Shining the Light on St. Michael’s Best Practice Spotlight Organization Achievements

Shining the Light on St. Michael’s Best Practice Spotlight Organization Achievements FALL 2020

This annual newsletter highlights some of St. Michael’s best practice achievements with examples of how our nursing teams are implementing, evaluating and sustaining best practice guidelines into standardized processes that support evidence based nursing practice.

Determining best practice surrounding the use of physical restraints (pg.3)

Who Were 0 Our 2019/2 BPG Nurse Champions and more inside...

Sabrina Parker, RN Trauma and Neurosurgery (Credit: Yuri Markarov)

Pain Assessment Tool introduced at St. Michael’s (pg.4)

2020 Nursing Week Virtual BPG Sustainability Poster Gallery (pg.6)

BPSO stands for Best Practice Spotlight Organization, the designation awarded by the Registered Nurses’ Association of Ontario to organizations upon successful implementation, evaluation and knowledge translation of established nursing best practice guidelines. St. Michael’s has been a proud designated BPSO since 2012.

A few words from Murray Krock Senior Director, Nursing Practice and Education

(SMH) eighth year as a designated This year recognized St. Michael’s Hospital rio (RNAO) Best Practice Spotlight Registered Nurses’ Association of Onta ntation of 42 best practice guidelines Organization (BPSO) and the impleme the BPSO designation since 2012 and (BPGs) since 2009. SMH has proudly held nt, sustain and spread BPGs. There we are committed to continuing to impleme orting best practice guidelines across were 28 quality improvement initiatives supp to March 2020. These initiatives were 23 different clinical areas from October 2019 ns and supported by dedicated BPG led by 34 committed BPG Nurse Champio year 2020 will go down in history as unit and Professional Practice mentors. The the COVID-19 pandemic. We were unprecedented as we were confronted with munity of practice (CoP) scheduled in at a loss for words when our year end com We do however, want to acknowledge March had to be unexpectedly cancelled. e Champions and their mentors who and congratulate the 2019/2020 BPG Nurs BPG quality improvement initiatives. persevered and worked hard to complete their n of SMH BPG Nurse Champions and This is a remarkable example of the dedicatio care. While we were unable to come their commitment to safe quality patient mpions and their accomplishments together to celebrate the BPG Nurse Cha Week 2020 Virtual BPG Sustainability during National Nursing Week, the Nursing able on the nursing intranet. Here you Poster Gallery was shared and remains avail /2020 BPG Nurse Champions and to will have the opportunity to meet the 2019 proud to be designated as a BPSO by review their poster presentations. SMH is rio. This prestigious award is given to the Registered Nurses’ Association of Onta are committed to working with the healthcare and academic organizations that by implementing evidenced based best RNAO to ensure the highest quality of care CoPs will welcome new and returning practice guidelines. The 2020/2021 BPG will continue to come together to share BPG Nurse Champions and mentors. They ng strategies in a supportive learning knowledge, advice, tools and problem solvi ntation and sustainability of BPGs and environment that facilitates the impleme also, leadership development.

Murray

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Determining best practice surrounding the use of physical restraints

By Selma Al-Samarrai Patients in the Trauma & Neurosurgery unit at St. Michael’s Hospital sometimes exhibit behaviour that poses a safety risk to themselves or their care team. This occurs due to a host of reasons including neurological or mental health issues, or difficulties with mobilization and communication. In those instances, when all possible alternative interventions have been exhausted, the team may need to temporarily use physical restraints.

Sabrina Parker, a Registered Nurse on the unit and a Best Practice Guideline Nurse Champion, has created an algorithm to outline when physical restraints are absolutely needed, and to improve communication between team members about why and when physical restraints are used. Parker was the 2020 recipient of the Piera Cardella Scholarship Fund which provided additional funding to further support the BPG initiative. The late Piera Cardella was a nurse at St. Michael’s dedicated to the needs of all those who were in her care. The Piera Cardella scholarship was set up to support quality improvement initiatives that enhance nursing care and services. The scholarship is awarded to an initiative that is responsive to the needs of health care, as articulated by the Ministry of Health of Health and Long Term Care, and matched with the needs of St. Michael’s Hospital’s patient populations.

“I focused on two key areas with this initiative: the first was to ensure that the medical orders for physical restraints were accurate, and the second was to make sure that our documentation of their use was being done properly,” explained Parker.

