“Patients should not have to register twice to have their procedure.”
HOW DO YOU MAKE THE
PATIENT EXPERIENCE BETTER
AT CAPITAL HEALTH?
Debbie Darrow, RN
Clinical leader, Cobequid Emergency Department
“I try to make the day-to-day operations go more
smoothly. I put out fires, fill in as a regular nurse for
triage, greet patients and assist with critical patient
events and resuscitations. When patients or their
families aren’t happy or they’re in crisis, I intervene
to help them.”
Dr. Mike Clory
Chief, Cobequid Emergency Department
“At Cobequid, we make the patient the priority.
It’s a challenge providing patient-centered care
in a Community ED without having specialist
consultation on-site. I try to keep the focus on the
patients’ care and co-ordinate their ongoing care
as needed.”
Communicable Disease Team,
Public Health Services (for assistance call 481-5800)
“We educate people about how diseases are
spread, relieve fears and provide information to
about how people can protect themselves and
prevent the spread of diseases. We are a unique
service; we get about 25 calls per day from health
care providers, nursing homes, day cares and
other individuals.”
Heather Gage, RN research co-ordinator
Cancer Care Clinical Trials Program
“I do primary nursing with the patients enrolled
in the drug trials. Using the study protocols,
I co-ordinate their tests and drugs and provide
them with ongoing support.These drug trials
are important because they give
patients other treatment options,
provide comfort and hope and make
the diagnosis a bit easier. ”
EDITOR'S DESK
Welcome to the second edition of
Capital Calling. You’ll notice that this
issue has a different format than the
previous one. The newsletter’s
editorial board has decided to use this
less formal template throughout the
year and save the magazine format for
the edition that will be published
during Quality Week in May.
This issue’s Q-TIP (Quality Tools in
Practice) features the communication
tool SBAR (Situation–Background
–Assessment–Recommendation), a
simple yet effective tool being used
by health care professionals around
the world to communicate a patient’s
condition (see the example on the
back of the tool). It has use in other
daily situations and is now being
used by our Executive Management
Team in its reports (any presentations
made to the EMT use this template).
We encourage you and your
colleagues to use the tool and to give
us feedback on how we can improve
it to meet Capital Health’s needs. In
the next edition, which will come out
in December, we will feature a team
that has used this tool and learn
about its success.
The editorial board welcomes your
suggestions about how we can
improve Capital Calling in order to
reach more of our staff and
physicians. We’ll look forward to
hearing from you!
Kathleen M. Martin
Editor and director, Quality and
Risk Management
WHAT'S ON TAP:
• Canadian Patient Safety Week October 20–27
(www.cpsi-icsp.ca/news_eng/safety_week_en.htm)
Editorial board: Susan Anderson, Marg Boak, Elaine Hamm,
Heather Hampson, Peter MacDougall, Kathleen Martin, Michele
Steele, Karen Willis Duerden. Contributors: Jamie Crosby, photographer; Jane Doucet, writer/editor; Monique Perreault, designer.
Please submit your comments and story ideas that will make us
think, laugh and even cry to: [email protected]
• IHI satellite broadcast of the 18th annual national
forum, Holiday Inn Harbourview, December 12–13
• Prepare your Quality Award submission now!
Updated 2007 Quality Award packages are located
at www.cdha.nshealth.ca/quality/index.html.
Deadline is January 12, 2007.
Capital
calling
-supporting quality and patient safety-
ISSUE 1 • FALL 2006
ANTIDOTE KIT WINS GOLD AT 2006 T
QUALITY AWARDS
IN THIS ISSUE
Cover
Antidote Kit Wins Gold
at 2006 Quality Awards
Page 2
Accreditation is a Time for
Teams to Strut Their Stuff
Page 3
Safer Healthcare Now!
Campaign
Page 3
Saving Lives: New Central
Line Infection Guidelines
Page 4
Streeters
his year’s gold Quality
Award winners are the
staff members who created
the Antidote Kit, hailing from
Capital Health Emergency
Medicine, Capital Health and
IWK Pharmacy Departments and the IWK Regional Poison Centre. So what was their
outstanding project about?
Well, if you live in the Capital Health district and you get bitten by a black widow spider, you
don’t have to panic—just get to the nearest hospital Emergency Department (ED), where
a member of the ED team will retrieve and administer the antidote. Since black widow
spiders aren’t native to Nova Scotia, that’s an unlikely example of a potential poisoning that
ED staff might have to treat. However, because Halifax is a port city, where products from
all over the world are unloaded at its docks, there is a small chance the venomous spider
could appear.“Emergency Departments are about preparedness,” says Dr. Mark Fletcher,
an ED physician at Cobequid Community Health Centre in Lower Sackville.
