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Volume 36 Issue 1 Winter/Hiver 2015/2016
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JOURNAL OF CANADIAN HEALTHCARE ENGINEERING SOCIETY
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CONTENTS
HEALTHCARE DEVELOPMENT
12 Breaking New Ground St. Michaels Hospital sets sights on
becoming Canadas premier critical care hospital
14 National Treasure McGill University Health Centre's
Glen site makes history
SAFETY & SECURITY
18 A Dangerous Time Tackling growing violence in
healthcare facilities
24 The Gold Standard CSA Z8002 sets out core
requirements for managing healthcare facilities
EMERGENCY PREPAREDNESS & RESPONSE
26 A Flood of Memories Alberta Health Services recounts
2013 natural disaster that took province by storm
28 Treading Water Steps to stay afloat when H20 supply
is disrupted
30 Prescription for Disaster Failure to have proper crisis plans
in
place can have cataclysmic results
PUBLISHER/DITEUR Kevin Brown [email protected]
EDITOR/RDACTRICE Clare Tattersall [email protected]
SENIOR DESIGNER/ Annette CarlucciCONCEPTEUR
[email protected] GRAPHIQUE SENIOR
NATIONAL SALES/ Stephanie PhilbinREPRSENTANTE
[email protected] CANADA
PRODUCTION MANAGER/ Rachel SelbieDIRECTEUR DE
[email protected]
PRODUCTION Karlee Roy COORDINATOR/ [email protected]
COORDINATEUR PRODUCTION
CIRCULATION MANAGER/ Maria SiassiniDIRECTEUR DE LA
[email protected]
CANADIAN HEALTHCARE FACILITIES IS PUBLISHED BY UNDER THE
PATRONAGE OF THE CANADIAN HEALTHCARE ENGINEERING SOCIETY.
SCISS JOURNAL TRIMESTRIEL PUBLIE PAR SOUS LE PATRONAGE DE LA
SOCIETE CANADIENNE D'INGENIERIE DES SERVICES DE SANTE.
CHES SCISSCanadian HealthcareEngineering Society
Socit canadienne d'ingnieriedes services de sant
PRESIDENT Mitch WeimerVICE-PRESIDENT Preston KosturaPAST
PRESIDENT Peter WhitemanTREASURER Craig. B DoerksenSECRETARY Sarah
ThornEXECUTIVE DIRECTOR Donna Dennison
CHAPTER CHAIRS Newfoundland & Labrador: Brian Kinden
Maritimes: Robert BarssOntario: Roger HollissManitoba: Craig B.
DoerksenSaskatchewan: Al F. KriegerAlberta: Tom HowardBritish
Columbia: Steve McEwan
FOUNDING MEMBERS H. Callan, G.S. Corbeil, J. Cyr, S.T.
Morawski
CHES 4 Cataraqui St., Suite 310, Kingston, Ont. K7K
1Z7Telephone: (613) 531-2661 Fax: (866) 303-0626E-mail:
[email protected] www.ches.org
Canada Post SalesProduct Agreement No. 40063056ISSN #
1486-2530
CANADIAN HEALTHCARE FACILITIESVolume 36 Issue 1
12
DEPARTMENTS
6 Editor's Note 8 President's Message
10 Chapter Reports
4 CANADIAN HEALTHCARE FACILITIES
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6 CANADIAN HEALTHCARE FACILITIES
2015 WAS A BUSY YEAR for hospital construction. Several high
profile projects were completed, many of which have graced the
pages of this publication. Of note is the new Humber River
Hospital, which reached substantial completion in May. Five months
later, on Oct. 18, North Americas first fully digital medical
facility opened its doors. Around that time, Five Hills Health
Region readied itself for the opening of a new regional hospital in
Moose Jaw, Sask. The $100-million project is the first to be built
using the integrated lean project delivery process in Canada. Most
recently, on Dec. 13, Halton Healthcare closed the doors on its
Oakville Trafalgar Memorial Hospital to move to its new Oakville
Hospital location marking the end of one of the largest healthcare
redevelopments in Ontario, and the beginning of a new era of
healthcare delivery in the region.
In this issue we look at two healthcare developments one newly
opened while the other just broke ground. National Treasure delves
into one of the largest construction projects and patient transfers
in Canadian history. Covering an area of 20 city blocks, McGill
University Health Centres newest addition, fondly called the Glen
site, is also considered one of the most innovative academic health
centres in North America. Also innovative is the St. Michaels
Hospital redevelopment project (pg. 12), which includes a new
patient care tower, renovated emergency department and significant
upgrades to improve the existing hospital space. Upon entire
completion in 2019, St. Michaels will achieve its goal of becoming
the premier critical care hospital in the country.
From here we turn to a growing problem in healthcare facilities:
acts of violence. A Dangerous Time explores this issue and how
staff can reduce the risk of such incidents occurring.
Continuing with the topic of workplace safety, we explore CSA
Z8002, Operations and Maintenance of Health Care Facilities (pg.
24). Published in 2014, the first edition of this standard details
the requirements for managing equipment and systems in all types of
healthcare facilities to ensure the safety of building
occupants.
Rounding out this issue, we look at the impact the great flood
of 2013 had on Alberta Health Services facilities in the Calgary
zone (pg. 26), water disruption best practices (pg. 28), and the
importance of emergency management and business continuity planning
(pg. 30).
Clare Tattersall [email protected]
EDITOR'S NOTE
Reproduction or adoption of articles appearing in Canadian
Healthcare Facilities is authorized subject to acknowledgement of
the source. Opinions expressed in articles are those of the authors
and are not necessarily those of the Canadian Healthcare
Engineering Society. For information or permission to quote,
reprint or translate articles contained in this publication, please
write or contact the editor.
Canadian Healthcare Facilities Magazine RateExtra Copies
(members only) $25 per issueCanadian Healthcare Facilities (non
members) $30 per issueCanadian Healthcare Facilities (non members)
$80 for 4 issues A subscription to Canadian Healthcare Facilities
is included in yearly CHES membership fees.
La reproduction ou ladaptation darticles parus dans le Journal
trimestriel de la Socit canadienne dingnierie des services de sant
est autorise la condition que la source soit indique. Les opinions
exprimes dans les articles sont celles des auteurs, qui ne sont pas
ncessairement celles de la Socit canadienne dingnierie des services
de sant. Pour information ou permission de citer, rimprimer ou
traduire des articles contenus dans la prsente publication,
veuillez vous adresser la rdactrice.
Prix dachat du Journal trimestrielExemplaires additionnels
(membres seulement) 25 $ par numroJournal trimestriel (non-membres)
30 $ par numroJournal trimestriel (non-membres) 80 $ pour quatre
numrosLabonnement au Journal trimestriel est inclus dans la
cotisation annuelle de la SCISS.
HEALTHY DEVELOPMENT
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2015 WAS MARKED by great achievements for CHES, which is a
testament to the leadership of now past president, Peter Whiteman,
and the National board. Highlights include: introduction of a new
CHES chapter in Saskatchewan; launch of the Canadian Certified
Healthcare Facility Manager (CCHFM) program; ongoing success of the
Canadian Healthcare Construction Course (CanHCC); appointment of
our first two official CHES representatives to CSA Group
subcommittees; and a number of outstanding chapter conferences. In
particular, the 2015 CHES National Conference in Edmonton was a
resounding success and has set the bar higher for future
conferences.
At present, the B.C. Chapter conference team is hard at work
planning the 2016 CHES National Conference in Vancouver. By all
accounts so far, it is shaping up to be another success. The team
is busy pouring over abstract submissions for the education
sessions and developing interview questions that will help in the
selection of the keynote speaker.
