topic of training to direct care staff. According to Best Practice Guidelines developed by the Registered Nursing Association of Ontario, a head-to-toe skin assessment should be carried out with all residents at ad-

mission, and daily thereafter for those identified at risk for skin breakdown. Particular attention should be paid to vulnerable areas, especially over bony prominences. In many homes, a specialized tool is used to determine skin health. One example is the Braden Scale, which is a point-based system for measuring pressure sore risk. This is completed upon admission and kept as part of the resident’s chart. It is much easier to prevent a wound than to heal one. The care team works towards all residents being as active and engaged as possible in order to provide optimal health and quality of life. For skin health, this is done through activities, nutrition, hydration, exercise and socialization, to keep residents active and healthy. Personal Support Workers report all incidents of “altered skin integrity” and Nurses provide treatments to damaged or open areas of the skin. Sometimes, due to frailty and lack of mobility, open areas may become infected or cause sepsis. The typical resident at greatest risk of skin breakdown is elderly, frail, and incontinent, with poor nutrition and hydration and is confined to a bed. Any bony prominence can be at risk, including edges of ears, shoulder blades, hipbones, spine, knees and ankles. Residents who are bed-bound may be physically turned or shifted every few hours to minimize the effects of pressure in one area. For bony areas such as ankles and feet, residents may

wear booties or have a special frame to lift sheets from feet so there is no friction from rubbing on the sheets.

NUTRITION AND SKIN HEALTH Residents are offered nutritious meals and snacks to encourage nutrients necessary for healthy skin. While all nutrients help to keep the body healthy, there are some that are known to be beneficial for skin. Adequate calories are important for providing skin with the energy to grow new cells and remove old and damaged cells, and dietary protein keeps all layers of the skin structurally healthy. Protein also produces enzymes that help reactions in the body to happen quickly, which is essential to reduce aging and keep the top layer of the skin in strong and healthy condition. Antioxidants such as vitamins A, C, E and the mineral selenium are known to minimize the damage of skin cells in the aging process through their ability to remove harmful chemicals from the body. These nutrients come from frequent intake of vegetables and fruits. Vitamin C is also a component of collagen, which helps in the health and elasticity of skin and helps in reducing infections. Omega 3 fatty acids are important to keep the top layer of the skin strong and help to avoid the damaging atmospheric effects. The mineral zinc helps to maintain the structure of skin, and may also help in the division of skin cells. This may play a role in healing of skin breakdown. Zinc also is involved in immune function, helping to heal skin infections. In addition to these nutrients, fluids are also essential, since water conveys nutrients into the cells and removes toxins and waste materials from the www.hospitalnews.com

LONG-TERM CARE NEWS skin. Water keeps the skin hydrated, which therefore keeps skin supple and limits wrinkles and sagging. Maintaining optimal blood sugar levels is an important nutrition goal for people with diabetes, especially in dealing with diabetic foot ulcers.

EXERCISE AND SKIN HEALTH The body is healthier with activity. All residents should take advantage of daily exercise classes, or could simply walk or move around the home. Physical activity stimulates blood flow, carrying essential oxygen and nutrients around the body. Exercise also assists blood to carry waste materials from cells, keeping them working at peak efficiency. Wounds are painful and lead to immobility, discomfort, isolation and in worst cases, can be fatal. They are also an expensive use of resources, including staff time, specialized supplies

and costly treatments. It bears repeating that it is easier to prevent a wound than to heal one, and this is the reason

for focused interdisciplinary attention on skin health for residents in longterm care. A resident who is active,

engaged, nourished, hydrated and active is more likely to maintain healthy H skin. ■

Dale Mayerson, BSc, RD, CDE, and Karen Thompson, BA Sc, RD are Registered Dietitians with extensive experience in Long-term care. They are co-authors 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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LONG-TERM CARE NEWS

