In Touch newsletter: November 2015

INTOUCH NOVEMBER 2015

Angelina Berlin, a nurse in the MSICU, uses the TalkRocket Go app to communicate with a patient.

(Photo by Katie Cooper, Medical Media Centre)

iPad app gives a voice to MSICU patients with breathing tubes

By Corinne Ton That

Reading a patient’s lips and interpreting hand gestures can be tricky – especially if the patient who is trying to communicate is in the Medical Surgical Intensive Care Unit and breathing through tubes.

A pilot study conducted by a team of speech language pathologists, nurses and respiratory therapists at St. Michael’s Hospital found that an iPad app called TalkRocket Go could help clinicians better communicate and care for patients with endotracheal or tracheostomy tubes.

“For some patients in the ICU, their hands are so swollen that they aren’t able to hold Printed on 100 per cent recycled paper

a pen to write things down, and they’re weak, which makes it hard for them to communicate,” said Orla Smith, a nurse researcher who worked on the study.

“There can be unmet needs for patients, and clinicians might not know if they’re being understood by their patients.”

The app, which can be downloaded for about $130, allows users to push buttons with pre-programmed questions, statements, answers and pictures.

“Patients are able to communicate more easily through the app, and I think it can improve their overall wellbeing,”

said Angelina Berlin, a nurse in the MSICU who took part in the study. “It’s frustrating when you can’t express what you need.”

Darcy Roza, a speech language pathologist who worked at the hospital until this summer, was the principal investigator for the study. She taught clinicians how to use the app and helped identify appropriate patients for the study.

Patients had to be alert, able to follow commands, and able to read and identify pictures.

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NOVEMBER 2015 | IN TOUCH | 1

OPEN MIKE with Dr. Matthew Muller

Medical Director of Infection Prevention and Control

We all play a pivotal role in keeping our patients and staff free from infection Every one of us plays an important role in preventing the spread of infection at St. Michael’s. By sanitizing our hands, getting vaccinated against influenza, performing regular infectious disease screening on our patients, cleaning and disinfecting shared medical equipment and not coming to work when we’re sick, we are all protecting the health and safety of our staff and patients.

St. Michael’s Infection Prevention and Control Program is comprehensive.

There is not one foolproof solution to keeping our staff and patients safe from infection, but instead a series of initiatives that build upon each other, to protect those with whom we come into contact every day.

While we all individually play a pivotal role in preventing the spread of infection, we have a dedicated group of infection control professionals whose job is to guide and educate us on the best practices in infection control.

The team works with: • Corporate Health and Safety Services to promote the influenza vaccination for staff, physicians, students and volunteers • Environmental Services to ensure that best practices and evidence-based strategies are in place to minimize the risk of infection spreading from the hospital environment into the community • Perioperative Services, surgery, anesthesia and the Medical Device NOVEMBER 2015 | IN TOUCH | 2

Reprocessing Department to ensure that all of the essential processes required to perform safe and infectionfree surgery are in place • Engineering and Environmental Services to ensure we have full and functional hand sanitizer dispensers where you need them • Planning and Engineering to ensure appropriate infection prevention and control plans are developed and implemented for planning, construction, renovation and maintenance projects

Continued from page 1

Most patients had been breathing through endotracheal or tracheostomy tubes for 22 days before taking part in the study.

“We don’t want to eliminate other types of communication – rather, we want to help clinicians gain more insight into how patients are feeling,” said Roza. “This app allows patients to elicit full conversations with the staff caring for them.”

• All our front-line health care workers to make St. Michael’s a safer place We have policies and procedures in place to cover routine practices and precautions, address the proper moments for performing hand hygiene, identify the management and control of patients with antibiotic resistant infections, such as Methicillin-resistant Staphylococcus aureus or Clostridium difficile.

Finally, we have a mandatory hand hygiene e-learning module that everyone must complete when they start at St. Michael’s, to ensure they understand when and where to perform hand hygiene.

As we prepare for yet another change of season, I want to thank you for your continued dedication to keeping your colleagues and our patients safe and infection free.

And remember – get your flu shot!

