In Touch newsletter: October 2014

Printed on 100 per cent recycled paper OCTOBER 2014 | IN TOUCH | 1

These hands were made for washingBy James Wysotski

Sophia Wong sings “These hands were made for washing” at the 14 CC nursing station. Watch her performance online at http://bit.ly/SophiaWong. (Photo by Katie Cooper, Medical Media Centre)

With mike in hand, registered nurse Sophia Wong flips on the PA system. She’s live. Although small in stature, her voice booms. It helps that speakers amplify her across St. Michael’s largest unit, 14 Cardinal Carter.

“This is a reminder that clean hands are healing hands,” Wong said.

While her daily overhead announcements bring the floor to a halt, it’s her adaptation of Nancy Sinatra’s These Boots are Made for Walkin’ that’s the showstopper.

“These hands are made for washing,” Wong sang in an impromptu video circulating on the unit, “and that’s what we will do, because one of these days

these hands gonna do vital signs on you.”

For a unit looking to increase its hand hygiene compliance rates, the message couldn’t be more on point.

“Whatever you’re doing, you have to stop and listen because it’s just so engaging,” said Shirley Bell, the interim clinical leader manager of General Internal Medicine on 14 CC, as she pulled out a plastic hand-clapping device. It’s a rule that staff have to clap whenever they hear the announcements.

The engagement Wong’s song elicits has helped staff on 14 CC buy into what their interdisciplinary hand hygiene committee has instructed since forming in July 2013 when compliance rates for before patient

INTOUCHOCTOBER 2014

contact – Moment 1 of 4 – were a dismal 30 per cent; the hospital’s target is 65 per cent. Former St. Michael’s registered nurse Qasim Mohiuddin, the committee’s head at its inception, said the staff “is so busy in their tasks that sometimes they need friendly reminders to help them remember to wash their hands.”

Now headed by Wong, the committee identified barriers to success, such as too few hand sanitizers in less-than-optimal positions, and immediately began addressing the issues. Bold signs emblazoned with “Stop, wash your hands” went up in highly visible locations across the unit. Sanitizers were attached to every workstation. There was no escaping the reminders.

Continued on page 5

OCTOBER 2014 | IN TOUCH | 2

This fall we publicly launched Inspire 2018 to raise $200 million for a patient care tower, a new Emergency Department and other vital projects, including research and education. The campaign has been an incredible success to date, raising $168.5 million as of Sept. 15! I am excited to share our progress and the details of the support we’ve received.

St. Michael’s has always been fortunate to have generous partners. We received the largest single gift in our history – an extraordinary $30 million lead commitment from Peter Gilgan of Mattamy Homes. This gift is a real investment in the future of health care at St. Michael’s. Thanks to Gilgan’s generosity, the Peter Gilgan Patient Care Tower, featuring hybrid operating rooms, new intensive care spaces and four inpatient units, will

L. Alayne Metrick President, St. Michael’s Foundation

transform the quality of care provided across the hospital.

Thanks to Element Financial and its gift of $15 million, St. Michael’s will gain the Element Financial Atrium and the Element Financial Way. This new public atrium will connect with the pedestrian walkway, running the length of the hospital, making it easier for patients and their families to navigate our campus.

St. Michael’s was most honoured to receive a generous gift of $10 million from the Slaight Family to support the Slaight Family Emergency Department. An anonymous donor has given $10 million to create The Urban Angel Fund for Homeless People, to test new approaches to help homeless people.

Thanks to the $5 million gift from the Geoffrey H. Wood Foundation, patients will benefit from the Geoffrey H. Wood Foundation Respirology Unit in the new Peter Gilgan Patient Care Tower. Long-time friends, Barbara and the late Patrick Keenan, donated $4 million and created a chair in critical care and

OPEN MIKE with

respiratory medicine. This gift brought the Keenans’ cumulative total giving to an astounding $30 million.

With these facilities, St. Michael’s will become the premier critical care hospital in Canada, ensuring best outcomes for patients with life-threatening injuries.

These visionary donors are an inspiration to us all. We are well on our way to making the reimagination of St. Michael’s a reality, but we still need your help to raise the remaining $31.5 million and complete the campaign. Every contribution to Inspire 2018 will help us to offer excellence in patient care today and tomorrow.

To know more or to contribute to Inspire 2018, please visit our website at www.stmichaelsfoundation.com or drop by 1-025 Donnelly.