New research

Study gives voice to elderly long-term care residents By Brian Swainson ork Region’s two municipal long-term care homes have just begun participating in an 18-month national research study that will examine enhancements intended to improve the communication of information and choices available to long-term care residents, and to better understand their preferences regarding end of life care. Referred to as BABEL (Better tArgetting, Better outcomes for frail ELderly), the study is being conducted by The University of Waterloo in partnership with The Canadian Frailty Network and is designed to review and identify

the benefits of standardizing Advance Care Planning in long-term care. The Principal Investigator for the BABEL study is Dr. George Heckman, MD, FRCP(C). Dr. Heckman is the Schlegel Research Chair in Geriatric Medicine and Associate Professor in the Department of Health Studies and Gerontology at the University of Waterloo, and an Assistant Clinical Professor of Medicine at McMaster University. Dr. Heckman’s primary research interests include management of heart failure in long-term care and other frail seniors, primary care management of dementia, home care safety

THE STUDY IS DESIGNED TO REVIEW AND IDENTIFY THE BENEFITS OF STANDARDIZING ADVANCE CARE PLANNING IN LONG-TERM CARE.

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

and vascular aging. He is an acknowledged expert in the field of frailty assessment, having previously served as the lead Geriatrician for the Waterloo Wellington Local Health Integration Network. Staff at Newmarket Health Centre and Maple Health Centre, York Region’s two long-term care homes, received training from the Waterloo research team prior to launching the study. One facility will serve as an intervention site, implementing the enhanced approach to Advance Care Planning discussions, and the other facility will be a control site, for the purpose of assessing the impact of the BABEL approach in aligning residents’ Advance Care Planning decisions with

their personal values, preferences and discussions with loved ones. The study will not impact the current level of care and services the homes provide to their residents, but may lead to enhanced discussions surrounding Advance Care Planning in the sector overall. Brian Swainson, Director of Seniors’ Services for York Region adds, “We are thrilled to partner with Dr. Heckman and his team to participate in the BABEL research study, as it strengthens York Region’s commitment to continuous quality improvement through innovation in resident-centred care.” Information about the BABEL study is available at https://the-ria.ca/ H project/babel/ ■

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38 HOSPITAL NEWS JUNE 2019

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Brian Swainson is the Director of Seniors’ Services for York Region’s Paramedic and Seniors’ Services branch in the Community and Health Services Department. www.hospitalnews.com

INNOVATIONS IN AGING AND BRAIN HEALTH

Have an innovative idea

in aging and brain health? By Rebecca Ihilchik t’s no secret that point-ofcare staff have a deep understanding of the needs of older adults. Care professionals like nurses, social workers, physicians, personal support workers, and arts and recreation therapists who work with older adults often improvise to meet the growing demands of an aging demographic – and hold key insights into what can be improved in seniors’ care. As the Canadian population ages, those unique insights are needed now more than ever in order to improve the lives of older adults with dementia and their care partners. The Centre for Aging + Brain Health Innovation (CABHI), powered by Baycrest, invites point-of-care staff to apply to the 2019 Spark program to bring their innovative ideas to life. CABHI’s Spark program empowers point-of-care staff to translate their grassroots ideas into novel innovations in the field of aging and brain health that can improve the quality of life of older adults living with dementia and their care partners. The program provides up to $50,000 (CAD) per project over 12 months to develop and refine early-stage solutions or adapt and test a commercially available solution in a real-world environment. CABHI invites staff working at Canadian healthcare organizations and members of the Seniors’ Quality Leap Initiative (SQLI) to apply for funding. In total, up to $2.5 million is available across all projects. This year, the Spark program is accepting applications aimed at addressing one of five priorities: • Aging in place: solutions that enable older adults with dementia to maximize their independence so that they can age in their desired setting (e.g. by reducing falls, addressing social isolation, etc.) • Caregiver support: solutions that support caregivers (formal and in-