Follow St. Michael’s on Twitter: @StMikesHospital

A patient speaks with an Ontario certified pharmacist via video call during a NuVision Health Pharmacy demonstration in the Emergency Department. (Photo by Yuri Markarov, Medical Media Centre)

St. Michael’s Emergency Department prescribes convenience with new pharmacy dispensing kiosk

By Kendra Stephenson Picture this: it’s two in the morning and a patient has finally been discharged from the Emergency Department, prescription in hand, knowing they will soon feel better – after getting to a pharmacy. If it’s late at night or early morning (outside of regular pharmacy hours) they’d be out of luck: until now.

Prescriptions can now be filled 24/7 at St. Michael’s new pharmacy dispensing kiosk in the Emergency Department waiting area.

Although dispensing machines are not new technology, the NuVision Health Pharmacy is the first of its kind in a downtown Toronto hospital.

The other kiosk locations in Ontario are Orillia Soldiers’ Memorial, NuVision’s headquarters in Mississauga and a future site at Newmarket’s Southlake Hospital.

Despite its futuristic look, the vending machine-like pharmacy is as simple to use as an ATM and still provides a face-toface interaction with an Ontario certified pharmacist. In three easy steps (scan, speak, collect), a patient can fill his or her prescription at any time of day or night.

The entire process takes only about seven minutes.

“It’s a very convenient option, especially

because we see many of our patients afterhours, when pharmacies aren’t always open,” said Dr. David MacKinnon, deputy chief of the Emergency Department. “We know that the extra step of going to a pharmacy contributes to higher rates of prescription drug non-compliance. With the machine, the pharmacy is on their way out and patients can start treatment immediately.”

The kiosk video-calls a pharmacist located at the company headquarters in Mississauga who helps patients scan their prescriptions, provides any additional information and discusses the medication.

Once the process is complete, the machine deposits the prescribed medication and dosage in a double-sealed container. The kiosk accepts debit, credit, insurance plan or ODB cards directly. For safety and security, cash is not accepted.

On top of convenience and potentially improving compliance, Dr. MacKinnon said the service is a safer option for people leaving the ED late at night, and could also be more cost-effective.

“The company operating the kiosk has matched their pharmacy and drug pricing with Shoppers Drug Mart,” said Dr.

St. Michael’s is an RNAO Best Practice Spotlight Organization

MacKinnon. “It’s stocked with genericbrand medications that are covered by most drug plans and is also cheaper for patients paying out-of-pocket.”

The kiosk has 650 slots holding various pre-packaged doses of antibiotics, antiinflammatories and topical treatments, and is restocked every one to two weeks.

Narcotics, including opioids, are not stocked in the machine for safety and regulation reasons.

The inventory is aligned with the LHIN’s guidelines and treatment recommendations, but the hospital has some control over the stocked medications based on needs and usage. As the guidelines change, the inventory can be adjusted to reflect current best practices.

Doctors in the emergency department also have access to a website linked to the machine’s current inventory.

“If I need to prescribe a certain medication to a patient, I can check to see if it’s available in real-time,” said Dr. MacKinnon.

“With the kiosk, I can guarantee their medication is available, save them an extra trip and get them on their way home – all within seven minutes.”

NOVEMBER 2015 | IN TOUCH | 3

Using pagers and name tags to better

RN Ramata Tarawally and clinical assistant Alvin Lumbres are two staff on General Internal Medicine using name badges, which could help enhance health-care providers’ interactions with each other and patients. (Photo by Yuri Markarov, Medical Media Centre).

New name badges offer more personal patient experience in General Internal Medicine

By Jordyn Gibson When Diana Potts, the administrative manager of General Internal Medicine, read the book The Checklist Manifesto, highlighting the importance of remembering seemingly small or obvious things such as people’s names, she thought: “You have a better team when people know each other’s names.”

providers’ interactions with each other and patients on General Internal Medicine, many of whom are seniors. In October, staff and physicians began wearing both to help enhance communication.

Potts said she wondered whether name badges in addition to hospital ID badges – with their small print that can be difficult to read – could help enhance health-care

The new blue and white tags with the person’s first name help patients and their families clearly identify who is coming in and out of their rooms, Potts said.

NOVEMBER 2015 | IN TOUCH | 4

“We are dealing with patients who are very vulnerable, who rely on support for the basic levels of care,” said Potts.

“Often patients refer to staff members, but don’t remember their names and it becomes difficult to acknowledge their exchange,” said Potts.

The GIM leadership team hoped the badges would boost collaboration among healthcare providers and patients.