When it came to giving antidotes to patients who had overdosed or been poisoned, the EDs
didn’t always work as efficiently as they do now. In fact, in 2001 Mark read an article in the
Canadian Medical Association Journal stating that only one in 179 Ontario hospitals surveyed
stocked all 10 antidotes that were considered necessary for treating patient poisonings.
“At the time I was chief of Emergency at Cobequid,” says Mark,“and I wondered if Capital
Health facilities were any better off, so I sent a survey to all of the sites asking what
antidotes they carried. Sure enough, we weren’t in any better shape. The question was,
what are we going to do about it?”
That’s where Laurel Ross, then a senior pharmacy technician, and staff pharmacist
Theresa Hurley (at left) came in. Laurel helped create the kit, and Theresa, with the
assistance of IWK pharmacists and the IWK Regional Poison Centre consultant, produced
the accompanying 113-page manual containing antidote and dosing information for
adult and pediatric patients.“It was a team effort involving many people,” says Theresa.
“None of us could have accomplished this project by ourselves.”
Between March and November of 2005, the kits and manuals were distributed to
Capital Health’s seven EDs and the IWK’s ED. The three-tier kit in its sealed container
has 17 antidotes, and it’s recommended that seven more are stocked in each ED.
The approximate cost of each kit is $10,000 (Capital Health executive
administration paid for the initial kits, and the EDs pay to replenish them).
“We’ve had 11 patients, including eight different types of overdoses, in three
different sites benefit as a direct result of having the kits in place,” says Theresa.
“All of those patients survived, which makes us very proud of the work we did.
The kits make everything so much easier for the health care providers. As
pharmacists we’ve all been in situations where a nurse has called in a panic
needing an antidote right away, then we get in a panic looking for it. That
doesn’t happen anymore. Now staff is saying, this is a dream! Everything is
in one place and so organized. It’s better ‘one-stop
shopping’ than we ever had before.”
Read what patients had to say in a recent survey:
“Stop talking and laughing loudly during the night at the nurses’ station. Patients can’t sleep.”
very three years, as part of an international
accreditation process, health organizations around
the world take part in a self-assessment followed by
a survey visit. The survey includes a review of
documentation, team interviews, facility tours and
focus-group meetings with various stakeholders,
including physicians, nurses and patients.
E
The purpose of the process is to assess and improve
standards of care in order to enhance patient outcomes
as well as communication and working relationships
among health care professionals. Here at home accreditation allows the Canadian Council on Health Services
Accreditation (CCHSA) and Capital Health staff members
to evaluate the quality of the organization’s services by
comparing them to nationally accepted standards.
[
world in such exotic locales as
Saudi Arabia, Ireland and Australia.
He is a member of CCHSA’s board
of directors and recently completed
a two-year term as board chair.
“It’s hard for busy people to be involved in
accreditation,” says Murray.“When I meet a new team,
the first thing I always say is,‘Relax and pace yourself.’
We’re trying to minimize the amount of extra work as
much as possible. And it’s important for the staff
members who are taking part to realize that it’s not
meant to be an overwhelming make-work project that
wraps up after the survey is done, but rather an ongoing
continuous-improvement process that doesn’t stop. The
teams must recognize the value of the process and that
it will help them maintain their standards of care.”
In the decade that Murray has been a surveyor, he has
witnessed many changes in the nature of the evaluation
standards. For example, current standards are more
client-focused than they used to be, and in
the last year a bigger emphasis has been
placed on patient safety.
]
“When you're doing a good job at something and you have an independent
surveyor come in and give your work
two thumbs up, that's a great reward”
“Accreditation is a chance for us to strut our stuff and
to shine,” says Kathleen Martin, the director of Capital
Health’s Quality and Risk Management Department,
which co-ordinates the process.“When you’re doing a
good job at something and you have an independent
surveyor come in and give your work two thumbs up,
that’s a great reward.”
Kathleen says that staff members and physicians use the
data from their self-assessments to drive system improvements—and they do it by working as a team.“There’s a
real sense of pride in their accomplishments,” she says,
“and the teams that really hum become ‘best in show.’ ”
Of course you can’t become “best in show” without hard
work—and the self-assessment is a lot of work,“both for
the teams and the surveyors, but the rewards are
tremendous,” says Dr. Murray Nixon, who is a member of
the interdisciplinary team at Capital Health’s Geriatric Day
Hospital, which is located in Veterans’ Memorial Building.