CHES continues to evolve at a great pace, driven by the strength
and enthusiasm of its members. Our membership base is so strong now
that we are seeing great competition for local chapter and National
executive positions.
Several members have worked tirelessly behind the scenes to help
drive our major accomplishments. Of note are Jeff Smith and Robert
Barss, chair and Maritime Chapter representative of CHESs
professional development committee, respectively. They deserve
recognition for their multi-year commitment to bringing the CCHFM
designation program to completion. As the CHES executive liaison to
the committee for the past two years, I know how much time and
effort they put into this endeavour.
Not to be outdone, Saskatchewans Al Krieger and Peter Whiteman
concluded almost five years of work to create a fruitful
partnership with the Health Facility Resource Council (HFRC) of
Saskatchewan. This concluded with a resounding vote by HFRC members
to join CHES as our newest chapter.
Considerable work continues to be done to further CHESs goals
and objectives with partner organizations. We are working with the
CSA Group to develop some of the best healthcare facility standards
in the world, as well as in an advocacy role. While members have
long been involved with the association, we recently took the next
step with CSA to provide official CHES representatives for some of
the standards. Ontario Chapter chair, Roger Holliss, and B.C.
Chapter chair, Steve McEwan, are our representatives on the
subcommittees for CSA Z7396.1, Medical Gas Pipeline Systems, and
CSA Z8002, Operation and Maintenance of Health Care Facilities,
respectively. Id also like to congratulate Gordon Burrill, who
served as CHES National president from 2003-2005, in his resounding
appointment as the chair of the CSA technical committee for
healthcare facility engineering and physical plant.
As you read this edition of Canadian Healthcare Facilities,
please remember the journal relies heavily on information and
articles from our membership. Please take some time to submit your
editorial pitches to the MediaEdge team.
Mitch WeimerPresident, CHES National
PRESIDENT'S MESSAGE
DRIVEN TO SUCCEED
8 CANADIAN HEALTHCARE FACILITIES
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CHAPTER REPORTS
ONTARIO CHAPTER
The Ontario Chapters vice-chair, Jim McArthur, and I had an
introductory meeting with the Firestop Contractors International
Association (FCIA) Oct. 29, 2015. The goal of the meeting was to
determine
if there is value in developing a partnership between the two
organizations. FCIA is looking to increase its presence in Canada,
specifically Ontario. Overall, the take away was positive. There
are plans to meet again in 2016, to share calendars so that each
association can potentially participate in the others
conferences.
The Ontario Chapter was approached to participate in PM Expo in
Toronto, Dec. 2-4, 2015. The chapters secretary, John Marshman, and
I accepted the offer to take part in a seminar The Building
Engineer of Tomorrow: How this Role is Evolving? that addressed the
unique aspects of healthcare construction and renovation in
Ontario.
The Ontario Chapter continues to support energy-saving
initiatives with another financial contribution to the Healthcare
Energy Leaders Ontario (HELO) program.
We are currently developing a CSA Z8002, Operation and
Maintenance of Health Care Facilities, training day for Ontario
Chapter members, to take place some time in early 2016.
The 2016 CHES Ontario Chapter Conference & Trade Show is
progressing well now that we have locked in a location Bingemans
Conference Centre in Kitchener, Ont. The organizing committee and
various subcommittees are making good headway, including
coordinating a unique Oktoberfest in spring element. The theme of
the upcoming conference: Leading through Change.
Roger Holliss, Ontario Chapter chair
10 CANADIAN HEALTHCARE FACILITIES
SASKATCHEWAN CHAPTER
It was a busy fall for the Saskatchewan Chapter. Our annual
general meeting, conference and trade show was held in Regina Oct.
25-27, 2015, at the Hilton DoubleTree. The event was well-received,
with more than 40 delegates and 34
vendors in attendance. We were fortunate to have four
significant sponsors this year: Stuart Olson, Hippo CMMS,
Saskatchewan Masonry Institute and Aqua Air Systems Ltd. We thank
them for their generosity. The trade show was also open to invited
guests of vendors as well as the local healthcare community, with a
free lunch for those who registered. This proved to be successful
as the trade show was very busy. The conference kicked off with a
tour of the new heliport at Regina General Hospital. The
educational sessions were diverse but primarily targeted
alternative project delivery methods. There are several different
methods currently in use in Saskatchewans healthcare system so this
was very relevant.
The Saskatchewan Chapters conference committee is already
planning the 2016 conference and trade show, which will be held
Oct. 23-25, in Saskatoon, at TCU Place. The focus will be rapidly
changing technology in healthcare.
The chapter will host the 2019 CHES National Conference. The
location and venue have not yet been determined but planning is
currently underway.
Alan F. Krieger, Saskatchewan Chapter chair
NEWFOUNDLAND & LABRADOR CHAPTER
The Newfoundland & Labrador Chapter has been operating with
a vacant vice-chair position for some time now. We called for
nominations on a number of occasions but were unsuccessful. It was
decided
at our last chapter executive meeting that current secretary,
Colin Marsh, will assume the role of vice-chair. As a result, we
now have a vacancy in the secretary position. We will call for
nominations for this position in the coming months.
Our 2016 Professional Development Day will be held May 29-30 in
St. Johns, Nfld. Planning for the event is ongoing so if there are
specific topics that youd like to see, please e-mail your
suggestions to [email protected].
It is with great excitement that I inform you the chapter will
host the 2018 CHES National Conference in St. Johns, Nfld. Over the
coming months, we will be looking for members to sit on a planning
committee for the conference. 2018 will be the second occasion that
we have hosted the CHES National Conference. The last time was in
2009.
Brian Kinden, Newfoundland & Labrador Chapter chair
MANITOBA CHAPTER
The Manitoba Chapter offered two educational opportunities in
2015, the most recent in conjunction with the Manitoba Building
Expo. On Oct. 6, the chapter presented an education session at the
industry event, which
is a partnership of the Building Owners and Managers Association
(BOMA) Manitoba, Winnipeg Construction Association and the
Mechanical Contractors Association of Manitoba. The Manitoba
Chapter also supported the event by covering the cost of member
attendance at the CHES-sponsored seminar, keynote luncheon with
retired Gen. Rick Hillier and trade show. Ian MacDonald of RJ
Bartlett Engineering Ltd. spoke to more than 30 chapter members and
a dozen other conference attendees about fire safety in buildings
under construction and during renovation. You can view the
presentation slides at www.ches.org/chapters/manitoba.html. I
provided an overview of the impact the March 2013 fire had at the
Health Sciences Centre (HSC) Winnipeg. As you probably recall, the
fire was deliberately set at the construction site of HSCs new
diagnostic imaging centre, located adjacent to Childrens
Hospital.
The 2016 Education Day is scheduled for April 28. The theme is
Energy Savings: Building Upon Past Success. A committee comprised
of the chapter executive, members and industry partners is in the
final stages of selecting topics and speakers.
The Manitoba Chapters annual general meeting will take place in
conjunction with the education day. There will likely be proposed
bylaw changes to reflect current management practices. These will
be shared via e-mail prior to the meeting to provide members the
opportunity to vote before or on April 28. We will elect new
officers to the executive at this time as well. Please keep your
eyes open for nomination information, which will also be sent via
e-mail.
Craig B. Doerksen, Manitoba Chapter chair
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CHAPTER REPORTS
WINTER/HIVER 2015/2016 11
ALBERTA CHAPTER
Id like to thank again everyone who supported the 2015 CHES
National Conference in Edmonton. We are looking forward to the next
national conference and know the B.C. Chapter will do us proud.