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formal) in providing care to older adults with dementia • Care coordination and navigation: solutions that help older adults, caregivers and healthcare providers to better coordinate and navigate care for older adults with dementia • Cognitive health: solutions that improve brain/cognitive health for aging adults and/or support the identification and assessment of adults at risk for dementia/cognitive impairment • Aging Indigenous and rural populations: solutions that address aging and brain health challenges particularly focusing on Indigenous populations and individuals living in rural and remote areas Successful Spark program applicants will have an opportunity to participate in CABHI’s new Spark+ Curriculum, a four-module acceleration curriculum which will run in parallel to the project and help guide project leads toward a plan for success and sustainability. The Spark program also provides access to end-user focus groups and CABHI’s acceleration services in business development, knowledge mobilization, commercialization, and marketing and communications. Past Spark innovations include: • Toronto HEARS, a community-based hearing program for at-risk seniors • Prescribing VR (Virtual Reality), a project team that used VR technology to expose people with dementia to simulated natural environments to decrease depression, anxiety, and stress • Mindfulness intervention groups for caregivers of patients with Alzheimer’s • Aging Out, a program that disseminates best practices in LGBTQ aging, health, and dementia care across seniors’ care organizations

Interested? Eligible applicants are invited to submit an expression of interest by 5 p.m. EDT on Fri-

day, July 5, 2019. Apply and learn more about the Spark program at H www.cabhi.com. ■

Rebecca Ihilchik is the Marketing & Communications Specialist at The Centre for Aging + Brain Health Innovation (CABHI).

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LONG-TERM CARE NEWS

Surging demand for long-term care By Rumana D’Souza landmark report released today by BC Care Providers Association (BCCPA) projects the B.C. healthcare system will struggle to meet the demand for long-term care due to the demographic bulge created by the baby boom generation and a lack of investment. The report quantifies for the first time the surge in demand that will result from the province’s aging demographic, using data extrapolated from the Ministry of Health’s own growth forecast for B.C.’s frail elderly population. With boomers now reaching retirement age, demand for long-term care in B.C. is expected to spike in the next two decades, with a projected need of up to 45,000 net new long-term care beds by 2041/42. BCCPA’s report, titled Bedlam in BC’s Continuing Care Sector: Projecting Future Long Term Care Bed Needs, makes 12 recommendations that include exploring new care models, developing regional initiatives, and improving and expanding other

Key facts • Between 2013 to 2017 the number of long-term care beds grew by approximately 900. To keep pace with the proportion of the population over 75, the number of additional beds should have grown by an additional 550 beds (1,450 in total). • In 2017/18, the average length of stay in long term care decreased nine percent when compared to the previous year. • According to data provided by the Conference Board of Canada, over 30,000 new long-term beds must be added in B.C. over the next 20 years. To service these new care beds, B.C. will need to hire 19,000 new care providers, including 13,000 health care aides, 4,000 nurses and 2,000 allied health professionals.

supports such as home care and assisted living. “Regardless of what methodology you use to project future demand for longterm care, the consequences for our health system and provincial budget are frankly daunting,” says BCCPA CEO Daniel Fontaine. “Surprisingly, B.C. has only had one successful bid to develop new publicly-funded care beds in the whole province in the past two years. “Our analysis of data provided by the Conference Board of Canada shows that B.C. is already short by roughly 3,000 long-term care beds. Now factor in a requirement for another 1,000 to 2,000 additional spaces per year until 2035, and you can see the scale of the challenge.” While adding new long-term care beds is a major part of the solution, the Bedlam report looks at alternative approaches, such as improving wait times through better reporting and tracking, investing in new builds and renovating existing long-term care and assisted living spaces, supporting strategies for health human resources, and leveraging federal funding to upgrade aging infrastructure. “The gap between available beds and those who need them will continue to widen unless there are substantial investments in the number of longterm care spaces,” says Fontaine. “We have had decades to plan for this, so why are we still just catching up?” As of March 2018, there were approximately 1,400 people waiting for admission into long-term care – a seven per cent increase over the previous year. About 75 per cent of people waiting for admission into long-term care were people living in the community with the remainder waiting in hospital. “We know that partnerships with non-government providers are a critical part of meeting this growing demand,” adds Fontaine. “This report should provide an impetus for all the key players in government and the private sector to meet and hammer out a plan.” A full copy of the report is available H at www.bccare.ca. ■

Rumana D’Souza works in communications at the BC Care Providers Association. 40 HOSPITAL NEWS JUNE 2019

Congregate

dining:

Enhancing patient wellbeing at mealtime By Mariela Castro esearch has found that people who eat together generally enjoy better health. With this in mind, one of several transformative initiatives planned for the new West Park Healthcare Centre will enable patients, their family and friends to have the option to dine together. Congregate Dining – a program designed to facilitate communal dining for West Park inpatients in a dedicated dining room on each unit – will ensure that mealtime provides more than just sustenance. West Park is currently building a new hospital that is scheduled to be completed by 2023. At the new facility, mealtime will be a time to slow down, catch up, and connect with other patients, family, and friends. The premise is simple, the effects are great. “We are really excited to plan for the launch of Congregate Dining in the new hospital,” explains Martha Harvey, Director, Operational Readiness for the Centre’s Campus Development. “Existing studies have found that older adults may be at risk for malnutrition during hospitalization. These studies suggest that strategies such as congregate dining, which encourage social interaction, have the potential to benefit a patient’s food intake in healthcare settings.” She adds, “We’ve also seen how increased socialization improves a patient’s wellbeing.”

FROM PILOT PROJECT TO CENTRE-WIDE INITIATIVE The Congregate Dining program builds on and takes its cue from the Centre’s popular Eating Together initiative, a program led by West Park volunteers and speech language pathologists. Monday to Friday, an enthusiastic group of complex continuing care patients on select units gather to eat together at lunchtime on the floor’s rotunda area. There is a waiting list to participate and lunches often feature holiday or other themes, and socialization activities. West Park volunteer Donatella Dell’Agnese has been volunteering with the program for six years. “When patients eat together, we see them engage with others and really express themselves. I’ve seen first-hand their quality of life at the hospital enhanced, without a doubt, with communal dining,” she says. “Patients and their family members have reacted quite positively to the program.” Designed to serve as multi-purpose meeting spots, each dining room in the new hospital will feature an open and inviting layout, and built-in flexibility to accommodate multiple table configurations, large group activities, and patients in wheelchairs, scooters and other mobile devices. For those who require assistance with their meal experience or prefer an additional level of privacy, some separation will be accommodated in the room. Inpatients will be encouraged to dine together in the dining rooms www.hospitalnews.com

LONG-TERM CARE NEWS Right: Westpark patients enjoying the benefits of communal dining

RESEARCH HAS FOUND THAT PEOPLE WHO EAT TOGETHER GENERALLY ENJOY BETTER HEALTH. according to their meal preference. Those choosing to take part in congregate dining will have assembled meal trays delivered directly to them in the dining room by staff and trained volunteers, who will also provide feeding support as required.

ENSURING PROGRAM SUCCESS FOR WEST PARK PATIENTS As part of West Park’s Post Occupancy Evaluation (POE), research is currently being conducted by the Centre to ensure the program’s successful implementation. “We’re investigating the potential facilitators and barriers to eating together from the patient,

family/friend, and staff perspective,” explains Shelley Ditty, West Park’s Vice President, Campus Development & Support Services. “We are engaging patients, their family and friends, and staff to contribute feedback on how they would like to see the program implemented. Eating together is a small act, but can have very powerful and therapeutic effects. The chance to build relationships, to reflect on the day with others, to share experiences; this is one step towards empowering patients to reclaim their lives. Ultimately, our goal is to provide the most positive, inclusive program possible, to contribute to helping patients get their H lives back.” ■

Marielo Castro works in communications at West Park Healthcare Centre.

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LONG-TERM CARE NEWS

Time to knock down the siloes for the long-term care of tomorrow By Candace Chartier s CEO of the Ontario Long Term Care Association (OLTCA) for almost seven years until turning the page to the next chapter in my life last March, I was proud to have helped Ontario’s Registered Practical Nurses (RPNs) take on increasingly influential leadership positions throughout all areas of the provincial public health system, including in hospitals, longterm care centre s, and community health clinics. Ever since the Long-term Care Homes Act was introduced in 2007, it has been challenging to make budgets work favourably for RPNs across the network and has put added stress on the ability to care for patients. That legislation – which was conceived and passed with very little consultation with the long-term care (LTC) industry or the health care professionals working in the sector – had a huge impact on LTC homes throughout the province and the RPNs they employed. The unfortunate reality at the time was that many LTC operators, particularly the smaller ones in rural areas of the province, were forced to lay off a large number of RPNs, many with decades of experience under their belts. At the time, I worked hard to help our privately owned LTC company create a number of new Nursing Administrative Services management positions that provided our RPNs a chance to hang on to their jobs by taking on a greater range of resident care responsibilities in the homes we operated. By and large, though, the impact of that legislation was devastating and is still being felt today in many LTC homes across the province, as operating budgets are squeezed even tighter by the legislative compliance requirements. Not all the historic legislative outcomes have been negative for RPNs though.

