October 2018 OUR SHARED PURPOSE Finding the right number of tests New project provides doctors with an opportunity to reflect (pg. 8) Protecting our communities Naloxone now available in Emergency Department (pg. 2) HONOURING A LIFE NOT LIVED How a small gift is making a big difference to patients (pg. 4) Risky business An interactive session is helping teens come to grips with trauma (pg. 7) Butt out Quitting smoking may be the latest benefit of receiving rehab (pg.3)
HELPING PREVENT DEATH BY OVERDOSES BY SELMA AL-SAMARRAI These Naloxone nasal spray kits will be distributed to individuals using opioids who require care in our network s two emergency departments Naloxone, a drug that helps reverse an opioid overdose, is now available for free to individuals using opioids and seeking care in the emergency department at St. Joseph s. Naloxone will also be available soon at the St. Michael s emergency department. We send an explicit message to our patients and their friends, family and contacts when we hand them naloxone kits upon discharge - we re telling them this is a dangerous condition and one that can represent repetitive behaviour, says Dr. Glen Bandiera, who recently wrapped his term as chief of Emergency Department Services at St. Michael s. We will emphasize that there are treatments available, but also that until they access successful addictions treatment, we want to prevent death by overdose. Substance use treatment is multifaceted: it includes medication, pharmacological support, medical support, and psychosocial support. The process of dispensing naloxone keeps people alive so that we can connect them with the services available to The process of dispensing naloxone keeps people alive so we can connect them with services to support the journey to recovery LEIGHANNE MACKENZIE PROGRAM DIRECTOR support the journey of recovery, says Leighanne MacKenzie, program director of Inner City Health at St. Michael s. If naloxone is administered as soon as an individual shows signs of an opioid overdose it can temporarily reverse the opioid s effects. But emergency medical attention is still needed and it s essential that a call is also made to 911 immediately. take the first step. A large majority of opioid overdoses seen in emergency departments are from using street drugs. We know addiction issues are seen across all socioeconomic status groups, says Paula Podolski, administrative director for St. Joseph s Emergency Department. Many who struggle with addictions are either not aware of resources available, or may require multiple attempts to engage them in recovery before they are ready to Other resources currently offered at St. Joseph s and St. Michael s include treatment services such as Rapid Access Clinics, harm reduction services such as needle exchange programs, and specialized programs such as the Toronto Centre for Substance Use in Pregnancy. Our Shared Purpose is a monthly newsletter highlighting our people and the ways they are improving care, patient experience and the health of our communities. Learn more: www.oursharedpurpose.com 2 OUR SHARED PURPOSE
FIT TO QUIT Research at Providence helps patients with smoking cessation BY ANA GAJIC A smoking cessation trial at Providence was effective and worthy of implementing for all patients, say James Lam, director of Clinical Services, and Vivian Li, a pharmacist specialist. (Photo by Ramon Syyap) For a patient admitted to an in-patient unit at a rehabilitation hospital, that hospital becomes home for at least a couple of weeks, and sometimes months. A patient in this setting will often have the opportunity to focus on accomplishing key goals both rehab-related and otherwise. At Providence Healthcare, James Lam, director of Clinical Services, saw the opportunity to help patients tackle smoking cessation. He teamed up with the University of Ottawa Heart Institute s Ottawa Model for Smoking Cessation (OMSC) program to pilot a study at Providence and help patients who identified as smokers quit during their stay. The OMSC is the gold standard for smoking cessation in hospital settings, Lam says. We tailored the approach for our setting. It was most logical to have pharmacists lead the initiative as they take an active role in medication-related activities at Providence. Vivian Li, a pharmacist specialist who had been trained as a Certified Tobacco Educator, provided cessation intervention at the bedside for the one-year pilot study. She consulted with patients in-hospital and co-ordinated follow-up calls after discharge. This will give the OMSC more data to inform them of current trends. We are contributing to a collective