The Alberta Chapter executive is expected to meet in early 2016,
to plan for the year ahead. The executive team is considering
moving the chapters yearly conference to spring (from late
October). We will look at how this will impact the 2016 Clarence
White Conference & Trade Show. At this time, we dont have a
date for the event. We will update members once plans are
confirmed..
Alberta Health Services will have a new CEO in 2016. We will
introduce the new incumbent to CHES and all the benefits we can
continue to provide. With change comes opportunity, and it looks
like 2016 will be full of both.
Tom Howard, Alberta Chapter chair
BRITISH COLUMBIA CHAPTER
Planning for the 2016 CHES National Conference in Vancouver is
well underway. Most of the sponsorship opportunities are filled and
more than half the booths are already booked. We are very pleased
and excited to host
the upcoming national conference at the Vancouver Convention
Centre. I hope everyone is able to set a little time aside to visit
this world-class city.
The B.C. Chapter has renamed the Okanagan College education
bursary in honour of Graham Baker, for his long-time dedication and
support of education during his involvement with CHES. On Nov. 19,
2015, chapter secretary, Sarah Thorn, and Grahams wife, Coralynn,
attended the awards ceremony at Okanagan College in Kelowna, B.C.,
to honour the student by celebrating with donors, other award
recipients and the college foundation. The 2015 grant recipient the
first to be awarded the bursary under Grahams name is studying
power engineering.
Steve McEwan, British Columbia Chapter chair
BOTTOM LEFT: Celebrating National Healthcare Facilities &
Engineering Week in the Maritimes. Left to Right: Shawn Langley,
Daniel Moore,
Mike Eisnor, Randall Harnish and local chapter chair, Robert
Barss. BOTTOM RIGHT: Ian MacDonald of RJ Bartlett Engineering Ltd.
spoke
candidly during the CHES-sponsored seminar on fire safety during
construction and renovation at the 2015 Manitoba Building Expo.
s
MARITIME CHAPTER
The Maritime Chapter hosted a successful Education Day Nov. 17,
2015, in Truro, N.S. The event attracted more than 80 registrants
from across the healthcare sector. Registration was free, with the
chapter picking
up the cost thanks to the support of several vendors. Session
topics covered: testing for and prevention of legionella; infection
prevention and control best practices; preventive maintenance and
insurance; updates to fire codes; and energy management in
healthcare facilities.
The 2015 recipient of the $1,000 Per Paasche bursary was Kyle
Bouchie, son of Maritime Chapter member, Joe Bouchie. Joe is the
environmental director at R.K. MacDonald Nursing Home in
Antigonish, N.S.
The Maritime Chapter has been actively encouraging participation
of New Brunswicks Vitalit Health Network. The response has been
reassuring and we are hopeful it will lead to an increase in
membership and involvement.
The conference planning committee is working on the program for
the 2016 CHES Maritime Chapter Spring Conference & Trade Show
to be held May 15-17 in Moncton, N.B. It is also in the process of
developing a planning manual.
Following the conference, the chapter will host a Canadian
Healthcare Construction Course (CanHCC) May 18-19. Members are
encouraged to speak with their contractors regarding attendance at
this program.
The Maritime Chapter has been able to balance its books while
offering several financial incentives to its members. Assets are
approximately $46,000.
The chapter executive has approved the following motion: Should
a Maritime Chapter member hold the chair position of a National
committee at the time of a CHES National Conference, the chapter
will reimburse the member for expenses so that he/she can attend
the conference and lead the only annual committee face-to-face
meeting as well as participate in other conference meetings, as
required. This policy will be reviewed and approved annually by the
chapter executive.
Robert Barss, Maritime Chapter chair
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BREAKING NEW GROUND
Downtown Torontos St. Michaels Hospital, which sees 750,000
ambulatory and diagnostic visits and performs more than 30,000
surgeries annually, has begun an ambitious redevelopment project to
transform patient care. It includes a new 17-storey patient care
tower, renovated and expanded emergency department, new front
entrance with a spacious light-filled lobby, and renovated
ambulatory care areas. Senior-friendly design, infection prevention
and control measures, and patient safety are critical to the
plans.
BUILDING UP AND OUT
The Peter Gilgan Patient Care tower has been specifically
designed to care for critically
ill patients from those requiring emergency surgery to patients
being treated in the orthopedics unit. It will also have enlarged
in-patient facilities for oncology and respirology, and expanded
intensive care units (ICU) for coronary and medical-surgical
patients. The towers new operating rooms will be large enough to
include state-of-the-art medical imaging equipment, such as CT
scanners and angiography.
Renovations to existing hospital space will nearly double the
size of the emergency department and replace the 100-year-old
Shuter wing with a new three-story structure on the corner of Bond
and Shuter streets. Originally designed to accommodate 45,000
patient visits per year, the emergency department now sees more
than 75,000 a
St. Michaels Hospital sets sights on becoming Canadas premier
critical care hospital
HEALTHCARE DEVELOPMENT
12 CANADIAN HEALTHCARE FACILITIES
By Kate Manicom
-
BREAKING NEW GROUND
year a number that continues to grow with the downtown Toronto
population.
The emergency department will be renovated to meet the needs of
St. Michaels unique patient population which ranges from trauma
victims to people with mental illness and other vulnerable
residents of the inner city and to accommodate changes in
technology (the department was last renovated in 2000). It will
include larger and more private patient treatment areas, on-site
diagnostic imaging, including a CT scanner, and a larger rapid
assessment zone a special section for more efficient diagnosis and
treatment of lower acuity patients.
One of the most notable changes will be the addition of a
dedicated mental health area a quiet, soothing and secure section,
physically separated from the rest of the emergency department. It
will be staffed 24-7 by dedicated, specially trained crisis workers
and healthcare providers.
SENIOR-FRIENDLY AND SAFE
St. Michaels took the opportunity to integrate best practices in
infection prevention and control measures and senior-friendly
design into the redevelopment project to improve patient safety and
enhance the care experience.
All in-patient rooms in the new tower will be single-occupancy.
This not only reduces the transmission of healthcare-acquired
infections but also provides more privacy for patients. All rooms
will have dedicated comfortable space for families and caregivers,
which enables them to be more involved in care, leading to better
patient outcomes. The
rooms will also have greater access to natural light, which has
been shown to promote overall health and reduce the risk of
falls.
Hospital planners applied Code Plus Senior Friendly Design
standards to meet the unique needs of elderly patients and
visitors. These evidence-based guidelines take into consideration
how well a physical environment is equipped to address the
developmental needs of older adults and promote safety,
independence and functional well-being for aging patients and
visitors.
An important feature incorporated into the design is rubber
flooring, which is matte. Shiny floors can appear to some,
particularly those with dementia, as being wet, causing confusion.
Rubber flooring is also non-slip, which helps to prevent falls, and
reduces noise and echoes, creating a quieter and calmer
environment.
The atrium in the new patient care tower, which is intended to
be the heart of the hospital, will bring 10-storeys of natural
light into the building, improving visibility when entering and
exiting. Maintaining a gradual change in lighting is important in
helping reduce confusion, disorientation and problems with depth
perception.
The project will also include improvements in areas of the
hospital that see high levels of older patients, such as the
coronary ICU and the orthopedic in-patient unit. For example, while
the current orthopedic in-patient unit has narrow hallways that are
obstructed by equipment, its future home in the new tower will be
more spacious. Wider corridors, larger patient rooms and fully
accessible washrooms will help orthopedics patients
recovering from surgeries affecting their mobility to better
navigate the hospital.