Murray is one of more than 300 CCHSA-designated
accreditation surveyors in Canada and has been
conducting surveys for the past 10 years in every
province except Nova Scotia (surveyors can't conduct
reviews in their home province), as well as around the
SAFER HEALTHCARE NOW! CAMPAIGN
Capital Health staff members continually work hard to improve their practices to enhance patient care.
Capital Calling spoke to the following three employees to find out what they’ve been doing in this area that stems
from their participation in the Safer Healthcare Now! campaign:
• Allison Callaghan, clinical pharmacy manager, Cardiology and Neurology: “I’m a committee member for the
medication reconciliation process, which aims to eliminate in-patient adverse drug events. Safer Healthcare Now!
allows us to talk about the mistakes that sometimes happen so we can work together to reduce them happening
again. It’s uniting nurses, pharmacists and physicians in a common goal.”
• Fatima Renshaw, nurse, ICU/CCU, Dartmouth General Hospital: “At DGH we have decreased the number
of Code Blue calls as well as the need to transfer patients into the ICU, which decreased by 40 per cent in six months.
This means faster recovery and a decrease in the length of stay. The patient is assessed, diagnosed and stabilized
quickly. Families are very pleased that their loved ones are being promptly dealt with.”
• Amy Howard, interim clinical nurse specialist, QEII: “I was interested in what new initiatives were being
undertaken to improve patient care and amazed at how simple cost-effective initiatives, such as nasal versus oral
feeding tubes, could have such a profound effect on the outcomes of our patients. I was eager to implement these
initiatives and to share the knowledge I had acquired with my colleagues.”
SAVING LIVES: NEW CENTRAL
LINE INFECTION GUIDELINES
Murray lights up when he talks about his
work as a surveyor.“It’s constant learning,
and you get to see how things are done
well in other places, plus you get to meet
untold numbers of interesting people,” he
says.“It has been one of the most satisfying
experiences in
my professional career.”
A
This is the first in a
series of articles about
accreditation. The
next Capital Health
accreditation survey
will take place in
November of 2007;
Yvonne Martin will be
accreditation
co-ordinator (contact her
at yvonne.martin@cdha.
nshealth.ca or 473-5919).
For more information
about accreditation, visit
www.cdha.nshealth.ca/
quality/accreditation.html.
“The central line guidelines started with the Safer
Healthcare Now! campaign, which was based on the
100,000 Lives Campaign in the U.S.,” says Donna Gamble,
3A ICU’s health services manager. Donna and Dr. Kate
Shields, an anaesthesiologist and intensivist at the QEII,
led the implementation of new guidelines that would cut
down on the number of “line sepsis,” or the infections that
were occurring in the IV lines being inserted into patients’
necks or shoulders.“Before we put the initiative in place in
April, we had gone 190 days with no line sepsis,”says Donna.
“In May we had two, and since then we’ve had none. Our
track record was pretty good to begin with, and now it
has the potential to be even better.”
cross Capital Health, many initiatives to improve
patient safety are being practiced by staff
members. The big push for enhancements in this area
comes from the Canadian Safer Healthcare Now!
campaign. That’s what kicked off the good work being
done in the ICU at the VG site, in particular in 3A’s
Medical Surgical Intensive Care unit.
The four steps to ultimately eliminating the number
of line sepsis are: (1) maintaining proper hand hygiene;
(2) using maximum barrier protection, which means
covering the patient from head to toe with a sterile
drape when the line goes in and the health
professional wearing full protection, such as a
cap and gown; (3) using standard skincleaning antiseptic; and (4) selecting the
most appropriate catheter site, such as
the vein by a patient’s collarbone.
Each day staff must ask themselves
whether it is really necessary to continue
to use the line or if they should remove
it. Plus they must use a dedicated line for intravenous
nutrition, access the line aseptically and regularly check
the site for inflammation.
“The only way this works is having the commitment
on the part of the nurses and physicians,” says Donna.
“They’re an extremely talented group, and they’ll do
whatever it takes to improve patient safety, even if it
means more paperwork and effort on everyone’s part.
No one has resisted the new processes.”
Kate, who is the medical liaison initiating the guidelines,
works with the nursing staff, Infectious Diseases and
Infection Control, plus database personnel to track the
results.“It has been great to have the co-operation of
everyone involved,”
she says.“We’re
saving
lives.”
Donna Gamble (left) and Dr. Kate Shields
ACCREDITATION IS A TIME FOR
TEAMS TO STRUT THEIR STUFF
“Be courteous. Patients need someone to listen and be patient with them.”