dataset that will benefit patients JAMES LAM DIRECTOR OF CLINICAL SERVICES At three months after discharge, self-reported abstinence rates were significantly higher for those who had received the intervention than those who had not participated in the OMSC. Our original business case was to demonstrate that a pharmacist-led intervention in a rehab setting could work, and our research proved that it did, Lam says. Now, the intervention is available to all patients who enter Providence s doors and identify as smokers. Li continues to support and follow-up with patients, contributing information to the OMSC s larger database that will inform future studies and practices across Canada. We are one of the largest rehab hospitals in the province, which means we have a lot of data, Li says. This will give the OMSC more data to inform them of current trends. We are contributing to a collective dataset that will benefit patients in our hospital and beyond. OUR SHARED PURPOSE 3
GABRIEL S GIFT helping parents create memories after stillbirths and neonatal loss BY SELMA AL-SAMARRAI Pictured here are Crozier s two other sons: five-year-old Nathaniel, who was born before Gabriel, and two-year-old Joshua Gabriel, who was born almost exactly a year after. Jennifer Crozier was nine months pregnant when she experienced the unimaginable. She noticed a change in her unborn baby s movement, and was told at a subsequent appointment that his umbilical cord had wrapped around his neck and stopped his breathing. Crozier was admitted to St. Michael s knowing that her delivery of Gabriel would be a stillbirth. I didn t believe he was dead. I just kept hoping they were wrong, says Crozier of her initial reaction to the news. After the birth, you re just in a state of shock and you re not thinking very clearly. I had prepared very well for a living baby but I had no idea what to do with my baby now. When she left St. Michael s, Crozier found her grieving was compounded by the fact that she had very few mementos of Gabriel. My home felt so empty and I had nothing to touch. I felt that I needed to hold something of Gabriel s but I hadn t collected enough memories of him to be able to do so, Crozier After the birth, you re just in a state of shock... I had prepared very well for a living baby but I had no idea what to do with my baby now JENNIFER CROZIER GABRIEL S GIFT says. Through this painful experience, and through hearing similar experiences from other mothers coping with the aftermath of stillbirths or neonatal loss, Crozier came up with the idea of creating a box of items to help mourning parents gather memories of their babies in the short time they get to spend with them. She named the box Gabriel s Gift. I learned that an important part in many people s healing is memorializing their child in some way. I didn t get beautiful pictures or enough of Gabriel s hair. Gabriel s Gift was born out of that, as a place for people to touch and hold the memories of their child, says Crozier. Gabriel s Gift contains 15 items including a handwritten letter from Crozier explaining why she started this box, a book titled Wherever You Are: My Love Will Find You, a blanket, baby outfit, organic toiletries should the parents want to bathe their baby, and a clay set for handprints or footprints. Crozier started Gabriel s Gift at St. Michael s in January 2016, only five months after Gabriel was delivered. Dozens of families have since received the box. 4 OUR SHARED PURPOSE
WHAT S IN GABRIEL S GIFT? A hand written letter from Crozier A book titled: Wherever you are: My Love Will Find You Hand knit blanket by Jennifer s mother Joni Asboth Candle Book about parenting through loss named Loving Your Baby by Shari Morash Tiny baby bereavement outfit Towels and toiletries should the parents want to bathe their baby Keepsake hand-prints or foot-prints kit Photo album to remind families to take pictures Soft bunny plush toy Information guide High-quality paper and ink set for hand and foot prints Capsule for hair clippings Memory book Journal Amanda Hignell, a social worker at the maternity unit and neonatal intensive care unit at St. Michael s, has often witnessed the huge impact that Gabriel s Gift has on parents dealing with a stillbirth or neonatal loss. Everyone reacts so differently in their grief, but one common theme I see over and over again is this paralysis that comes after loss, of really not knowing what you need, and that s where I see that Gabriel s Gift has been such a gift for families, says Hignell. As awful as this moment is, the baby is part of the family forever even if they haven t lived beyond birth