FINDING THE WAY
In addition to the transformations in care that will be
generated by the redevelopment, the project also includes
improvements in the way patients, visitors and staff will navigate
the hospital.
These changes will be evident from the moment people arrive at
the newly created main entrance to the hospital. Walking through,
theyll find themselves in a light-filled, welcoming lobby with
information desk front and centre for those who need help finding
their way. Digital wayfinding tools will also be available to
bolster communication.
From here, a new pedestrian highway will run throughout the
first floor. This artery will connect the new lobby with the
historic Bond Street lobby, and improve wayfinding between the
hospitals wings.
Along with better navigation across St. Michaels will be
improved access to the hospitals upper levels with the installation
of 10 new elevators. With separate, designated elevator banks for
visitors and ambulatory patients, patient transfer and hospital
services, people travelling among the hospitals 17 storeys will be
able to reach their destinations quickly and easily.
Kate Manicom is a communications advisor at St.
Michaels Hospital, one of two adult trauma centres
in the Greater Toronto Area (GTA). St. Michaels is
also a teaching and research hospital fully affiliated
with the University of Toronto.
HEALTHCARE DEVELOPMENT
WINTER/HIVER 2015/2016 13
s TOP LEFT: View of the interior of the Element Financial Atrium
from the second floor. TOP RIGHT: Inside the hospital's new
light-filled lobby located at the corner of Queen and Victoria
streets.
-
NATIONAL TREASURE
What should the future of healthcare in Montreal look like?This
was the question that focused the
attention of McGill University Health Centres (MUHC) leadership
more than 20 years ago when they began planning a new health
centre. Accustomed to working in turn-of-the-century buildings
where medical practices had outgrown the spaces in which they were
performed, they visualized building a consolidated, modern,
healthcare facility. The goal was to provide quality acute services
across the age spectrum in order to meet the present and future
needs of health care. The outcome: One of the largest construction
projects and patient transfers in Canadian history.
This new hospital complex, fondly referred to as the Glen site,
was built on the former Glen railway yards in Montreals
Notre-Dame-de-Grce neighbourhood. It is now home to three legacy
hospitals Royal Victoria Hospital, Montreal Childrens Hospital and
Montreal Chest Institute as well as the new Cedars Cancer Centre
and the Research Institute of the MUHC. Before the moves, these
legacy hospitals had been providing, cumulatively, 350 years of
renowned experience at independent sites in Montreal.
TOURING THE GLEN
The site itself is tremendous, covering an area of 20 city
blocks. The facility is 2.5 million square feet and contains more
than 12,500 rooms. At its highest point, the building reaches 14
floors and is accessible via 58 elevators.
Each of the facilitys 500 single-patient rooms comes with a
private washroom, large windows, fold-out sofa for comfortable
family stays and ample space for healthcare teams to work.
The Glen site also houses $255 million worth of cutting-edge new
equipment that allows employees to carry out their tertiary and
quaternary care mandate.
Moreover, the building is LEED (Leadership in Energy and
Environmental Design) silver certified a reflection of MUHCs
commitment to serving as an example of responsible environmental
stewardship within the healthcare sector.
BUILDING A SUPERHOSPITAL
Designing a building of this size was a herculean endeavour.
Hospital planners
spent years meeting with experts to ensure the new space met the
latest standards in hospital care and scientific research. Among
these experts were 800 MUHC employees, who were consulted
throughout every step of the process in order to build an
environment that ref lected their departmental needs. Not only did
this allow staff to feel more at home in their new environment but
it also was an exercise in reflection and cooperation that brought
many interdisciplinary teams together.
The planning department also visited several academic health
centres around the world in search of inspiration. Seeing the ways
in which other modern hospitals conceptualized their environments
allowed the MUHC to explore different models and define best
practices along the way. It was also a chance to learn from the
mistakes made by other institutions and, as a result, sidestep
possible pitfalls.
Once consolidated, the plans were handed over to the McGill
Healthcare Infrastructure Group, a consortium led by SNC-Lavalin
who is the private partner responsible for the projects design,
construction, financing and maintenance for 30 years. Construction
began in June 2010,
Montreals MUHC hospital makes history
14 CANADIAN HEALTHCARE FACILITIES
HEALTHCARE DEVELOPMENT
By Elizabeth McPhedran
-
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took just over four years to complete and cost a total of $1.3
billion dollars.
PREPPING FOR OPENING DAY
With final construction complete in November 2014, and the first
patient move less than six months away, the task of activating the
site began.
The aim of any activation period is to ensure the new hospital
is fully functional before it begins clinical operations. In order
to carry out this task, staff identified as early activators were
selected to go to the Glen site and inspect their respective areas
to confirm everything was in working order. From light switches to
equipment, every last detail had to be tested and deemed ready
before patients arrived.
Another important part of hospital activation was training and
orienting the 8,500 staff. Daily general orientation sessions and
site tours were organized for 200 staff at a time over a span of
several months, in addition to numerous departmental and
equipment-specific training sessions.
Clinical simulations were vital to the activation process.
Simulations comprised of interdepartmental groups that mimicked
flow during critical situations from one area of the hospital to
another to determine best practices and optimal routes. For
example, they helped to identify the fastest route from
an in-patient room to the intensive care unit, and which
elevator should be used in an emergency by the code blue team.
Throughout the simulations, important protocols and
responsibilities were discussed, refined and validated to ensure
readiness before the move.
During the entire process, staff was guided by Health Care
Relocations (HCR), a Canadian company hired by the MUHC that
specializes exclusively in the transfer of healthcare facilities.
Two years of preparation with HCR went into this move, over which
time its team of employees assisted with activation services,
physical relocation of equipment, and patient transfer planning and
execution. In all, HCR called the Glen site the most complex
undertaking in its history.
THE BIG MOVE
Physically moving three fully functioning hospitals and their
patients from one location to another required 16 months of
meticulous planning and training. In the weeks leading up to each
hospital move, certain clinical activities progressively diminished
in order to reduce the number of patients to be relocated. This
also gave each department time to transfer equipment and set up in
the new facility. Though activity levels slowly
decreased, staff maintained the same medical care throughout the
move.
Each hospitals patients were transferred in a single day and the
process used for each hospital followed the same formula, with
patient safety being the number one priority. Starting at 5 a.m. on
a Sunday, the new hospital officially opened its doors while the
emergency department at the former hospital simultaneously closed.
Throughout the patient transfer process, both sites were fully
operational and able to provide care, with working operating rooms,
a birthing centre, laboratories, medical imaging capacities, a
pharmacy and admitting services open until the last patient had
left the building.
Beginning at 7 a.m., one patient was transferred every three
minutes using a fleet of ambulances and medical transfer vehicles.
The health of every patient was evaluated before departure, and
each was accompanied in the ambulance by a nurse and, if necessary,
a respiratory therapist or physician. From bed to bed, the trip
took on average 30 minutes to complete (depending on the hospital).
Police were positioned along the route to manage traffic flow and
ensure the safe passage of medical vehicles.
As many as 2,500 staff members were on hand at any given time to
help coordinate different aspects of the move. In total, there were
20 teams of hospital workers wearing colour-coded T-shirts to
identify their role and help manage logistics flow. During the
transfer, social workers were ready to liaise with families and
notify them of the arrival of their relative at the new site.
In total, the MUHC safely transferred 273 patients during five
separate move days with the help of 12,000 staff. These events
represent a historic undertaking, the final chapter to a successful
project and a great investment in the future of health care for the
people of Montreal and Quebec.
