General Express October 2016


Hospital Snap shots  
Safety Fair expands its focus and attracts record numbers
"Defence" was the word of the day for preventing bed sores. Oscar Reimer, Clinical Educator/RN, Professional Practice, and Karen Rolland, Clinical Educator Medicine, wore team jerseys as a part of the display's sporting theme. Over 200 staff, students and volunteers attended the event. There were many safety initiatives on display included ones designed to support a safe working environment for staff. Jen Pranger, Project & Risk Coordinator, stands beside the Medication Reconciliation display. "Med Rec" is one of the major patient safety initiatives this year.
Also spotted around the Hospital....
Long-time GGH nurse (almost 30 years!), Rose Rainville (front middle) dropped by a recent meeting of Resource Nurses. Rose has moved on, and up, to North Wellington Health Care as a Clinical Educator. As the last of the original Resource group, Rose paid a visit for an unofficial passing of the torch to its many new members.
September was Healthy Workplace Month. To help mark the occasion, Marianne Walker, President and CEO (third from left) and Gail Johnson, VP Patient Services and Chief Nursing Executive (second from right) went unit to unit handing out healthy snacks.
Representatives from Stone Road Mall recently dropped by with a cheque for $9,500 and lots of stuffed bears for our paediatric patients.
On hand to accept the donation were Linda Craig from our Foundation (left) and Shannon Maier, Director Family Birthing Unit (second from right).

Hospital-wide staff training initiative has begun
CIT training
Crisis Intervention Training includes practical, hands-on, self-defense training.

"We have an ambitious goal of being one of the safest hospitals in Ontario." So begins an email from Marianne Walker, President and CEO, to all staff last month. "Knowing that the most common cause of reported harm to our staff is the result of “patient actions”, we have started a significant staff training initiative. It provides useful tools and strategies for those experiencing potentially unsafe interactions. Research has shown that a high proportion of this behaviour is predictable and therefore preventable with proper training and awareness."

The Hospital will be funding two mandatory training sessions for large groups of staff for dealing with potentially harmful and aggressive behaviours - Gentle Persuasive Approach (GPA) and Crisis Intervention Training (CIT).
GPA training focuses on behavioral strategies for those with Dementia/Delirium and who may be exhibiting what is called responsive behaviours. GPA is evidence-based, interactive and practical. Staff who have attended these sessions have told us that the program has helped them to prevent and de-escalate behaviours.  
CIT focuses on behaviour management and de-escalation skills for dealing with potentially aggressive persons in a way that minimizes the risk of injury to self and patient. This is paired with practical hands-on physical training to assist staff who may find themselves in a situation where someone’s behaviour has escalated and he/she is striking out. 
This is a big undertaking. Some training takes as little as half a day. Some take as much as two full days. The Hospital is committed to investing sufficient resources to have all training completed within three years.

Living our Strategic Directions - Providing focus to everything we do at the Hospital

Every issue there'll be an article about one of the initiatives either underway or completed that are supporting our four new Strategic Directions. This issue, the Direction being highlighted is, Create a coordinated, high quality system of care with our partners.

Within the Waterloo Wellington Local Health Integration Network (WWLHIN) and across the Province, improving outcomes for Chronic Obstructive Pulmonary Disease (COPD) patients through program integrations has been identified as a priority. Readmission rates for patients with COPD at Guelph General Hospital are some of the highest in the area. A collaborative approach was established to identify gaps in the care provided to our patients.

One Hospital initiative to improve coordinated care for patients with COPD is a dedicated unit on 4E/4W medicine. Grouping similar patients on a single unit allows staff to become experts in providing standard care to patients with a diagnosis of COPD. Education is standardized, oxygen is weaned quicker and early ambulation is encouraged. Standard discharge follow-up and communication with the primary care provider improves outcomes and experiences for COPD patients. They are placed on an electronic care plan which standardizes best practice. 

Before leaving the hospital, patients will have in hand a scheduled, follow-up appointment with their primary care physician within one week. Transfer of accountability is faxed to the primary care physician for tests. Also, procedures and immunizations are completed.

After leaving the hospital, patients are supported by the Community Care Access Rapid Response Nurse (CCAC-RRN). Transfer of Accountability from the CCAC-RRN is also provided to the primary care physician. Coming in the new year will be new pre-printed orders. 