For instance, Ontario college curriculums for RPNs have changed and are now much more broad-ranging and comprehensive than they were 10 or 12 years ago. By extension, the skill sets held by RPNs have expanded to the point that LTC operators can recruit and hire RPNs for a much broader role than they could in the past. Over the years RPNs have taken on very diverse roles in long-term care environments and have taken on a wide variety of other leadership roles in the entire LTC ecosystem. However, this reality underscores the need for more changes. If you look ahead to the next 20 years, it’s anticipated that there’s going to be more than twice as many people over the age of 75 in Ontario than there is now. With that, the government is putting in 15,000 more LTC beds, which by our calculation will require 20 per cent more staff across

the board, including RNs, RPNs, nurse practitioners and personal support workers. The problem is that right now, across the province, there’s a shortage of RNs available to take positions in any health care environment, including hospitals and LTC homes. Unfortunately, it’s only going to get worse for everyone if the legislation isn’t changed to enable more flexibility in staffing. Hospitals and other players in the acute care sector are also struggling with changing staffing needs. We’re all competing for the same staff across LTC, home care and acute care. And, there’s wage imparity between the sectors, putting a lot of pressure on everyone to keep spending more, while budgets are squeezed all around. While it may not be a popular notion with everyone, the new Ford government’s Ontario Health Teams ap-

proach might actually help to alleviate some of the problems, as the government says it’s aiming to put more focus on patient care needs. However, in order for this approach to work, the government is going to have to give all the health care sectors the flexibility to determine what staff it can hire to properly address the needs of their care setting. If we continue to work in siloes and legislating and mandating that those divisions are maintained, we’re not going to be able to meet the growing patient needs that are going to hit this province very soon. I’m optimistic that with the Ontario Health Teams approach, the bandage may finally get ripped off and that a lot of the staffing-related administrative burden is lifted on all the players in the Ontario health care system. When you’re looking at the patient and building services around the paH tient, that can only be a good thing. ■

Candace Chartier is the former CEO of the Ontario Long Term Care Association. 42 HOSPITAL NEWS JUNE 2019

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SAFE MEDICATION

Potentially inappropriate medication use in older adults:

A multi-incident analysis By Kelly Ng, Jim Kong, and Certina Ho atients aged 65 years old and above represent the fastest growing segment of the Canadian population. Chronic medication use has now become the norm in geriatric healthcare, as quality of life for geriatrics has increased and younger population cohorts exhibit less healthy behaviours compared to previous generations. Inappropriate medication use may lead to patient harm when factoring in the myriad of complex health issues and risk factors that older adults experience. We conducted a multi-incident analysis on medication use in older adults in order to gather data on the prevalence and impact of potentially inappropriate drug use to mitigate patient harm and improve medication safety. Medication incidents were extracted from the ISMP

Table 1

Canada Community Pharmacy Incident Reporting (CPhIR) Program from 2010 to 2015. A total of 184 medication incidents were included in this analysis. Qualitatively, two major themes were realized: (1) patient-specific factors and (2) drug interactions.

PATIENT-SPECIFIC FACTORS Patient-specific factors refer to individual-specific criteria in older adults that may potentiate patient harm when using medications. These include allergies and intolerances, medical conditions, and inappropriate dosing based on age. Potential causes identified were the lack of transparency or consistency among healthcare practitioners in documenting patient allergies and intolerances, outdated patient records,

and knowledge deficits regarding cross-allergic reactions, drug-disease interactions, and pharmacokinetic properties in geriatric patients.