Elizabeth McPhedran is a communications officer at
the McGill University Health Centre.
16 CANADIAN HEALTHCARE FACILITIES
A convoy of ambulances and other reserved vehicles transported
more than 270 patients during five separate move days to the new
MUHC Glen site.
HEALTHCARE DEVELOPMENT
s
-
SAVE THE DATE!
The CHES 2016 National Conference will be held in Vancouver BC
at the Vancouver Convention Centre (VCC), September 11-13, 2016.
The VCC features a harbor front location and breathtaking views of
one of the most beautiful settings in the world. A block of rooms
has been reserved at the Pan Pacific Vancouver at the rate of $189
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located on the water with spectacular water & mountain views
and walking distance from cosmopolitan restaurants, world class
shopping and countless entertainment options.
The theme of the 2016 conference is RISKY BUSINESS: Is
Healthcare Sustainable?
The CHES 2016 Education Program is still under development but
will once again feature dual tracks with talks on relevant industry
topics from high-profile experts in the field. Join us for the CHES
Presidents Reception and Gala Banquet again in 2016! The banquet
will celebrate the accomplishments of our peers with the 2016
Awards presentations, while enjoying great food and entertainment
with friends.
We look forward to seeing you in Vancouver in 2016!
For more info visit our website at
www.ches.org
Follow us on Twitter!
@CHES_SCISS
-
A DANGEROUS TIME
There is mounting evidence that violence in the healthcare
sector is on the rise. According to recent research released by the
International Association for Healthcare Security and Safety
(IAHSS), the violent crime rate per 100 U.S. hospital beds
increased by 25 per cent from 2012 to 2013, while the rate of
disorderly conduct incidents rose 40 per cent during the same time
period. In Canada, approximately one-third of nurses report being
physically assaulted over the course of a year, according to a
Statistics Canada survey.
The World Health Organization reports that most violence is
perpetrated by patients and visitors. Healthcare workers most at
risk include nurses and other staff directly involved in patient
care, emergency room staff and paramedics. Between eight and 38 per
cent of healthcare workers will suffer physical violence at some
point in their careers.
Violence may occur anywhere in a hospital but it is most
frequent in the emergency department and on in-patient
mental health wards, where patient behaviour is less predictable
and, in the case of the emergency department, sometimes fuelled by
alcohol and/or drugs. Residential care facilities are especially at
risk for violence as a result of the increasingly high
resident-to-staff ratio and number of cognitively impaired
residents who are more likely to assault staff and other residents
than their cognitively intact counterparts.
DEEP IMPACT
To reduce the potential for violent incidents, healthcare
facilities should develop and implement a workplace violence
program. This type of program is required in most jurisdictions by
the regulatory agency that governs workers safety. Accreditation
Canada, the independent inspecting body that does peer reviews,
also requires processes be in place to mitigate the risk of
violence. The healthcare facility must have a policy that defines
its position on violence. Risk assessments must be conducted, and
violent incidents reported and tracked. Investigations related to
worker injuries or
near misses must be conducted with findings often resulting in
changes to some aspect of the workplace violence program.
Perhaps no aspect of the workplace violence program is more
important than staff training and education on preventing and
managing aggressive behaviour. Staff, including security personnel,
need to be trained for the level of risk associated with their work
area. This helps employees recognize warning signs of potential
aggressive behaviour and intervene early in an escalation of
behaviour, where possible, using both verbal and non-verbal
techniques. The training also focuses on personal safety, allowing
staff to avoid physical injury until support can arrive.
That support is often in the form of a code white team staff,
including security personnel where possible, that is specially
trained to manage and, if necessary, physically restrain the
aggressor until the behaviour is controlled. Ideally, this is a
multi-disciplined team, bringing diverse skills and experiences to
the situation. The code white team should train and practice
together, debrief after
Tackling growing violence in healthcare facilities
By Don MacAlister
SAFETY & SECURITY
18 CANADIAN HEALTHCARE FACILITIES
-
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each incident and annually refresh training. Including security
in team training is important, not only to help ensure a cohesive
response in a code white situation but also to embed a
patient-centric philosophy rather than a police-centric focus in
their response to aggression.
CAUSE FOR ALARM
Other risk mitigation measures can be built into an
organizational response to prevent and manage violent
behaviour.
Flagging patient electronic records or charts, or denoting the
patient name on the room entry log are methods commonly used to let
staff know a particular patient may have a propensity for violence,
allowing them to take appropriate precautions. In a large
healthcare organization, an electronic medical record that is
flagged through the admitting process at one hospital can be
leveraged across multiple institutions, mitigating risk if a
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The risk assessment may also drive the requirement for duress or
panic alarms, allowing staff working in higher risk areas to
immediately generate a call for assistance and response from
security and/or the code white team. Depending on the system, these
alarms may be carried by staff and/or fixed in accessible
locations. Critically, these devices must be regularly tested and
maintained.
LETHAL WEAPON
For security and facilities professionals, the hospitals
physical environment plays an important role in mitigating the risk
of violence. The IAHSSs Security Design Guidelines for Healthcare
Facilities provide guidance for the use of duress alarms, security
cameras and access control technology, as well as assist hospital
planners with the creation of zones of separation to mitigate
safety and security risk, including violence.
The emergency department guideline, for example, emphasizes the
separation between the front-of-house (public area) and
back-of-house (treatment area), and describes appropriate design
measures to ensure the safety of staff in each of those spaces. A
seclusion room is also recommended, reflecting the need to have
enough space outside a room to allow a code white team to safely
operate.
Given recent world events, there is increasing emphasis on
healthcare facilities being able to respond in the rare but
catastrophic event of an active shooter. The philosophy run, hide,
fight that is prevalent in most active shooter plans does not fit
well in a healthcare setting where many patients are
non-ambulatory. Instead, the focus is on developing a strong
restricted access plan, referred to in some organizations as
lockdown. Hospital leadership should have the capacity to secure
their facility from external access and, ideally, be able to secure
specific areas of the building, through a series of secured pods or
compartments. In many hospitals, much of this is already in place
with already securable paediatric and maternity units, intensive
care units, operating room suites and mental health units.
Don MacAlister is COO for Paladin Security,
the largest provider of healthcare security
services in Canada. Don is a certified
healthcare protection administrator (CHPA)
and has worked in both public and private
sector healthcare emergency management
and security for more than 25 years.
20 CANADIAN HEALTHCARE FACILITIES
SAFETY & SECURITY
-
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-
ducation is one of the three necessary pillars of health care,
along with research and clinical practice. Beginning in late 2014,
the Boards and leadership teams of Michener and UHN came to
see how the Ontario health system will benefit from having
health labour force planning informed by experts in education
design. This would create the capacity to rapidly adapt health
professional training to meet pressing challenges observed in the
clinical setting, and to seize new opportunities for innovative
health care education solutions identified through research.
Maureen Adamson, President and CEO of The Michener Institute,
answers the key questions about integration with UHN:
How did the integration conversation get started?The
conversation actually started in the late 1950s, led by our
founder, Dr. Diana Michener Schatz. She was ahead of her time in
recognizing that the way allied health practitioners
were being taught was out of step with how medicine was being
practiced and with the rapid advances in medical and computer
technology. Learning from her legacy, we saw the value in bringing
education back to the clinical site and creating real-time
education solutions that can be diffused expeditiously across
Ontario.