Parker discovered, through interviews with various staff on the unit, that inaccuracies and lack of documentation occurred either because staff did not have sufficient information or there wasn’t proper communication between the team members.

Sabrina Parker, RN, Trauma and Neurosurgery (Credit: Yuri Markarov)

“Lack of documentation can lead to unsafe use of physical restraints, miscommunication of a patient’s clinical status, and delays in the patient’s ability to transition out of hospital. It’s extremely important that we have a clear and comprehensive process for when and why patients need physical restraints,” Parker said.

After understanding the root cause of these issues, Parker did two key things. First, she organized education sessions with the Registered Nurses and Clinical Assistants on physical restraint safety and what alternative options exist. She then created an algorithm for the team to follow when a patient exhibits certain behaviours to assess whether they need de-escalation strategies such as calling a family member, providing an activity to occupy their time, or assigning a constant care provider, or physical restraint as a temporary measure.

Since Parker introduced the education sessions and the algorithm, immediate and quantifiable changes included a 60 per cent increase in Soarian documentation and a 13 per cent decrease in physical restraint use.

“I’ve been on this unit for four years. It was through my own clinical practice and collaboration with our interprofessional team that I was able to identify this particular issue and the many ways that we could improve it,” said Parker.

FALL 2020 I 3

Pain Assessment Tool introduced at St. Michael’s to assess pain in palliative care patients

By Selma Al-Samarrai In order to provide the right care, health care teams need feedback from patients about how they’re feeling. But how can a team assess the pain experienced by patients with dementia when their ability to explain their pain is compromised?

In response to this gap of critical information, Registered Nurses Victoria McLean and Aysha Siddiqa Patel worked together to pilot the Pain Assessment in Aysha Siddiqua Patel, RN Victoria McLean, RN Advanced Dementia (PAINAD) Scale on Palliative Care Palliative Care the Palliative Care Unit at St. Michael’s Hospital. The PAINAD, already used in other healthcare rollout of the tool which allows for a standardized and institutions, assesses pain in patients with advanced dignified approach to assess behavioural and psychological dementia by observation when the patient’s ability to symptoms associated with pain,” explained McLean, who self-assess isn’t possible. It is one of the assessment is a Best Practice Guideline Nurse Champion along with tools recommended by the Registered Nurses’ Patel.

Association of Ontario in the Delirium, Dementia, and McLean and Patel are hoping that the PAINAD tool will Depression in Older Adults: Assessment and Care Best eventually be more widely used across Unity Health Toronto Practice Guideline, and has been used on the Palliative as it would standardize the approach to pain assessment Care Unit since January of this year. for persons with advanced dementia.

The PAINAD tool assesses breathing, facial expressions, “The PAINAD tool is thorough because it measures various body language, negative vocalizations, and how easily a behaviors, and also provides information on how to manage patient can be consoled when they are upset. It is used the symptoms according to the score you receive; which is on patients who are living with advanced dementia and significant to client-centered care,” said Patel. “This has the are unable to report their pain clearly. potential of becoming a universal tool across our network.”

“Our staff members were actively engaged with the

4 I FALL 2020

Who Were Our 2019/20 BPG Nurse Champions?

A BPG Nurse Champion is a nurse selected to lead, facilitate and inspire the BPG implementation and evaluation process in their local unit.

From October 2019 to March 2020, there were 34 BPG Nurse Champions from across 23 clinical areas who led BPG initiatives in their local areas/ departments. To learn more about our 2019/20 BPG Nurse Champions visit

St. Michael’s BPSO intranet page.

What are key qualities of a BPG Nurse Champion?

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A nurse who demonstrates initiative and commitment to best practices in their current role;

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Passionate about a BPG topic, patient population and the potential outcomes that can be achieved;

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Has the ability to lead, coordinate and facilitate an initiative and, role models positive clinical leadership.

FALL 2020 I 5

2020 Nursing Week Virtual BPG Sustainability Poster Gallery

In May 2020 we celebrated St. Michael’s eighth year as a designated RNAO BPSO and the implementation of 42 BPGs since 2009. Annually during Nursing Week, BPG Nurse Champions showcase their work during the BPG Poster Gallery Walk.