First and foremost, these initiatives have improved the quality of care for our COPD patients. They have also resulted in lowering the COPD readmission rate by 20 per cent over the past 12 months!


Major building maintenance work about to begin

This past summer, the provincial government announced a total of $175 million for helping hospitals keep their buildings and structures in good working order. GGH was allocated almost $4.3 million to help address some much needed building maintenance. Some of that work will start on November 8.

First up will be repairing the roof on the main building. Other work such as the roof on the main building and sealing and repairing exterior walls will follow. The work will be disruptive at times with noise and dust issues. In addition, there'll be parking challenges when some of the main lot is blocked off as a staging area for the construction. Details will be widely shared as they become available.

"We are extremely grateful for the ongoing investments in GGH," says Marianne Walker, President and CEO. "In the end, it’s all about needing well-maintained buildings to support our staff in delivering high quality care to our patients."

Some examples of repairs needed to the Hospital's exterior walls (click on photo to enlarge) 
Located by the outside stairs leading from the Emergency Department to the main parking lot, the wall shows the effects of water seeping through carrying road salt from the ambulance ramp.
The area below the window is darkened by water leaks. In addition, some of the bricks above and to the left are crumbling and in need of replacement.
Dark stains indicate water spilling over the wall from the roof above.

Improvements to Emergency Mental Health and Addiction Services proceeding quickly

In July, the Province announced over $3 million to improve Emergency Health and Addiction Services (EMHAS) in Guelph and Wellington County. Since then it's been full speed ahead in bringing in specialized staff and programs to help those vulnerable patients. 

The EMHAS Operations and Quality Team includes: front – (l-r) – Sarah Cheechoo, Admin., Michelle Bott, Senior Director, Craig Robinson, Project Lead
Back (l-r) – Gianni Accettola, North Wellington Health Care, Paul Obermeyer and Natasha Lemieux from Homewood Health Centre.

Four working groups have been established to implement opportunities for improvement of our EMHAS across Wellington County. Over the summer, we have focused our efforts on recruiting additional staff and modifying some of our existing processes. Some of the accomplishments to date are:

  1. Expanded our Consult Liaison service. A Mental Health RN has been added to our consult liaison team. Emergency Mental Health Unit (EMHU) nurses will be on the units assisting with assessments. In partnership with Homewood Health Centre (HHC), access to psychiatry is improved. As of Monday, Oct 24, there is access to two half-time psychiatrists who are available to consult GGH inpatients. One specializes in the care of adult patients and the other specializing in geriatric psychiatry. The referral process to access the team remains the same but there are some key changes. For example, the psychiatrist is not only providing an initial consult but also following up throughout the patient’s stay at GGH.
  2. We have recruited a full-time Program Manager for the expanded services. Paul Obermeyer was managing the Emergency Mental Health Unit on a half-time basis but now full-time with the expanded program. While he is a HHC employee, he is located on site at GGH.
  3. Additional part-time Social Work staff will provide support to our patients in the Emergency Department and in the EMHU on weekends and evenings. The new staff started the first week of October.
  4. This week additional nurses as part of the EMHU team began their orientation. Once complete, there will be a dedicated Mental Health RN in the Emergency Department (ED) 24 hours per day to assist with consults. The MH RN is expected to be in place in the ED by mid-November.
  5. An Addictions Counsellor has been recruited to the team. This staff member will counsel our patients in the ED and in the inpatient areas. More information about how to access the Addictions Counsellor will follow when their orientation is complete.
  6. This week, an Occupational Therapist joined our team. She will be key in helping to develop new Urgent Care services that will be provided to patients on an outpatient basis. At this point, the Urgent Care Services team is focusing on analyzing service needs to define the key services we will provide.
  7. Craig Robinson has joined GGH as Project Lead for the project. He is working with our project teams to help keep the project is on track.

We are working with Groves, Palmerston, and Mount Forest Hospitals to improve the timeliness of assessments and patient flow for patients in the northern half of Wellington County. Value Stream Mapping is planned for Nov 29.

Holding "mock" disaster exercises helps prepare for when a real one happens

Recently, a mock disaster, table top scenario was conducted lead by Kim Crawford, Director Emergency Department (ED), and Lisa Groulx, Clinical Educator for the ED. The table top was conducted with representation from ICU, OR, Medicine, Surgery, ED, FBU, Bed allocation, Security, ED Physicians, Security, Environmental Services, Health & Safety and Homewood. The scenario was completed using floor plans, and marbles to represent patients to provide a visual of the movement of person(s).