“Sometimes, the most obvious initiatives are staring you right in the face, and I think this one is getting an optimistic response,” she said.

communicate with our patients

Patient Regina Surotkosicz receives a pager from clerical assistant Aleisa Smith at the Hematology/Oncology Clinic, which is using pagers to let patients know when it’s time to receive care. (Photo by Yuri Markarov, Medical Media Centre).

Pagers for patients at Hematology/Oncology Clinic

By Jordyn Gibson

Charmaine Mothersill, the clinical leader manager of the Hematology/ Oncology Clinic, was at a restaurant one night when she was handed a round disc that vibrated and lit up when her table was ready.

It occurred to her that pagers could solve more than just long lineups at restaurants. Perhaps they could also make a difference in St. Michael’s busy Hematology/Oncology Clinic to alert patients when it’s time for them to receive care, she thought.

When patients check in at the registration desk, they now receive

a number and a device the size of a smart phone that lights up and vibrates when it is each patient’s turn to see a health-care provider. The devices’ signal reaches anywhere within the hospital. At the same time, a screen in the waiting area displays the patient’s number.

Previously, nurses had to step out into the hallway and call patients’ names. Mispronunciations were frequent. Language barriers caused misunderstandings. It could often take multiple attempts before the patient realized he or she was being called.

Patients would go to the bathroom,

or get something to eat, and missed hearing their names called.

“It would get really busy and loud,” said Mothersill.

The new system is better for those who are seeing or hearing impaired, or those who aren’t able to communicate in English, she said.

Mothersill said it also “reduces patient anxiety. They can go and get themselves something to eat, go for a walk, or use the bathroom without worrying they might lose their place in line.”

NOVEMBER 2015 | IN TOUCH | 5

A rending of the new Shuter Wing, which will house the expanded Slaight Family Emergency Department and a dedicated non-emergency patient transfer entrance into the hospital’s lower level. The new wing is expected to be completed in 2019. (Rendering by NORR)

Taking the ramp less travelled

By Kate Manicom

It’s mid-morning in the hospital’s Queen Street entrance and the lobby is buzzing with activity: Information Desk staff and volunteers offer directions, a Wheel-Trans driver calls out for her next pick up, contractors manoeuvre carts of supplies on their way to renovate Donnelly’s upper floors and a non-emergency ambulance attendant weaves a patient on a stretcher through the crowd.

It’s the hospital’s busiest public space, seeing 75 per cent of patient and public traffic, supporting 750,000 ambulatory and diagnostic visits and more than 30,000 surgeries annually.

On a daily basis, the Information Desk fields up to 600 inquiries and 50 stretchers pass through the lobby.

Next spring, when the Victoria Street entrance closes to make room for an expanded Emergency Department, almost all patient and public traffic will pass through the Queen Street doors.

“The stretchers take up a lot of room in the lobby, which is typically full of people waiting to be picked NOVEMBER 2015 | IN TOUCH | 6

up or picking up their loved ones,” said Sandra Couto, a team leader for Logistics who is responsible for the hospital’s Information Desks.

“And navigating through all of those people can be a real challenge for the attendants.”

However, congestion in this space will soon be eased with the construction of a new, non-emergency patient transfer ramp on Bond Street. When it’s completed in the winter of 2016, private ambulance companies who transport patients between hospitals and other health-care facilities will have a dedicated route into the hospital, providing faster access to and from appointments and better privacy for patients.

“Rerouting ambulance transfer patients is a key strategy to help reduce congestion at Queen Street during St. Michael’s 3.0 redevelopment,” said Michael Keen, senior director of Planning and Development. “The footprint of the lobby decreased slightly when construction hoarding was installed,

so with the increase in traffic coming through Queen, this will help patients, families and staff move through the space more efficiently and have more space to wait.”

The new entrance will also help to alleviate vehicle traffic in the Queen Street driveway by diverting ambulances to Bond Street, allowing for more room for Wheel-Trans, taxis and caregivers to drop off and pick up patients.

The last phase of the 3.0 project, slated for completion in late 2019, will see the demolition of Shuter Wing and the construction of a new building in its place. Below the expanded ED, the three-storey structure will include a transfer point for non-emergency ambulances into the hospital’s lower level, protecting patients from poor weather and connecting to dedicated patient transfer elevators. In the meantime, the Bond Street ramp will provide much-needed relief to the bustling Queen Street lobby.