and so having an opportunity to create these memories to hold on to and to honour their child In memory is so important. The impact of Gabriel s Gift that I ve witnessed is monumental. It reminds families right off the bat that they re not alone. Crozier is now a mother to two sons, five-year-old Nathaniel, who was born before Gabriel, and two-year-old Joshua Gabriel, who was born almost exactly a year after. She creates and delivers a Gabriel s Gift box to St. Michael s whenever the supply is low. I think that the best that we can all hope for at the end of our lives is to leave behind a legacy of good and love in the world. That s what I m trying to do for Gabriel, Crozier says, give him a legacy of compassion and love for other people. OUR SHARED PURPOSE 5
WHO ARE YOU PROTECTING? QUALITY IN ACTION The flu is a serious illness it causes more than 12,000 hospitalizations and 3,500 deaths in Canada every year. While everyone is at risk, there can be additional complications for children under five years old, people over 65, pregnant women and people with underlying health conditions including asthma, heart disease or diabetes people we see as patients in our hospitals every day. You can help keep yourself, your loved ones, patients and colleagues safe this flu season by getting your flu shot vaccination remains the single most effective way to protect the people around you. The shot will be available at all three sites during flu season, including at mobile clinics keep an eye on your site s internal communications for more details. NEW PYXIS MEDSTATIONS SAVE TIME AND IMPROVE SAFETY New automatic drug dispensing cabinets called Pyxis MedStations are rolling out to positive reviews on hospital units at St. Michael s. In April, 7 Cardinal Carter South became the first of four units to get one. Eventually, they ll be found hospital-wide. The cabinets improve patient safety by limiting access only to drawers with medications prescribed for each patient. Nurses log in with their ID and then call up patient profiles to request drugs tied to active physician orders that have been validated by pharmacists. The cabinets also save time and improve efficiency by proactively tracking usage, supply and expiry dates enabling nurses to be at the bedside instead of performing inventory-related functions. Registered nurse Yvonne To accesses medications from the Pyxis MedStation on 7 CCN while RNs Kim Le and Kiley Hunt witness. (Photo by Yuri Markarov) SHARING MEDICAL IMAGING DATA TO SHARING CUT RADIATION MEDICAL DATA TO CUT RADIATION DOSES DOSES Patients might expect radiation doses for CT scans to be Patients might expect radiation doses for CT scans to be comparable comparable from one hospital to the next, but a team at from one hospital to the next, but a team at St. Michael s Hospital St. Michael s Hospital says the dose variance can be startling. says the dose variance can be startling. The team is collecting and The team is collecting and analyzing data from eight hospitals analyzing data from eight hospitals for the Medical Imaging Metadata for the Medical Imaging Metadata Repository of Ontario (MIMRO) Repository of Ontario (MIMRO) to help reduce the province s to help reduce the province s average radiation dose per scan. average radiation dose per scan. Using artificial intelligence to Using artificial intelligence to sort the hospitals data, the team sort the hospitals data, the team generated comparative data by generated comparative data by facility, scanner and exam to help facility, scanner and exam to help determine best practices. MIMRO determine best practices. MIMRO is funded primarily by is funded primarily by St. Michael s and was created by two of its St. Michael s and was created by two of its radiologists, radiologists, Drs. Timothy Dowdell and Bruce Gray. Drs. Timothy Dowdell and Bruce Gray. Radiologist Dr. Radiologist Bruce Gray Dr. and Bruce data Gray analyst and data Lianne analyst Concepcion Lianne review Concepcion data review data submitted submitted to to MIMRO. MIMRO. (Photo (Photo: by Katie Katie Cooper) Cooper) 6 OUR SHARED PURPOSE