Angela Weber (left), Janice Direto and Dr. Ian Digby scan the Emergency floor plan to determine next steps in movement of patients.

The scenario was conducted in “real-time” scenario that had a large number of incoming patients from a car crash which were unable to be rerouted to other hospitals due to an ice storm.

Considerations had to be made regarding patients in the ED needing to be moved into the Hospital for care to help create room for the incoming patients from the accident. This included the movement and discharge of patients within our units to make room for the emergency patients requiring care.

In addition, considerations had to be made regarding getting discharge orders for patients, cleaning of rooms prior to patient moves, incoming phone calls and family members asking questions about their family members. At one point in the exercise, a “Code White” was added to illustration that it may not always be “all hands on deck” for the incoming emergency when there are other situations to handle too.

The group was able to test and discuss the calling of a Code Orange, implementation of IMS structures during the initial onset of an event, communication between departments, resources, and staff fan-out processes.

Table top scenarios are a great way to test our systems without affecting the work being conducted throughout the hospital. The scenario conducted for this table top exercise provided great insight into areas which require more review and clarification, as well as highlighted the collaborative approach GGH has cross departments. Outcomes include, revamping Code Orange, looking at a more efficient fan out system, more training for IMS leaders and an evaluation plan algorithm

Emergency Measures Committee would like to thank Lisa Groulx and Kim Crawford for leading this exercise. We are looking forward to conducting more scenario-based exercises and mock drills which help us be as prepared as possible for emergency situations.

Stay tuned for upcoming mock exercises coming in November.

Guelph General Hospital's Materials Management Team secures $743,000 in savings

At Guelph General Hospital, the Materials Management team is leaving no stone unturned in helping the Hospital meet one of its strategic priorities - to sustain its financial health. At the same time, adding to the challenge is finding these savings and efficiencies without sacrificing the high quality of care for which the Hospital is known. That said, thanks to the team’s dedication, almost $743,000 in purchasing savings from April 1, 2015 to March 31, 2016.

Jeff Carter, Director of Materials Management (third from right), along with members of his team recently celebrated National Healthcare Supply Chain Week (click photo to enlarge).

Much of this success to can be attributed to working in collaboration, rather than in silos, says Jeff Carter, GGH’s Director of Materials Management.  “Collaborating with internal hospital departments as well as external partners is critical to increasing purchasing power to negotiate significant contract savings.”

Another significant contributor to this level of saving is the hospital-wide commitment to look at every single input and how the Hospital can be more efficient in its use, find a more cost effective alternative, or negotiate a lower contract.
Jeff gave some specific, recent examples to illustrate from where these savings are coming.
  • Renegotiated a contract for hip and knee implants that will result in up to $36,000 in savings per year over the next two years.
  • Negotiated a contract for contrast media used in the Diagnostic Imaging Department that resulted in about $25,000 in savings per year over the next 5 years.
  • Negotiated OR surgical gloves and warming blankets contracts that will result in $6,627 and $8,887 in savings per year over the next two and four years respectively.
  • Negotiated stationary and toner products contracts that resulted in over $50,000 in savings over the previous contract.
Jeff also credited Sue MacNeil, Director Food Services and Environmental Support, for leading a team to look more closely at how they use their linen supplies (story featured in the previous issue of General Express). Through changes they have implemented, $25,000 has been saved over the past six months.
With government funded hospital operating budgets getting leaner and leaner, efficient spending is an absolute must. The savings that the Materials Management team have achieved helps ensure that as much funding as possible is available to support patient care.
By striving to get the best deal, donations are also used most effectively, said Suzanne Bone, CEO of The Foundation of Guelph General Hospital. “When we purchased our MRI at the end of the MRI & More campaign, we were able to negotiate the lowest price ever seen for an MRI in Canada. This meant that donor dollars were stretched further.”
Each year, the first week of October is dedicated to acknowledging and celebrating healthcare supply chain professionals. Some of the best can be found at Guelph General Hospital.
Infection Control Week included many promotions to highlight its importance
We have been successful in achieving a hand hygiene compliance rate of 80% and above the past year. Now, it’s time to take it to the next step by forming a partnership with our patients and their families in promoting safety for all. 
How? By inviting patients and their families to ask us if we’ve cleaned our hands. To help raise awareness, we are asking staff to wear a button (pictured below). It shows our commitment to support patients and their families as active participants in making sure their health care is provided safely. We need to make it as inviting as possible for everyone to feel comfortable ensuring hands are clean. After all, Clean Hands are Caring Hands. 