Follow St. Michael’s on Twitter: @StMikesHospital

• The Emergency Department saw a record patients on one day this summer, Aug. 5.

• The previous record was

• As well, over the Labour Day weekend, ED staff saw 16 traumas in a 24-hour period. 24 hours

Emergency department summer statistics

277260

x16

OCTOBER 2014 | IN TOUCH | 3St. Michael’s is an RNAO Best Practice Spotlight Organization

Unlocking a door, turning a handle and running a tap are three actions that many people take for granted, but for a patient receiving occupational therapy they can be challenging.

St. Michael’s Inner City Health Occupational Therapy team and Engineering partnered to develop a custom tool to improve recovery at the bedside. Known as a manipulation board, the tool allows patients to practice using everyday items such as door knobs, faucets and chain locks.

“For individuals such as stroke patients that have suffered a loss of motor skills, the board allows them to practice functional skills rather than just hand exercises,” said Leah Christie,

an occupational therapist involved in the project. “Before

we had the board, patients would use real doors and faucets on the unit, but that’s not always an option for our less mobile patients or for those in isolation.”

When occupational therapist assistants Kristin Broadhead and Tyrone Gordon started exploring options for purchasing a manipulation board, they were surprised by the cost. That’s when Engineering was engaged with the help of materials coordinator Jennifer Goss.

Darryn Cove, a carpenter in the Engineering Department, worked with Occupational Therapy to design a board based on a few options that were available on the market. The team was able to customize the board. For example, specific varnishes were used that are better from an infection control perspective.

With two highly customized boards that

The key to recovery

Edward Rowntree, a patient in General Internal Medicine, uses the manipulation board created by Engineering and the Occupational Therapy team. (Photo by Katie Cooper, Medical Media Centre)

By Patricia Favre

can be washed and shared, patients on 14CC will have greater access to diverse therapy and hopefully faster results.

“At a time when the hospital is emphasizing interprofessional care and breaking down silos, it’s great to be able to collaborate with a team we don’t usually work with,” said Jenna Egan, another occupational therapist involved in the project. “Engineering was a strong partner in this project, providing us with guidance and recommendations for the board.”

Cove was able to work with his colleagues to get everything he needed for the board. For example, the hospital’s locksmith provided the locks and the faucets came from plumbing.

“The Engineering Department affects patient care every day, but this was a unique opportunity to work with a clinical group,” said Cove. “For the first time, I got to see my work directly influence the patient experience.”

Did You Know? October is Occupational Therapy Month. St. Michael’s employs 24 occupational therapists and three occupational therapist assistants?

OCTOBER 2014 | IN TOUCH | 4

Good mouth care. Turning patients frequently in bed. Raising the head of the bed at least 30 degrees. Getting patients to sit up in bed when possible. These are all simple tactics that have gone a long way in helping St. Michael’s reduce pneumonia in the Trauma-Neurosurgery Intensive Care Unit from 17 per cent to 10 per cent.

“This is an impressive improvement over time when we compare our rates to other similar organizations in the American College of Surgeons Trauma Quality Improvement Program,” said Amanda McFarlan, a nurse, Trauma Program registry manager and quality assurance specialist.

The program is comprised of more than 200 trauma centres in the United States. St. Michael’s is the only Canadian site that compares itself

to other organizations with a similar patient population.

In 2011, when the TNICU’s pneumonia rate was 17 per cent, the Trauma Quality Improvement Program average was 4.9 per cent. McFarlan and a team committed to tackling the issue by coming up with a plan that included identifying target areas for improvement, holding nursing focus group discussions and reviewing the standard recommendations to prevent pneumonia.

“The pneumonia prevention tactics have certainly helped, but simply highlighting the issue with the front-line staff and engaging them has been key,” said McFarlan. “Once they learned that our pneumonia rates were high, they reinforced their standard practice –the

By Evelyne Jhung small things they could do to prevent pneumonia that are part of the standard bundle of recommendations for pneumonia prevention.”

While the hospital will never eradicate pneumonia in the TNICU due to its patient population, the goal is to keep the rate under 10 per cent.

McFarlan is helping Sunnybrook to join TQIP and is working with a number of Canadian groups, including the Trauma Association of Canada, Accreditation Canada and the Ontario Trauma Advisory Committee to expand quality improvement benchmarking in trauma programs across Canada.