DRUG INTERACTIONS Drug interactions refer to medication incidents that involved a combination of two or more medications that resulted in sub-therapeutic effects or drug toxicity. These include interactions between antibiotics and chronic medications, chronic medication interactions, and drug duplications. Underlying trends that may potentiate medication incidents associated with drug interactions include faulty drug-use-evaluation software, healthcare practitioners’ alert fatigue, lack of communication within the patient’s circle of care, and lack of independent double checks in the medication-use process.

Summary of Recommendations

• Consider programming the pharmacy practice management system or pharmacy dispensing software to restrict or alert certain dosages for older adults (e.g. high-alert medications, renally excreted medications, etc.) • Restrict the “copying prescription” function in pharmacy practice management system or pharmacy dispensing software • Ensure pharmacy practice management system and clinical decision support system are maintained properly and updated regularly • Review severity levels for drug-drug interaction alerts in pharmacy clinical decision support system or information management system to balance information needs and prevent alert fatigue • Implement computer alerts to flag medications within the same therapeutic class 4 • Ensure all medication information provided to patients and healthcare practitioners includes both generic and brand name (e.g. medication labels, drug information documents, medication profiles) • Implement computer mnemonics to minimize selection of the wrong medication (e.g. look-alike/ sound-alike drug name pairs) • Perform independent double checks in the medication-use process • Schedule follow-up appointments or reminders with patients at the time of dispensing

RECOMMENDATIONS Utilizing the hierarchy of effectiveness, we developed a list of recommendations for healthcare professionals to implement in their practice to reduce the risk of potentially inappropriate medication use in older adults (Table 1). Providing effective healthcare solutions for the growing numbers of geriatric patients is a challenge for our current healthcare landscape. Medication management for older adults involves a high degree of complexity and often requires intervention from multiple healthcare providers within the patient’s circle of care. ISMP Canada remains dedicated to providing effective strategies to mitigate patient harm from medication use and continues to encourage anonymous reporting of medication incidents for the purpose H of shared learning. ■

Hierarchy of Effectiveness

Forcing Functions

High-to-medium effectiveness Automation or Computerization

Reminders, Checklists, Double Checks

• When a prescription is brought into the pharmacy, verify with the patient or caregiver any clinical information about the patient that is necessary to confirm the appropriateness of the medication and its dose (e.g. allergies, opioid tolerance, indication of the prescription, etc.)

Rules and Policies

• Highlight the importance of look-alike/sound-alike drug names as part of pharmacy staff trainings and internal communication • Educate patients on the importance of retaining a best possible medication history or an up-todate medication list

Education and Information

Medium-to-low effectiveness

Kelly Ng is a pharmacist and she completed a pharmacy co-op work term at the Institute for Safe Medication Practices Canada (ISMP Canada) in 2015; Jim Kong is a Program Development Manager at ISMP Canada; and Certina Ho is a Project Lead at ISMP Canada. 44 HOSPITAL NEWS JUNE 2019

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NEWS

The power of music: Helping people with dementia By Steven Gallagher nside the activity room at the Extended Care Unit at Niagara Health’s Welland Site, Mary Lou McIvor is singing The Beatles’ song She Loves You. The 81-year-old is wearing headphones and listening to music on an iPod as part of the long-term care home’s Music and Memory Program. Her playlist features songs from some of her favourite performers: Ella Fitzgerald, The Beatles and Aretha Franklin, to name a few. The singing is intermittent, and beautiful. In between singing, Mary Lou is smiling, content, with her eyes closed. The Music and Memory Program has made a big difference for Mary Lou and other residents at the Extended Care Unit (ECU). Mary Lou, who has Alzheimer’s disease, sometimes has difficulty communicating. But when the music plays, her singing voice is easy to understand. Growing up, her daughter Cathy Thompson remembers her mom singing often around their home in

Mary Lou McIvor and her daughter Cathy at the Extended Care Unit at Niagara Health’s Welland Site. Aylmer, Quebec. Mary Lou worked for the federal government in Ottawa during the week and often had singing gigs on the weekend. “I think the fact the program is available is wonderful,” says Cathy. “Music has always managed to put Mom in a great mood and she has spent a lot of her life around music. It’s such a spirit lifter.”