What did it take to get it done?As with any major organizational
change, getting buy-in requires demonstrating the benefits of
change to those who will contribute to a successful outcome. We had
little problem convincing anyone this model would strengthen the
role of education as a fundamental part of Ontarios health system,
while improving quality care and patient safety. All levels of
government have been supportive and enthusiastic, and our
respective Boards and executive teams have worked solidly together
to design a shared governance model that draws on the strengths of
both organizational structures toward our shared goal.
How does this integration benefit the health
system?Strengthening the role of education as a fundamental part
of
Ontarios health system has a number of concrete benefits. It
helps ensure quality care and patient safety by translating
learnings in the clinical environment very quickly into curriculum
for our full-time programs and our continuing education programs
for current health care professionals. Similarly, it provides a
structure for translating health care research and technological
advances into curriculum, which allows us to seize new
opportunities for innovative health care education solutions.
This integration also creates the capacity to put students in
the clinical setting far earlier, and with more clinical placement
opportunities across the system. Michener students will get better
access to state-of-the-art technologies and some of the brightest
minds in the applied health sciences professions. Students are
groomed to be health care system leaders.
Whats innovative about this health care project?This is an
agile, real-time method of education. Michener has been the Ontario
health systems go-to for nimble curriculum design for more than 50
years, and now were matching that strength to the real pace of
health care innovation and research, meeting health system needs in
real time, where and when they arise.
How do you see integration shaping the future of health care in
Canada?I see this as beyond health care, to be honest. In
consulting with our partners and stakeholders over the course of
the summer, we heard that this model of integrating education into
the practice setting could benefit all public sectors. Were taking
a systems approach, looking at what capabilities will be required
in the health care system of the future and applying our combined
expertise to be prepared.
For example, advances in personalized medicine and
vastly-increased access to genetic testing have changed the nature
of the diagnostic testing professions. Weve already redesigned
programs and curriculum to prepare that new hybrid health
professional for the workplace. Working within the countrys largest
hospital network and research hub, well translate the knowledge
from our combined expertise and experience into a health work force
that is continually ready for evolving health system needs.
As 2015 draws to a close, major changes are taking place in
Canadas largest hospital network. University Health Network and The
Michener Institute for Applied Health Sciences are about to
integrate, creating a Canadian first, Made in Ontario Mayo Clinic
model of education solutions for health care.
What is a school doing in a hospital?
E
Maureen Adamson, President and Chief Executive Officer at The
Michener Institute
ADVERTORIAL
-
24 CANADIAN HEALTHCARE FACILITIES
SAFETY & SECURITY
24 CANADIAN HEALTHCARE FACILITIES
THE GOLD STANDARD
No one wants to go to hospital but once there patients
rightfully expect safe and efficient care. Responsibility for this
extends beyond the hospitals healthcare practitioners to operations
and maintenance personnel who ensure the facility, its systems and
equipment perform their intended function. If the built environment
and its functions are not performing as they should, then the
safety of not just patients but hospital visitors and staff may be
seriously compromised.
In an effort to ensure maximum safety at Canadas hospitals, the
CSA Group developed a standard specifically geared to operations
and maintenance staff facility and maintenance directors, managers,
supervisors and maintenance personnel, healthcare facility design
engineers, contractors, infection prevention and control personnel,
facilities management companies, risk managers and quality systems
personnel. Aptly named Operation and Maintenance of Health Care
Facilities, CSA Z8002 sets out specific requirements for building
and architectural systems, mechanical and electrical systems,
building services, interfaces for clinical equipment, isolation and
operating rooms, and internal and external operations and
maintenance staff. It also establishes a framework for operations
and maintenance procedures in all types of healthcare facilities,
from hospitals to stand-alone clinics.
At the core of the standard is the coordinated operation and
maintenance
program, or COMP, which aims to identify healthcare facility
equipment and systems that require operation and maintenance and to
make sure each element is continuously supported and monitored.
The program was developed to ensure staff members are not only
trained but to make sure testing protocols are being carried out on
a regular basis, says Bill Carson, chair o f t h e s t a n d a r d
s t e c h n i c a l subcommittee. This confirms (staff is)
operating in accordance with design requirements and in a safe
manner within the healthcare facility.
CSA Z8002 joins two other standards CSA Z8000, Canadian Health
Care Facil i t ies: Planning, Design and Construct ion, and CSA
Z8001, Commissioning of Health Care Facilities to comprise a
comprehensive suite of solutions for the full life cycle of a
healthcare facility. It is available in two formats, hardcopy and
PDF, or facility management personnel can take a standard-based
course. Delivered on-site and custom-tailored to meet the facilitys
specific requirements, the training program helps personnel
understand the standard and apply it effectively in their
buildings.
I t s h a r d t o g e t f a c i l i t i e s maintenance staff
out of their building for any length of time because theyre in such
high demand, so the course was designed to bring training to them,
explains the chair of the CSA technical committee for
healthcare
facil i ty engineering and physical plant, Gordon Burrill, who
is also a course instructor. There are nine modules from which to
choose that take staff and expert technicians through the process
of developing an effective operations and maintenance plan for each
technical area.
T hese a rea s inc lude : HVAC maintenance; maintaining pressure
critical rooms, including isolation rooms; maintenance for medical
gas systems; plumbing maintenance; maintenance standard operating
procedures for infection prevention; general electrical systems
maintenance and arc flash protection strategies; flood response in
healthcare facil i t ies; testing and maintaining steam sterilizers
in healthcare settings; and generator maintenance.
Each training module is one hour in length. All nine modules can
take two days in total to complete.
In addition to this training program, the CSA Group is working
with the Canadian Healthcare Engineering Soc i e ty (CHES) to p rov
ide an education session on the standard at the societys 2016
National Conference in Vancouver. CHES sponsored a workshop on CSA
Z8002 in 2014, following that years National Conference in Saint
John, N.B., and presently provides the top 10 CSA healthcare
standards (which includes CSA Z8002) free to CHES members in
support of their quest to keep up code compliance.
Maintenance and operations personnel sometimes struggle to keep
current with the massive amount of code and ever-changing
regulatory requirements, says CHES National president, Mitch
Weimer. CSA Z8002 is a key standard to help guide them towards
overall regulatory awareness. After all, without the awareness of
your shortcomings, you cannot take action.
CSA Z8002 sets out core requirements for managing healthcare
facilities
By Clare Tattersall
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THE GOLD STANDARD
WINTER/HIVER 2015/2016 25
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A FLOOD OF MEMORIES
On June 19, 2013, heavy rainfall in Calgary and the mountains
west of the city caused unprecedented flooding from multiple
watersheds. The rain over the mountains melted heavy snowpack
virtually overnight. Rivers breached their banks and flooded many
communities. The extreme weather event led to the costliest natural
disaster in Canadian history and had a major impact on many of the
healthcare facilities in the area.
Ive been in health care for 28 years and Ive seen a lot of
natural disasters, but I had never seen anything like the flood of
2013, says Allan Roles, senior director of capital management for
Alberta Health Services (AHS), Calgary zone, who recalls how he and
his team had little time to react to the fast-moving floodwaters.
Southern Alberta had almost no warning.
AHS capital management team and site staff had to act quickly to
lessen the impact of the floods on healthcare facilities
throughout the region. While many facilities were at risk, the
two hit hardest were in High River and Canmore, Alta.