The event demonstrates quality improvement initiatives that are informed by RNAO BPGs and contribute to quality patient care. Due to the extenuating circumstances brought upon by COVID-19 we were unable to host this annual event. A virtual BPG Sustainability Poster Gallery was created to showcase the 28 BPG quality improvement initiatives across 23 different clinical areas from October 2019 to March 2020. The virtual BPG Sustainability Poster Gallery can still be viewed on the SMH BPSO intranet page.

Global BPSO Network Over 1000 BPSOs Worldwide

6 I FALL 2020

Courtesy of RNAO

2019-20 Best Practice Guidelines Communities of Practice Highlights from Last Year...

From October 2019 until March 2020 28 Best Practice Guidelines (BPG) quality improvement initiatives were implemented across 23 different clinical areas. These initiatives were led by 34 BPG Nurse Champions and supported by 24 BPG Unit Mentors and four Professional Practice Mentors. One lesson learned through our Best Practice Spotlight Organization (BPSO) journey is that supporting BPG Nurse Champions leads to success.

Supporting BPG Nurse Champions is important to ensure success as we continue our BPSO sustainability and designation with the Registered Nurses’ Association

In the face of COVID I think we managed fairly well. Adaptability is an excellent skill to take away from the experience.

of Ontario. The first half of the CoP was dedicated to round table discussions that gave BPG Nurse Champions the opportunity to share experiences, including successes and challenges, related to implementing their BPG initiatives. The second half focused on methodologies of quality improvement and education in support of the professional development of BPG Nurse Champions, providing them with strategies and tools that could be applied to the implementation of their BPG initiatives.

This year the BPG CoP sessions were cut short due to COVID-19. The BPG Nurse champions persevered and demonstrated their flexibility and resilience to complete

Definitely useful for bedside nurses to be involved in these processes. It can improve collegiality to improve care.

their BPG implementation initiatives. The 2019/20 BPG Sustainability virtual poster gallery demonstrated the high caliber of work completed by this cohort of nurses. Here are a few comments from 2019/2020 BPG Nurse Champions.

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42 BPGs and Counting‌ 1. Adoption eHealth Solutions: Implementation Strategies 2. Assessment and Management of Pain 3. Assessment and Device Selection for Vascular Access 4. Assessment and Management of Foot Ulcers for People with Diabetes 5. Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition 6. Assessment and Management of Venous Leg Ulcers 7. Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour 8. Breastfeeding Best Practice Guidelines for Nurses 9. Caregiving Strategies for Older Adults with Delirium, Dementia and Depression 10. Care and Maintenance to Reduce Vascular Access Complications 11. Care Transitions 12. Client Centred Care 13. Client Centred Learning 14. Crisis Intervention 15. Decision Support for Adults Living with Chronic Kidney Disease 16. Delirium, Dementia and Depression in Older Adults 17. Developing and Sustaining Effective Staffing and Workload Practices 18. Developing and Sustaining Interprofessional Health care: Optimizing patients/clients, organizational and system outcomes 19. End of Life Care During the Last Days and Hours 20. Engaging Clients Who Use Substances 21. Embracing Cultural Diversity in Health Care 22. Establishing Therapeutic Relationships (ETR) 23. Integrating Smoking Cessation into Daily Nursing Practice 24. Interventions for Postpartum Depression 25. Managing and Mitigating Conflict in Health Care Teams 26. Nursing Management of Hypertension 27. Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease 28. Person and Family Centred Care 29. Preventing and Managing Violence in the Workplace 30. Prevention of Falls and Fall Injuries in the Older Adult 31. Preventing and Mitigating Nurse Fatigue in Health Care 32. Preventing Violence, Harassment and Bullying Against Health Workers 33. Professionalism in Nursing 34. Promoting Safety: Alternative Approaches to the Use of Restraints 35. Promotion of Continence using Prompted Voiding 36. Risk Assessment & Prevention of Pressure Ulcers 37. Screening for Delirium, Dementia and Depression in Older Adults 38. Strategies to Support Self Management in Chronic Conditions 39. Supporting and Strengthening Families through Expected and Unexpected Events 40. Stroke Assessment Across the Continuum of Care 41. Woman Abuse: Screening, Identification and Initial Response 42. Workplace Health, Safety and Well-Being of the Nurse

with Susan Beswick

Evidence Based Practice Nursing Manager

What is your favorite What is one change BPSO brought to SMH? part of the BPG Implementing and sustaining Best Practice Guidelines Communities of Practice? provides our nurses the opportunity to demonstrate the unique role of nurses throughout the organization and the direct impact they have on patient experience and outcomes. Our nurses, often working in interdisciplinary teams, are able to use a systematic, quality improvement approach to understand opportunities for improvement, evaluate current evidence and best practices to create cycles of change and implement improvement activities. It is a unique opportunity for the nurses at St. Michaels to be in a position to lead quality improvement initiatives at the local unit level. The creativity and relationship building across departments and programs has led to increased collaboration and partnerships across the hospital.