SIMULATING CONSEQUENCES BY MARY DICKIE High school students participate in a hands-on trauma simulation scenario as part of St. Michael s Think First Injury Prevention Strategy for Youth. The TIPSY program, which uses the Allan Waters Family Simulation Centre labs and mannequins, starts up again Oct. 12. Helping teenagers lose their assumptions of invincibility, face the realities of traumatic injuries and learn to avoid risky behaviours are the aims of a popular educational program offered through the school year at St. Michael s. The ThinkFirst Injury Prevention Strategy for Youth (TIPSY) offers interactive sessions with critical care and emergency nurses, trauma victims, simulation teams, Toronto Police and Mothers Against Drunk Driving. A collaboration between St. Michael s Trauma and Neurosurgery Program and the Allan Waters Family Simulation Centre, TIPSY challenges high school students to think twice before taking risks and to face the realities of traumatic injuries and disabilities. St. Michael s treats about 1,000 trauma patients a year. Motor vehicle crashes and falls are the main causes of injury, while texting and driving has now surpassed alcohol as the leading cause of collisions. Elizabeth Butorac, interim program director of Trauma/ Neurosurgery, and her late colleague Julie Mauceri started TIPSY in 2006. In 2014, the team added activities at the Allan Waters Family Simulation Centre, where students participate in a hands-on trauma simulation scenario using a high-tech mannequin. They love it, because it s very interactive, says TIPSY coordinator Vasuki Paramalingam. We really want the students to understand that there are consequences to everything they do and every decision they make. VASUKI PARAMALINGAM TIPSY CO-ORDINATOR Young people aged 15 to 19 are at the highest risk of being killed by motor vehicle collisions, the leading cause of death for this age group. These crashes can also leave survivors needing permanent breathing or feeding tubes and with no control over their bladder or bowels. videos and first-person stories. TIPSY presents the consequences of risky behaviours to the students through Some of them feel light-headed, because it can be overwhelming, admits Butorac. But we really want the students to understand that there are consequences to everything they do and every decision they make. We give them tangible information so they can make better choices and not end up here. The TIPSY program starts up again this month. OUR SHARED PURPOSE 7
HERE S HOW MANY TESTS YOU ORDERED BY EMILY DAWSON Members of the BPiM team (L-R): Dr. Ajay Kapur; Sharon Mulsant; Mallory Jackman; Elizabeth Wooster; Dr. Donna Arab-O Brien; and Dr. Maria Pasic Not pictured: Craig Barnes; Dr. Raheem Kherani; Dr. Jerry Maniate; Dr. Rishie Seth; Dr. Jennifer Taher; Dr. Victor Tron An interprofessional research team at St. Joseph s recently launched the Best Practices in Medicine (BPiM) project, which marries a personalized audit and an online learning tool to help practitioners right-size their laboratory and diagnostic imaging test utilization rates. The impact of over-utilization on health-care costs and patient care has been a hot topic in the medical community, says Dr. Ajay Kapur, chief medical information officer at St. Joseph s. We saw an opportunity to help practitioners reflect on their own practices and offer education to support behavioural changes. A key differentiator of the St. Joseph s research is that it examines both overutilization and under-utilization and it occurs in a community hospital. While not as widely discussed, under-utilization of tests is also cause for concern. It can result in insufficient information being available for diagnosis and patients not receiving appropriate care, explains Elizabeth Wooster, research associate in St. Joseph s Department of Medical Education and Scholarship. The research team started with two commonly ordered tests: Thyroid Stimulating Hormone and Vitamin D. Using data collected through hospital records, the team stratified the data to present 66 practitioners with a personal scorecard comparing their own order rates within a specific period against the entire hospital, their department, and their division. The purpose is to ensure that the right test is ordered for the right patient at the right time. ELIZABETH WOOSTER RESEARCH ASSOCIATE After reviewing their results, practitioners can voluntarily take an e-learning course about best practices in test ordering. This is about guided self-reflection with a goal to improve patient care, says Wooster. The purpose is to ensure that the right test is ordered for the right patient, at the right time. Dr. Kapur says the feedback about the project has been excellent. The majority have said this is a useful tool. Even if people choose not to complete the e-learning, they re talking about it and informally learning from each other, he says, adding he s excited by the opportunities to leverage BPiM for other tests, and across health disciplines. The BPiM methodology can be applied to any aspect of patient care. Now we can focus on expanding it beyond the department of medicine. 8 OUR SHARED PURPOSE