HIGH RIVER OVERRUN WITH WATER
As the name suggests, the community of High River had seen flood
conditions in years past but, in 2013, the flood impacted the
community and High River General Hospital like never before. By the
morning of June 20, after more than 300 millimetres of rain had
fallen in a 12-hour period, the
Alberta Health Services recounts 2013 natural disaster that took
province by storm
EMERGENCY PREPAREDNESS & RESPONSE
26 CANADIAN HEALTHCARE FACILITIES
By Jason Morton
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A FLOOD OF MEMORIES
floodwaters from the Highwood River approximately half a
kilometre away began pouring into the parking lot of the hospital
and were moving toward its front doors. At 9 a.m., AHS staff began
placing sandbags near the main entrance of the hospital.
What was amazing to see throughout the province was, as things
intensified, staff from all areas nurses to janitors dropped
everything, stayed calm and worked together, says Doug McKay,
director of rural and community for AHS, Calgary zone. There were
stories of (off-duty) senior physicians and administrators driving
into work to help lift sandbags.
By noon, water levels continued to rise. Electricity, Internet
and phone services in the town went down and the hospital had to
run on generator power. A few hours later, the generator itself was
at risk of being underwater as staff tried to protect it with
sandbags. By late afternoon, the supply of sandbags was exhausted
and teams had to use salt bags. At approximately 6 p.m., water
began to seep into the facility. While patients remained, all
non-essential staff was evacuated from the hospital on the back of
a manure truck. Thankfully, the generator was saved.
On June 21, the floodwaters had receded but the towns sewer
system was down, and the quality and safety of potable water could
not be guaranteed. A decision was made to evacuate the 150 patients
still being cared for at the hospital to other AHS facilities in
the area.
By June 22, most of High River was under mandatory evacuation.
Only essential services were allowed into the town and the Canadian
military was patrolling the streets. No contractors or AHS staff
could get to the hospital to assess damage.
RIDING OUT THE FLOOD IN CANMORE
Meanwhile, almost two hours away, the mountain town of Canmore
was dealing with floodwaters that carried in unique challenges.
By June 20, the full impact of the floodwaters that came from
the local mountains was beginning to be felt. At 6:30 a.m.,
portions of the Trans-Canada Highway between Canmore and Calgary
were washed out. There was no way to get
any help or supplies into the community from Calgary, an hour
away. The floods had also forced the closure of all roads to
Canmore General Hospital and water was threatening the
facility.
Canmore was on its own, says Craig Schultz, director of
facilities maintenance and engineering for AHS, Calgary zone.
Unlike High River, where we could get staff or supplies to come in
from other nearby facilities, there was no way in or out of
Canmore. They had to find solutions with what limited staff and
materials they had on hand.
At 11 a.m., the floodwaters pushed their way onto the hospitals
loading dock and staff entrance. Three hours later, water had
entered the hospitals basement.
ATCO, a utilities company, provided AHS with water pumps to move
water away from the front of the facility; however, there was
nowhere for the water to go.
That night, AHS staff and the local fire department worked to
try to contain the floodwaters by building a berm system using
elongated flexible tubes, called a tiger berm. At first, it
appeared the berm was going to work but, a couple of hours later,
all hope disappeared when water broke through.
Two teams of AHS facility and maintenance workers from Calgary
and Didsbury, Alta., were waiting at nearby airports to be taken by
military helicopter to Canmore to help with flood efforts. At 10
p.m., the military informed the teams they would not be able to
transport them as they were too busy airlifting residents out of
the High River area.
Not to be deterred, the teams were escorted to Canmore by the
RCMP, traversing rough roads en route that had been officially
closed. They arrived around 2 a.m. to provide much-needed help.
These teams were determined to get to Canmore to help their
co-workers, says Shultz. It was inspiring and I think really helped
to boost the morale of the local team who felt stuck and
isolated.
On June 21, the floodwaters continued to surge and there was
discussion of evacuating the 125 patients from the hospital. AHS
and the province made one final co-ordinated effort to contain the
water. They located concrete construction berms used by the
transportation department not
too far away. The concrete berms were carried to Canmore and set
up in front of the hospital. To the collective relief of everyone
working to protect the hospital, the berms held the water,
preventing further flooding at the facility.
AFTER THE WATER RECEDED
Throughout the Calgary zone, many healthcare facilities suffered
some flood damage but, for the most part, the damage was contained
because of the quick actions and hard work of AHS staff, the
provincial government, Canadian military, fire departments and
local RCMP.
At High River and Canmore General Hospitals, damage was limited
to flooring, millwork and drywall. The hospital in Canmore also had
damage to a CT chiller. In High River, there was a substantial loss
of contents to the detached workshops and major restoration was
required on support office buildings not far from the hospital.
A LESSON WELL LEARNED
The most important lesson learned from the 2013 flood is that no
amount of planning can prepare a hospitals emergency response team
for every eventuality during a disaster. However, ample advanced
planning will free up precious time during a crisis situation to
focus on the unexpected.
When preparing for disaster, Roles advises to regularly check
emergency supplies equipment. Its important to have an inventory
list and to make sure the hospital has everything it needs in case
of emergency at least once a year. If a facil ity doesnt have all
the necessary equipment or supplies, then it should have a process
in place to obtain those materials from other sites, facilities or
suppliers when needed. Its also critical to have a plan in place to
communicate if land, Internet and cellphone lines go down.
Should disaster strike, Roles says it is helpful to have
representation from the healthcare faci l i ty, Province and
municipality, along with other disaster management personnel, in an
emergency response room to address next steps.
Jason Morton is a senior communications advisor
with Alberta Health Services.
EMERGENCY PREPAREDNESS & RESPONSE
WINTER/HIVER 2015/2016 27
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28 CANADIAN HEALTHCARE FACILITIES
EMERGENCY PREPAREDNESS & RESPONSE
TREADING WATER
Access to water is often taken for granted. It is only when
crisis occurs that its importance is truly realized. For healthcare
facilities, loss of this precious resource can have a huge impact
on daily operations, patient care and safety. Here, Mike Hickey,
president of MF Hickey Consulting and former director of facilities
management and support services with the Northern Health Authority
in B.C., discusses steps healthcare facilities should take to
prepare for and respond to a total or partial interruption of
normal water supply.
What are the potential impacts of a water
disruption on a healthcare facility?
Several areas and operational functions can be affected by water
loss, including: boilers that provide building heat and steam; food
preparation; humidification; water-cooled refrigeration systems;
operating rooms; renal care units; laboratories; radiology;
water-sealed medical gas pumps; potable water; handwashing and
bathing/showering; laundry and housekeeping services; toilet
flushing; medical device reprocessing (MDR); and fire suppression
sprinkler systems.
What preventive steps should a healthcare
facility take to ensure it maintains services
during a water disruption?
CSA Z317.1, Special Requirements for Plumbing Installations in
Health Care Facilities, specifies that a reliable and adequate
alternative water supply should be provided so that service to the
healthcare facility is not significantly interrupted in the event
of failure of the primary potable water supply. Methods of
compliance can be a second water loop to the site, private
water source and/or proven contingency plan with the
municipality, including an alternate point of entry for a
connection outside the building. Most healthcare facilities have
two loops of water entering the building. If there is a water
disruption, the facility manager can close the primary loop water
source and open up the secondary supply to the building. A common
problem on a secondary water loop, however, is failure to regularly
exercise the isolation valve. If it is not regularly exercised, it
may fail when it is needed most.
Its also important to have a set of up-to-date drawings of all
domestic water zone valves in the building. All valves should be
numbered and have a corresponding location label. Their physical
location should be marked so they are easy to find, particularly if
they are positioned in ceiling space or a wall cavity. This can be
achieved by placing coloured stationery dots on the suspended
ceiling grid or wall. In an emergency situation, the last thing the
facility wants is to have maintenance or plumbing staff wasting
precious time trying to figure out where the valves are, and which
valves control what water supply.