In January 2020 Unity Health Toronto – St. Michael’s site hosted RNAO BPSO international visitors from Israel

Watching the BPG Nurse Champions grow and develop throughout the cycle of the Communities of Practice. The first CoP is often a quiet day where champions may not know any other attendees and are uncertain what they signed up for! Day one, champions will describe as a ‘word salad’ with acronyms like PDSA, QI, BPGs and MFI being thrown around.

By the last CoP the Nurse Champions have mastered the terms, have a solid understanding of Quality Improvement methodologies, have successfully implemented a BPG and are often thinking of the ‘next steps’ for their initiative or another important initiative for their practice area. It is very rewarding to see the champions develop their QI skills throughout the CoPs and to reflect on the cumulative positive impact all the BPG Nurse Champions have had on patient care and outcomes over the past 11 years.

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Congratulations to the following BPG Nurse Champions, Mentors and teams who have presented their BPG work at external conferences in 2019/20: A. Skiffington. Lead discussion in “Knowledge Café”. Best Practice Spotlight Organization Knowledge Exchange Symposium Toronto, ON. April 11, 2019 Keating A. “Using Responsive Behaviour Language and De-escalation Strategies in the ICU to Improve Staff and Patient Safety”. CACCN Dynamics of Critical Care, Halifax, N.S. September 16 -18, 2019 B. DeLaurier. “Patient and Family Centered End of Life Care in the ICU: The Development of an End of Care Life Bundle”. CACCN Dynamics of Critical Care, Halifax, N.S. September 16 -18, 2019 M. Harding. “Engaging Clients in the Emergency Department who use Opioids”. European Conference on Mental Health, Belfast, Ireland. October 2-4, 2019 Bisiker M. “Person-Centered Care Standards for the Support and Care of Transgender Clients in the CIBC Breast Centre”. Canadian Association of Nurses in Oncology (CANO), Winnipeg, MB. October 2023, 2019 Tavares D. “Bridging the Gap of Diverse Views on Cannabis Use in Cancer Care” Canadian Association of Nurses in Oncology (CANO), Winnipeg, MB. October 20-23, 2019

FAST FACTS Over the course of our 2016-2020 BPSO Designation Term…

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2

3

159 RNs

108 BPG

33 St. Michael’s

participated in the BPG Communities of Practice to implement 115 BPG initiatives

10 I FALL 2020

Sustainability Posters displayed during the Nursing Week BPG Sustainability Walk

nurses presented BPG work externally at national and international conferences

BPG WORD SEARCH Find the words below to refresh your BPSO vocabulary!