Residents with cognitive impairments like dementia can sometimes experience agitation and depression. The ECU staff and Brock University students introduced the Music and Memory Program to enhance the quality of life for residents. The team works with residents and families to create personalized music playlists.

The program has helped to improve the mood and behaviour of residents and has been effective in reducing incidence of falls by creating more relaxing environments. “It’s amazing when you see someone who really responds to the music and you see their face brighten and their eyes twinkle or a smile comes across their face,” says Lezlie Leduc, the ECU Program and Services Manager. “We are using these techniques more to try and manage the behaviour. For example, when a staff member sees a resident is agitated, they get the music and it creates a calming process for the individual.” Cathy says seeing Mary Lou’s reactions while listening to music “melts my heart.” “It makes me feel so happy. I know she’s happy when she’s singing,” says Cathy. “Before she had the music, she seemed kind of down. It was as if something might have been missing because she always had such a connection with music. It has really changed her mood. She is now more H at peace.” ■

Steven Gallagher is a Communications Specialist at Niagara Health.

New award inspired by 50 years of volunteer service By Taylor Grant ottie Frenssen started volunteering for the North Bay Regional Health Centre (NBRHC) and its legacy organizations for one simple reason: to help people. The German native was thankful for the generosity the Sisters of St. Joseph of Sault Ste. Marie showed when she first moved to the city of North Bay and wanted to give back. “The nuns really took me under their wing and helped me become a registered nursing assistant,” says Frenssen. “So I always said I would help out anyway I could.”

It’s a journey of volunteering that spanned a whopping 50 years. It began by knitting sweaters for babies in hospital, and then she says she felt a tug to volunteer her ‘spare’ time in the Gift Shop. “I hated seeing the Gift Shop closed, because I knew it helped the hospital raise money to purchase needed equipment,” Frenssen explains. “So if I was scheduled to work nights, I would volunteer from 6 to 9 p.m. before going to work.” After she retired from nursing, Frenssen’s volunteer work expanded into other areas – playing a vital role

Taylor Grant is a Communications Assistant at NBRHC. www.hospitalnews.com

with the Friends of NBRHC (formerly the Volunteer Association) and serving several terms as President, while also helping to raise funds for capital equipment through the sale of break open tickets. After a full-half century Frenssen decided it was time to retire from volunteering. Her legacy to NBRHC however, lives on. In 2018, the Health Centre’s Volunteer Involvement (VI) Committee decided to create the Lottie Frenssen Volunteer Award to honour her years of service. Continued on page 47

Laurie, Vega & Lottie.jpeg: Lottie Frenssen (right) congratulates Laurie Mills and his dog, Vega, for winning the Lottie Frenssen Volunteer Award. JUNE 2019 HOSPITAL NEWS 45

NEWS “People appreciate the small things we can do for them,” says Valentina Azzolin (right), alongside fellow volunteer Terry Bey outside St. Joseph’s Health Centre.

Volunteers offer comfort and compassion By Emily Dawson t’s not yet 10 a.m. and a man arrives at the St. Michael’s Hospital emergency department with a significant head injury, perhaps from an accident on the skateboard he clutches in his hand. Dazed, he glances around the busy room trying to orient himself. Within moments of his arrival, Colin, a volunteer, is at his side, gently guiding him to a chair and taking his health card to the nurses’ check-in station. People come to emergency departments (EDs) during some of the most stressful and difficult times of their lives, as patients, friends or family members. St. Michael’s Hospital and St. Joseph’s Health Centre – the acutecare sites in the Unity Health Toronto network – operate two of the busiest EDs in the Greater Toronto Area with almost 178,000 visits every year. “Our ED is one of the most fastpaced and erratic places in the city, and the only trauma centre in down-

town Toronto,” says Jenny, a community support worker at St. Michael’s. “Our team works incredibly hard just to keep up with the pace and our patient demographic keeps us on our toes day and night.” Unity Health’s 60 ED volunteers like Colin reflect the organization’s core values of by providing compassionate care to all in need. Whether greeting a new arrival, helping a family locate a loved one, opening a door for a rushing EMS team, or getting a sandwich for someone who hasn’t eaten all day, volunteers offer vital assistance and peace of mind when people are at their most vulnerable. “I’ll greet patients, help them inside, and take their health card so that they feel seen and heard. I hope they get comfort knowing that someone is looking out for them,” says Colin. “People might come in here looking for a family member who’s been admitted. They may not have any de-