Amanda McFarlan updates the pneumonia rates on the dashboard behind the nursing station in the Trauma-Neurosurgery Intensive Care Unit. (Photo by Yuri Markarov, Medical Media Centre)

Fighting pneumonia in the TNICU

GOAL SETTING target pneumonia rates were set at 10 per cent for 2013

OCTOBER 2014 | IN TOUCH | 5

Dr. Linda Taggart, physician lead for the Antimicrobial Stewardship Program, reviews patient cases with clinicians from the Trauma and Neurosurgery Intensive Care Unit, to assist with optimizing their antibiotic therapy. (Photo by Katie Cooper, Medical Media Centre)

Antimicrobial Stewardship Program helping to streamline antibiotic use in critically ill patients

Each weekday Dr. Linda Taggart, the ICU pharmacist, physicians and a microbiologist meet in the Trauma Neurosurgery and Medical Surgical Intensive Care Units to discuss each patient’s antibiotic treatment plan, to determine whether it should be adjusted. Suggestions could include a dose increase or decrease, a change to a different antibiotic, or removal of an antibiotic altogether.

Dr. Taggart, the physician lead for St. Michael’s Antimicrobial Stewardship Program, said studies have shown that up to 50 per cent of antibiotic use is inappropriate in some way. This may be because the prescribed antibiotic covers a wide variety of different bacteria instead of just the bacteria that needs to be treated, is given for a longer duration than needed or is not needed at all.

The program was created to optimize antibiotic use among patients in the Medical Surgical and Trauma Neurosurgery Intensive Care Units and help to reduce antibiotic resistance, which is becoming a growing issue across the globe. Another goal of the program is to help lower the hospital’s C. difficile infection rate, since antibiotic use is associated with increased rates of this type of infection.

“There is a time and place when

By Heather Brown

antibiotic use is necessary,” said Dr. Taggart. “But we must ensure the medication is being prescribed for the right reason, in the right dose, and for the right period of time.”

Antimicrobial stewardship programs are an important quality improvement and patient safety initiative. Infections caused by antibiotic-resistant bacteria create challenges in the ability to appropriately treat infections, which can put a patient’s health further at risk and

prolong their stay in the hospital.

The two intensive care units were chosen for this program first because many of their patients require multiple courses of antibiotics. These units were two of many academic ICUs across the province to begin this initiative with support from the Council of Academic Hospitals of Ontario. The Cardiovascular Intensive Care Unit will be the next area to be brought into the program later this year.

While these changes helped, audits showed it still wasn’t enough.

“It was hard to get buy-in initially because everybody was convinced they were washing their hands,” said Bell. “How could you work here and not wash your hands?”

It wasn’t until Mohiuddin trained as an auditor that change kicked into high gear.

“The key for [staff on 14 CC] was to trust

Hand hygiene story continued from page 1 the system, to show them that the auditing process does work,” said Mohiuddin, who spearheaded education sessions designed to address confusion and ambiguity surrounding what qualifies as Moment 1.

Now, reporting hand hygiene is incorporated into nurses’ transfer of accountability. Plus, everyone’s encouraged to approach colleagues and physicians with reminders to wash hands. The trick, said Bell, is to “ask a question as opposed to making a statement.” It’s friendlier and less

disciplinary. And it works.

By September 2014, Moment 1 compliance rates rose to 43 per cent. Moment 4 (after patient contact) rates saw similar gains, jumping from 46 to 65 per cent. While they still haven’t hit the Moment 1 target, nobody’s throwing in the towel.

As for Wong, she made an encore sung to The Guess Who tune These Eyes. With a quiver in her voice and arms outstretched to a sanitizer, Wong sang, “These hands are crying out for you.”

OCTOBER 2014 | IN TOUCH | 6

Photos from the old Volunteer Art Program are getting a new life in patient waiting rooms and clinics throughout St. Michael’s.

“There is evidence that artwork can be beneficial to patients by acting as a positive distraction to illness and improve the look and quality of health care facilities,” said Josh O’Neil, a planning coordinator at St. Michael’s.

Volunteer Services used to have an “art cart” that would take photos to inpatient rooms and allow patients to select one to be hung on the wall.