Commonly, a healthcare facility should have a three-day supply
of safe potable water on-site for patients and staff. While the
World Health Organization recommends storing 10 litres of water per
day for each person, every facility needs to determine an
appropriate amount since factors such as climate will impact how
much will be consumed. The healthcare facility also needs to
consider its location for access to the next available
replenishment. Average shelf life of bottled water is one year
compared to five years for boxed water, making it a more economical
option. Regardless, stock should
be regularly rotated to ensure a fresh supply is always
maintained.
Communication is key in time of crisis so its imperative that a
healthcare facility has an emergency management and business
continuity plan in place. CSA Z1600 provides healthcare
organizations with a framework to manage risks and hazards more
proactively.
What steps should a healthcare facility take
in the event there is a water disruption?
As part of a risk management review, the healthcare facility
needs to identify critical functions and determine their minimum
water needs to keep them in operation.
In the event there is a water disruption, the healthcare
facility needs to consider water-saving measures and suspend
non-essential services. This could include cancelling clinics,
adjusting showering/hygiene schedules, stopping grounds irrigation
and/or reducing/shutting down services such as on-site laundry, if
feasible.
Healthcare facilities must also identify emergency water source
options. Many facilities have arrangements to obtain water from
their municipality during a water supply interruption. The
municipality should have plans to provide alternate water sources,
including arrangements for water trucks to keep the healthcare
facility supplied with potable water or techniques to tie into the
buildings water supply.
It is also critical to work with the infection control team to
ensure the water system provides a clean source of water to areas
that need it. There are many processes for sanitizing lines,
including hyper-chlorination, superheating, copper silver
ionization, use of chlorine dioxide gas and flushing of the
system.
Steps to stay afloat when H20 supply is disrupted
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BEFORE AFTER
TREADING WATER
CALL FOR NOMINATIONS FOR AWARDS
2016 Hans Burgers Award
For Outstanding Contribution to Healthcare Engineering
DEADLINE: April 30, 2016
To nominate:
Please use the nomination form posted on the CHES website and
refer to the Terms of Reference.
Purpose The award shall be presented to a resident of Canada as
a mark of recognition of outstanding achievement in the field of
healthcare engineering. Award sponsored by
2016 Wayne McLellan Award of Excellence
In Healthcare Facilities Management
DEADLINE: April 30, 2016
To nominate: Please use the nomination form posted on
the CHES website and refer to the Terms of Reference.
Purpose To recognize hospitals or long-term care
facilities that have demonstrated outstanding success in
completion of a major capital project, energy efficiency program,
environmental stewardship program, or team building exercise.
Award sponsored by
For Nomination Forms, Terms of Reference, criteria, and past
winners
www.ches.org / About CHES / Awards
Send nominations to; CHES National Office [email protected]
Fax: 613-531-0626
For nomination forms, Terms of Reference, criteria and past
winners: www.ches.org / About CHES / AwardsSend nominations to:
CHES National Office [email protected] Fax: 613-531-0626
CALL FOR NOMINATIONS FOR AWARDS2016 Hans Burgers Award
for Outstanding Contribution to Healthcare EngineeringDEADLINE:
April 30, 2016
To nominate:Please use the nomination form posted on the
CHES website and refer to the Terms of Reference.
PurposeThe award shall be presented to a resident of Canada as a
mark
of recognition of outstanding achievement in the field of
healthcare engineering.
Award sponsored by
2016 Wayne McLellan Award of Excellencein Healthcare Facilities
Management
DEADLINE: April 30, 2016
To nominate:Please use the nomination form posted on the
CHES website and refer to the Terms of Reference.
PurposeTo recognize hospitals or long-term care facilities that
have demonstrated outstanding success in completion of a major
capital project, energy efficiency program, environmental
stewardship program, or team building exercise.
Award sponsored by
CHES SCISSCanadian HealthcareEngineering Society
Socit canadienne d'ingnieriedes services de sant
WINTER/HIVER 2015/2016 29
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EMERGENCY PREPAREDNESS & RESPONSE
PRESCRIPTION FOR DISASTER
Emergency management is more than just quickly responding to a
crisis and engaging in disaster recovery. It also requires having
plans in place for prevention, mitigation, preparedness, response,
recovery and business continuity.
T he func t ions o f emergency management cannot exist without
those of business continuity. Communities and patients rely on
healthcare facilities to ensure continuance of operations in an
emergency situation. These facilities may be called upon to respond
not only to internal or external incidents that directly impact
operations, but also to disruptive events that occur in the
community and the resulting patient surge.
NATURAL PARTNERS
Emergency events can occur in many forms, such as natural
disasters, power outages, computer viruses and network disruptions.
A business continuity plan provides a roadmap to reduce the impact
of an emergency event. Though no plan is able to provide all the
answers or ensure every conceivable situation is addressed, having
systems and processes in place before a crisis situation occurs is
critical to keeping a healthcare facility running.
Continuity planning is the process of ensuring an organization
is able to survive an event that causes significant disruption to
normal business operations. A successful emergency management plan
contributes to a strong business continuity plan. After all, being
able to resume operations as quickly as possible means nothing if
healthcare
workers and patients cant safely weather the actual emergency
event.
The first step in creating an integrated emergency management
and business continuity plan is to establish the right framework.
It should address the tools necessary to implement and maintain the
plan, and the right processes and procedures. Involvement of senior
leadership is vital they are the decision-makers who set
priorities, and provide the required support for the processes and
procedures meant to keep everyone safe and life-saving functions
operational. When plans, priorities and support are in place, the
workforce is ready for training.
TEACHING MOMENT
Staff trained in emergency management and business continuity
planning is a healthcare facilitys greatest asset in the face of a
crisis situation. Workers who are adequately trained should have a
clear understanding of the concepts of risk management and why a
business impact analysis is so critical. The business impact
analysis is one of the foundations on which emergency and
continuity management programs are built. It identifies, quantifies
and qualifies the impacts of loss, interruption or disruption of
critical activities on an organization, and provides the data from
which appropriate continuity and recovery strategies can be
determined. A critical activity is any function or process that is
essential for the organization to deliver its products and
services.
A trained workforce is able to promote the safety of patients
and staff; reduce the
potential for costly damage; lessen environmental and other
impacts; assist emergency staff in initiating corrective actions;
reduce recovery time and associated costs, both financial and
human; and help ensure patient and public confidence in the
healthcare facilitys ability to successfully manage a crisis
situation.
SETTING THE STANDARD
Standards play an important role in helping an organization
implement an effective emergency management and business continuity
program. CSA Z1600, Emergency Management and Business Continuity
Programs, is a good example. It is harmonized with the U.S.
National Fire Protection Associations (NFPA) 1600: Standard on
Disaster/Emergency Management and Business Continuity Programs. CSA
Group developed and facilitated the writing of the standard to be
consistent with Canadas emergency management framework. It has
since created a Z1600 customized training program that is tailored
to healthcare facilities and delivered on-site.
Checklists are also critical for healthcare facilities to
successfully implement the necessary processes and programs to
manage various forms of disasters. The Ontario Hospital Association
(OHA) developed a toolkit in response to a need to have a
province-wide emergency preparedness and response framework that
helps hospitals address all types of emergencies.
Ron Meyers is a project manager for health and
safety standards at the CSA Group.
Failure to have proper crisis plans in place can have
cataclysmic results
By Ron Meyers
30 CANADIAN HEALTHCARE FACILITIES
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PRESCRIPTION FOR DISASTER
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Untitled-1 1 2015-12-23 8:29 AM