tails and they’re distressed just trying to locate their loved one. I can take them right to the bedside as quickly as possible.” Colin’s compassion extends beyond patients and families. In an environment like St. Michael’s, people experiencing disadvantage frequently visit to get necessities. “St. Michael’s is there for the patient and for the whole community. Someone will come in and say, ‘I need something to eat.’ I will bag a sandwich, fruit and juice for them. They might also need a pair of shoes or a winter hat; we keep all kinds of things to give to those who need it most,” says Colin. “I just try to be sensitive, human, and totally focused on the experience someone is having. I have all the time in the world to be present with them. This is the best role for me.” Says Jenny, “Colin is fantastic. Volunteers work out of the goodness of their hearts and ask for nothing in re-

turn. We are proud to have them here with us.” There are a couple of new faces in the St. Joseph’s Emergency Department this year. Valentina Azzolin and Terry Bey both started as volunteers within the last several months. “We are judicious in how we recruit ED volunteers,” says Michael Kidd, Unity Health’s director of Volunteer Services. “We look for proactive problem-solvers with great customer service skills, and people who are good listeners. They add tremendous value to the care experience.” Azzolin came to Canada from Italy to learn English. Currently enrolled in Medical Administration classes, she spends every Wednesday at St. Joseph’s. She is soft-spoken, empathetic and calm – gifts she offers to patients looking for solace in the chaotic ED setting. “I help out wherever I can. I often assist patients with their food trays and I bring warm blankets to Continued on page 47

Emily Dawson works in communications at Unity Health. 46 HOSPITAL NEWS JUNE 2019

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NEWS “I just try to be sensitive, human, and totally focused on the experience someone is having. I have all the time in the world to be present with them. This is the best role for me,” says St. Michael’s Hospital volunteer Colin.

Comfort and compassion Continued from page 46 patients who are cold. I help patients find their way through the emergency department. The staff is so busy so I try to do little things for patients,” says Azzolin. Bey, a father of two hockey players, has visited St. Joseph’s ED on more occasions than he cares to count. “I always thought they were great here, and I wanted to give back.” As a courtesy greeter, Bey is the first point of contact for patients. He relishes the many roles he plays in alleviating stress by offering assistance and helping them find their way within the ED and around the health centre. “I try not to just point people in the right direction. I add a personal touch and escort them to their destination. I walk about 10,000 steps in my three-hour shift!” To illustrate her love for giving back, Azzolin compares her restaurant job to volunteerism.

Careers VIEW CAREER ADS AT:

“At work, I serve people food and nobody’s really grateful. Here, I will ask people, ‘how was breakfast?’ They are so happy to talk, so grateful. I am in the ED for three hours without pay and it feels much better than working for money. People appreciate the small H things we can do for them.” ■

Volunteer service Continued from page 45 “The award is a small way to pay tribute to Lottie and share her legacy with new volunteers,” says Ron Walsh, member of the VI Committee. “It honours those who share Lottie’s tireless efforts and devotion to the Health Centre and set the standard for volunteering, leadership and caring.” Since the award’s inception, 30 volunteers have been nominated by patients, staff and peers for their significant contributions to the Health Centre.

Pet therapy volunteer, Laurie Mills was named the recipient of this year’s award. “Laurie has been volunteering with the Health Centre’s Pet Therapy Program for over 20 years. He has gone out of his way to provide services to all areas of the hospital with his dog Vega, specifically our mental health and the law program,” explains Walsh. “We are very grateful to have such a wonderful man and amazing dog as part of H our team.” ■

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Safe healthcare workers mean better care. Together we are reducing violence in healthcare.

Introducing New Workplace Violence Prevention resources from PSHSA for Hospitals, Community Care and Long Term Care.

workplace-violence.ca Through conversation and collaboration we can keep frontline workers safe.