“The artwork was put on patient walls with doubled sided Velcro, but audits consistently showed art was going missing,” said Michael Kidd, director of Volunteer Services. “The losses were unsustainable and so the program

ended in late 2010, and was replaced by a book cart program.”

The 50 to 60 prints were then donated to the Planning Department to be hung around the hospital.

The artwork can be found on display in clinics and waiting rooms in the Robert McRae Heart Health Unit and Heart and Vascular Clinic on 7th Floor Donnelly, the CIBC Breast Centre on 3rd Floor Donnelly and the Martin Family Centre’s new Bond Wing clinics.

Planning made sure to use artwork based on evidence that certain types of

Donated artwork hung around the hospital helps with healing

Dr. Shannon Ajodha lines up a photo in the waiting area outside of her office. Evidence shows artwork in a hospital setting produces positive effects in patient healing. (Photo by Katie Cooper)

By Kaylea Forde

art, such as land and waterscapes and flowers, help with patient healing and pain management, said O’Neil.

According to the Center for Health Design, a nonprofit U.S.-based group that supports the health care and design industry to improve health care facilities, artwork increases pain threshold control and tolerance.

The Center for Health and Design also said art can reduce stress, making patients and staff feel better, act as a positive distraction to a condition or illness, improve perception of care at hospitals, act as a landmark for patients and visitors and make a hospital less intimidating.

Anyone interested in having this artwork from storage hung in a patient area of any unit can contact Josh O’Neil at [email protected].

“There is evidence that artwork can be beneficial to patients by acting as a positive distraction to illness and improve the look and quality of health care facilities,” said Josh O’Neil, a planning coordinator at St. Michael’s.

OCTOBER 2014 | IN TOUCH | 7

St. Michael’s patients who may be accustomed to a diet of meat and potatoes or lentils and rice are sometimes unfamiliar with the menu choices offered during their hospital stay.

David Johnston, who volunteers weekly on the orthopedic wards, noticed that patients often inquired about the same menu items such as tourtière or chana masala (spicy chickpeas).

He proposed creating a brochure for volunteers who help patients fill out their menu cards that would answer the most frequently asked questions.

“I was often asked about the French crumb cake (a cinnamon vanilla cake with a crumb topping), the frittata and the turkey wrap,” said Johnston. “I was happy to go to the kitchen and find out, but I was talking to Michael Kidd (director of Volunteer Services) and we decided a brochure for the volunteers would be the best idea.”

Johnston worked with Diana Huey, a graduate of Ryerson’s nutrition program and a fellow volunteer, to identify the most challenging items.

“Diana was the one I would always talk to in the kitchen,” said Johnston. “She was always there to answer my questions and she was the one who wrote the descriptions.”

Although St. Michael’s Patient Food Services accommodates a variety of diets and allergies, including kosher and vegetarian diets, some patients don’t always disclose their food sensitivities when they’re admitted. Others have distinct taste preferences. For Johnston, who’s volunteered at St. Michael’s since 2011, it comes down to helping patients feel as comfortable as they can during their hospital stay.

“Anything at all that I can do to improve how things work or help with a patient’s decision-making, that’s what’s important to me,” said Johnston. “And anything at all that helps the other volunteers to do their job.”

Volunteer-led initiative helps patients select their daily meals

David Johnston, a volunteer on St. Michael’s orthopedic wards, picks out an apple in St. Michael’s Patient Food Services area. (Photo by Yuri Markarov, Medical Media Centre)

By Kate Manicom

Sample breakfast menu

Test Patient

BREAKFAST LUNCH DINNER

Name: TEST1Room:463816 9/23/2014

Name:Test Patient Room:TEST1463816 9/23/2014

Name:Test Patient Room:TEST1463816 9/23/2014

Return completed menu with LUNCH TRAY.Return completed menu with LUNCH TRAY Return completed menu with LUNCH TRAY

(Please CIRCLE the numbers beside your

Cereal

Great Starts

The Bread Basket

meal choices.)

Breakfast Entrees

Beverages

Condiment

Tuesday

REGULAR

012 Orange Juice014 Apple Juice

016 Banana018 Applesauce

023 Cream of Wheat 025 Cheerios027 Corn Flakes

029 Ontario Florentine Frittata031 Peanut Butter

036 Cinnamon Scone038 Honey Bran Muffin

043 1% Milk045 Soy Milk

047 Coffee

049 Tea051 Chamomile Tea

056 Hot Water Only

058 Creamer062 Milkette064 Lemon Wedge069 Margarine 071 Brown Sugar

076 Natural Bran078 Ketchup

082 Raspberry Jam084 Grape Jelly

089 Salt091 Pepper093 Sugar packet

The Bread Basket

Delicious Desserts

meal choices.)