Star gazing

By Geoff Koehler

Dr. Yeni Yucel has set his sights on discoveries to prevent eye diseases around the world, but his research is not limited to Earth.

The pathologist and scientist recently visited NASA’s Johnson Space Center in Houston.

Dr. Yucel, who is also the founding director of St. Michael’s Hospital’s Human Eye Biobank, spoke with NASA scientists who are working to understand why astronauts have poorer vision after returning from space.

The condition can cause near- or farsighted vision issues and is called vision impairment and intracranial pressure, or VIIP. “About half of male astronauts who have spent time in space experience poorer vision during and after returning from long space missions,” said. Dr. Yucel. “VIIP is seen in more males, but likely because there have been so many more male astronauts than female.”

It’s believed that weightlessness in space leads to pressure changes in the brain and spinal fluid and these pressures

Cmdr. Chris Hadfield aboard the International Space Station, describing the eye tests astronauts do in space. Watch the Canadian Space Agency’s video: http://bitly. com/eyesinspace

can cause the eyeball to change shape.

Distinct physical changes to the shape of the eye are common for those with VIIP, but not every astronaut with impaired vision showed signs of the eyeball having changed shape.

A number of studies have looked for causes of VIIP and NASA is continuing this research.

Onboard the International Space Station, astronauts undergo tests to monitor vision, eye health and a test to measure pressure in the eye—which increases in space. Still, little is understood about the role of microgravity on brain pressure.

Back on Earth, Dr. Yucel’s team at St. Michael’s is able to track, map and measure how the circulatory system drains fluids from the eye and brain.

NASA scıentısts and St. Michael’s researchers aim to develop collaboratıve projects to better understand and to prevent thıs condıtıon.

“The truth is out there,” said Dr. Yucel.

“We’re working with NASA to find it.”

Dr. Yeni Yucel is working with NASA to learn more about the vision problems that plague astronauts when they return from outer space.

(Photo by Yuri Markarov, Medical Media Centre)

NOVEMBER 2015 | IN TOUCH | 7

Q&A PATTI LOU CHEATLEY, APHERESIS NURSE

By Corinne Ton That (Photo by Yuri Markarov, Medical Media Centre)

Q. When did you start working at St. Michael’s Hospital and what has kept you here?

they’re so sick and most of the time, they don’t even remember their first week here. I really love seeing them getting healthier.

I started working here as a staff nurse 40 years ago. In those days, there was a nursing surplus and only the downtown hospitals were hiring, so I came down from the east end of the city to St. Michael’s and got my first job here. Honestly, I never even thought of leaving – I couldn’t have asked for more. I’ve worked under great head nurses and doctors. It’s not always greener on the other side of the fence.

Q. What are some challenges you face as an apheresis nurse?

Q. Tell us about your role Most patients I see have autoimmune diseases, meaning they have an antibody that’s attacking parts of their body, be it muscles, blood or nerves. The antibody lives in the plasma of the blood, so I use this machine that takes out the person’s plasma and replaces it with some other type of plasma, depending on the diagnosis. The whole process takes between one and three hours.

Apheresis comes under the category of rare diseases, so it’s very hard to diagnose and very hard to treat. Your autoimmune system is a nasty little guy when it wants to be. But our goal is to have patients come in, and nothing personal, but we never want to see them again. We want them to get cured.

Q. What is the most rewarding part of your job?

To see patients walk out. When they come in, they’re so sick, but we’re often able to get them healthier. Another rewarding part of the job is getting to know the patients and their family.

We’re always in the room with patients, monitoring their vital signs and the machine. So I get to know them very well and they get to know us well too.

Q. This year you received the Values in Action Compassion Award - what does that mean to you?

Q. Tell us something your colleagues might not know about you.

I didn’t think for a moment I’d be awarded this because I don’t do anything differently than I always have. But really, I do love my patients, and I feel for them because when they first come in

I live on a boat in Scarborough Bluffs for about nine months of the year. We do have a house, but the kids live there – we’re on the boat unless there’s a big snow storm.

INTOUCH

NOVEMBER 2015

In Touch is an employee newsletter published by Communications and Public Affairs.

Please send story ideas to In Touch editor Leslie Shepherd at shepherdl@smh.ca.