V U A R E U B H K K V Z G D S H F A Y S A D M M X Y H V W Y Q Z O T B S U P T R

S T Z T G W T N E J F Y H Z Y I F R C O T D S S C M W K Y M T E V L P G S T J N

N I C T I D C Z C O L Z N F S H B L R I B A J P N T O B O G D G Q I L N H I L X

J D R L H K F W G J T Y P P J F M W F U T D I H R O S S X G Q B H H F X R K Y R

S L G Z A E L O F K I Z D Y E K H R I N V G Z A R D I X P F D S K J X I T A F K

T U B P G N U R S E C H A M P I O N E Z V L N E M D E T Z E N V W C W U K X K D

C R S M J A G P E U T N J I Z I A M R V L S U S V A D Z A O T K S D C N P W L R

A G D T K F V M G D B R L B T O E L V H F H W E H U J E I D W U O O J N U A E M

W U K U A U Q L P L U U P R G G C A A E V V E C G R O T E R N F F Y N Z J U K U

N S S Z B I O P T M T C U X A S Q R R P B W S F K H A C R N I E Z N A J W G O U

G M S Y C G N I T A D W A N S B M O G R Q O A N H L A R A U G G M P Y C L E W L

M V T E H I E A Q F F P A T B C F V G R V B A W E Q K B C Q S M F M I Z S H H D

E E E G C Y S A B G G M M W I A R M M F L I D R A Z H B D G C M Y C O E O N A X

T D Z R L O R Y U I E E Y F C O I C M U E U C S L J D E E P L L S X H C Z R W H

I H J W S E R F P G L E W C T K N J V P T I N N T T S Q R P Y C U H Y I E F P O

Y X W S A U W P N T L I O D S F K G Q V T O O L H Y M D T F A Z Z O P G O R G K

W O X Z Y X A A T A K U T D G Q B Z X U Q E I E Y P R F N P O K B V E Y F V R X

B B T U H W H J C N N G F Y Y H R K E R A E T F W G C Z E C E S C F O F O M Q J

T M I Z B C V O E T E I Y Q P E I P P C V D N G O Z P R C L U G Q E X L K I N N

F Y O F N P J V A Y P M Y P V L A C V U U G E V R P Q S Y Y T T U W N F I W F A

BPG NURSE CHAMPION BPG TOOLS CHANGE MANAGEMENT CUE DASHBOARD EDUCATION ESTABLISHING THERAPEUTIC RELATIONSHIPS FALLS PREVENTION HEALTHY WORK ENVIRONMENT INTERVENTION

U B G C E G T B T H O T E X K R A C C W J C V N K S B T L C V K D E I H I B E T

C Z S V Y Q I H E I I T W V E Y U N Q O H O E Q E B U Q I A I Z U M Q Y J M K A

I R S A M L O D K P J A G H O E T L L L Y S R O N O I A M W Q A C U K O S O U H

L S Q Y I O A L J N A V T I D R J J L A E R P G V K F B A I N Z F B C M C X Z S

I W R T N D N Q Y W X G X A Q M P N C Z O Y S H I W J X F B U P M T J Z X B G O

D Q Y M U X R P M X N I S W Q T B M D I A C L T R W D D D Z V A X P I O F I Y Z

M T X E L D Y J Z I V H T T K C T I I A E H L O O P U V N N C D L A H W B I W M

I O Y O Z D R L H H B V L F D P E F N Y K O A P N I V U A Y P Z F U C D Z N W L

T K W V Y H A S M O U J P H F T G E S S T R F L M M Q I T V L O V O A K U T N Y

P Z L Q W V I V A R N D Q N T U G G A P E I N Y E H V C N X I N I M Z H C E R P

B Z D P H L J R K W M N N U U S B P G T O O L S N U H R E J K S A R R Y R R K S

D L V F B G D Z D R H D S L A T Z D S M D J S A T K Z I I C H O E W Z I O V L S

B K W A S D I P H W F H L N M M C O N Y Q K S H U J V X T U V K A E K T I E M M

W G T O N L C T E M Y D Q E I C P H H B J O D U F Q Z I A M H M O C U U E N C Z

U S V W E P P B V E Y H J X D P R U V N Z L R C T R Z N P P Q Q B O N U W T N O

E R G X N T J U N V U W U A U C H W O I G E R E T R A H C T C E J O R P C I W L

G N I S R U N N I M S I L A N O I S S E F O R P J T H T C M J O Z K A Y P O X X

M E A F N K J Y I M H D O I C Y W W R V C G A N Z H R W R N H F X N R U S N V G

U Z Q V R M Z W L S H S K J W Q Q Q Y L Q U X E Z P Y R I O A X E R Z F G S K L

Q J M H C W A Q D O T J S T M G U H W I I N L O F Q R U P M E B T M E A A U I U

PATIENT AND FAMILY CENTRED CARE POSTER PROFESSIONALISM IN NURSING PROJECT CHARTER QUALITY IMPROVEMENT PROCESS RECOMMENDATIONS RNAO SUSTAINABILITY PLAN TRANSFER OF ACCOUNTABILITY FALL 2020 I 11

Did you know...

You can access BPG Nurse Champion Tools on the BPSO intranet site under Tools and Resources

Check out our BPSO Intranet Site to learn more about the BPG initiatives that have been implemented over the past years.

Stay tuned...

Please send your comments or story ideas to Marta Sliz marta.sliz@unityhealth.to Shining the Light on St. Michael’s Best Practice Spotlight Organization Achievements is an annual newsletter created by the Nursing Practice and Education Department at Unity Health Toronto, St. Michael’s Hospital.

Design and Photography by Medical Media Centre, Unity Health Toronto