Main Course

Condiments

(Please CIRCLE the numbers beside your

Beverages

Fresh Salads

Great Starts

(Please select 1 entree)

Tuesday

REGULAR

095 Cranberry Cocktail

097 Wheat Bread 103 Soda Crackers

105 1% Milk

107 Soy Milk

109 Tea

120 Coffee124 Chamomile Tea

126 Hot Water Only

128 Creamer132 Milkette140 Lemon Wedge146 Margarine

148 Lasagna152 Cottage Cheese Fruit Plate

157 Spring Mix Salad159 Italian Dressing160 French Dressing

165 Berry Applesauce 172 Fresh Orange

174 Ketchup

179 Cream of Mushroom Soup

180 Salt185 Pepper192 Sugar packet

meal choices.)

Condiments

The Bread Basket

Main Course

Savory Sides

(please select 1 entree & 2 sides)

Great Starts

Beverages

(Please CIRCLE the numbers beside your

Delicious Desserts

allergy to mustardREGULAR

Tuesday

194 Cranberry Cocktail

196 Wheat Bread 198 Soda Crackers

201 1% Milk206 Soy Milk

208 Tea

213 Coffee215 Chamomile Tea

217 Hot Water Only

219 Creamer230 Milkette234 Lemon Wedge239 Margarine

241 Rosemary Pork Loin250 Butter Chicken

254 Chocolate Chip Cookie 261 Fresh Pear

263 Steamed Rice267 Baked Potato Wedges270 Fresh Ontario Butternut Squash275 California Blend Vegetables

281 Ketchup

283 Vegetarian Broth

287 Salt290 Pepper302 Sugar packet

(Please CIRCLE the numbers beside your meal choices)

Q & AAt St. Michael’s Hospital, a group of administrative professionals support the hospital every day through the work they do. Dijana Jovic has been an administrative assistant at St. Michael’s for three years. This is what she had to say about the role, its benefits and its challenges.

Q. Tell us about your role as an executive assistant. What exactly do you do?

My main role is to support Judy Shearer, director of the Inner City Health Program. I also provide administrative support to Jim O’Neill, who is leading the hospital’s community engagement strategy. On any given day I take care of everything from payroll and scheduling to co-ordinating large meetings and events.

Q. What do you believe is the most important quality for an administrative assistant at St. Michael’s to have?

St. Michael’s can often be a hectic environment so I think the sign of a strong administrative assistant is someone with excellent organizational and time management skills. It’s important to be able to multi-task, all the while protecting our directors and-or executives and their time.

Q. What is the best part of your job?I love that I get to be in constant contact with people – whether

DIJANA JOVIC, ADMINISTRATIVE ASSISTANT, INNER CITY HEALTH PROGRAM

it’s my colleagues, doctors or other administrative professionals. I enjoy getting to cross paths with so many people on any given day. Personally, I also enjoy the challenge of organizing large meetings throughout the hospital.

Q. What kind of challenges do you and other administrative assistants face?

I enjoy the challenge of organizing large meetings but I know it’s a challenge that many administrative professionals face. When you’re trying to organize a meeting for a group of executives, physicians, managers and nurse practitioners for example, everyone has a different schedule. It can be challenging finding the right time for everyone without stretching out the day for everyone as well. It’s important to strike a balance.

I know that my colleagues who do scheduling in the large clinical units also find that to be challenging – I think the new My Business system will be helpful with that in the future.

Q. If you could have any job in the world, outside the hospital, what would it be?

I grew up in the former Yugoslavia and attained an economics degree there. I’m also taking advantage of the hospital’s tuition assistance program and am working toward a business management certificate at Ryerson. So if I were to ever to consider another role, I would venture into the business world.

By Patricia Favre

(Photo by Katie Cooper, Medical Media Centre)

INTOUCH OCTOBER 2014

In Touch is an employee newsletter published by Communications and Public Affairs. Please send story ideas to In Touch editor Leslie Shepherd at [email protected].

Design by Dermot Covel, Medical Media Centre