This GGH comic strip was developed to help staff become more comfortable responding to being asked by patients or family members if they cleaned their hands (click to enlarge).

Infection Prevention and Control (IPAC) Committee

Guelph General Hospital’s interdisciplinary Infection Prevention and Control Committee meets at least four times a year. Members include representatives from front-line staff, GGH Leadership, Professional Practice, Medical Device Reprocessing Department, Physician, Environmental Services, Infection Prevention and Control, Public Health, Regional Infection Control Network and Facilities. 
The Committee’s purpose is to provide guidance to the IPAC team which includes:
  • developing goals and objectives for quality improvements
  • program evaluation and improvement
  • sharing infection rates
  • policy and procedure approval
  • construction and renovation consultation
  • information sharing
  • Outbreak debriefing and follow up


GGH’s New Breast Cancer Assessment Clinic: Made Possible by our Supporters

This year, thanks to generous donors, we were able to bring three new ultrasound machines to our Hospital. Having these new machines fundamentally changed the way our Ultrasound department functions, bringing more efficiency and less waiting for our patients, not to mention that the new machines replaced those more than a dozen years old, providing a stunning improvement in the quality of images.

Take a look at the images of a cancerous tumour seen with both the new and the old machines. Even the untrained eye can see how much clearer the image is when taken with the new machine. 

What is really exciting is that we’ve opened a new Breast Assessment Clinic at GGH which would not have been possible without the new machines. The clinic is designed to significantly reduce the amount of time a woman spends waiting to know whether or not she has breast cancer.

Jeannette Rupert was the first Guelph resident to benefit from GGH’s new Breast Assessment Clinic.

The new machines are now in use; the clinic is up and running. The first person to benefit from the clinic, long-time Guelph resident Jeannette Rupert, is extremely thankful for both of these things.

The patient’s journey usually begins when a lump is found or a shadow appears on a screening mammogram. Then, it can take up to three visits to the hospital over a four- to six-week period before a diagnosis can be made. Usually, a second mammogram is needed which may be followed by an ultrasound. Then, some will need a needle biopsy with the sample sent to the lab. Now with the new clinic, all that is done in one day. 

Compare this with Jeannette’s journey which started recently when she found a lump in her left breast. Not one to ruminate and worry, she immediately phoned her doctor who referred her to the newly implemented Breast Assessment Clinic.

Jeannette arrived at GGH at 8:00 a.m. and by 10:30 a.m. she’d had a mammogram, an ultrasound and a biopsy! A week later she received the heartening news that all was clear. Understandably, she breathed a big sigh of relief.

“Yes,” Jeannette acknowledges, “it was nerve-racking to discover the lump and waiting is horrible.” Thankfully the time between discovery and diagnosis was relatively short. When asked about the care received she said she was very impressed with the clinic. “Everyone was fantastic, friendly, supportive and took the time to explain everything.” 

“This is about improving our patient’s experience by significantly reducing their time spent wondering whether or not they have cancer,” explains Dr. Samir Patel, GGH’s Chief of Diagnostic Imaging. “It’s also about providing the best care possible should cancer be found. By taking advantage of our modern, fully digitized and integrated diagnostic equipment including our mammography machine and brand new ultrasound machines, patients can get their diagnosis as quickly as possible which means treatment can be started sooner.”

We are so grateful for our generous donors. Our donors shape and improve patient experiences here at Guelph General Hospital each and every day.

Christmas mailing shares a wonderful story of how GGH twice changed someone's life

"My son Richard convinced me that if I wanted to live my life my way – doing things like visiting the Yukon for the dogsled races – I would have to have surgery. And I’m so glad he did.” 

The Foundation’s seasonal mailing tells the story of Margaret Durrer and how surgery at GGH (twice) changed her life. 

Our goal is to raise $100,000 for much-needed equipment for the ORs. We’ll post a link on our intranet when the mailing is ready. Our fundraising success is about our community supporting our Hospital, and its an indication of the great team of people who work here, and the care and compassion provided – so thanks! 

 The Guelph Storm are on a roll! Find out how to get discounted tickets and support the Foundation by going to a great hockey game! Just click on the poster for more information.

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