Printed on 100 per cent recycled paper MAY 2016 | IN TOUCH | 1

By Melissa Di Costanzo

Carolene Garcia, a registered nurse at Sumac Creek, created a program to help COPD patients improve their quality of life. (Photo by Katie Cooper, Medical Media Centre)

The Sumac Creek Health Centre will soon roll out a half-day health promotion program to help patients with chronic obstructive pulmonary disease to breathe easier.

COPD is a lung disease that includes chronic bronchitis and emphysema, and develops over time. Symptoms include an ongoing cough that produces mucus, shortness of breath, wheezing and chest tightness.

Registered nurse Carolene Garcia is a COPD champion who “quickly

recognized this specific population has an extensive needs -- especially following discharge from hospital.”

Garcia noted the COPD patients she works with are mostly low income, live alone with no social support, and have multiple co-morbidities.

That’s why she is creating a program with a team-based approach: she will work with a pharmacist and dietitian, as well as other health-care professionals, to assist with managing the disease and, most importantly, to improve patients’ quality of life.

Continued on page 2

INTOUCHMAY 2016

Helping COPD patients breathe easier

WELCOME ACCREDITATION

CANADA SURVEYORS

MAY 16-20

MAY 2016 | IN TOUCH | 2

Every Nursing Week allows me the opportunity to reflect on our collective successes over the past 12 months. And what a year it has been.

Did you know there were 26 local best practice guideline implementation and sustainability initiatives underway? This important quality work will continue to support our Registered Nurses’ Association of Ontario Best Practice Spotlight Organization designation.

We know that as nurses, you are committed to your ongoing professional development, including educational and research opportunities, which is why we will continue to offer you this support. We have been pleased to offer a range of workshops tailored to new graduates and to experienced nurses to enhance patient and family centered care.

We are also focusing attention on your health and wellness. We’ve engaged with you in the development of our new Interprofessional Strategic Plan, to be

released in June. The plan will continue to support nurses and their important role within the interprofessional team.

This year’s Canadian Nurses Association of Canada Nursing Week theme – “Nurses: with you every step of the way” – reminds us registered nurses are there for patients and their families 24 hours a day, seven days a week, providing knowledgeable, professional care in the hospital and in the community. RNs are exactly the professionals our patients and families need – and expect to be with them every step of the way.

Nursing is a knowledge profession. Nurses make excellent partners with our interprofessional team members, bringing your knowledge, professionalism, experience and evidence-based practice. When the team works together within a collaborative practice model, patients at St. Michael’s receive high-quality care. The hospital leadership is proud to support you every step of the way!

This year in particular is bittersweet for me. I’m retiring from St. Michael’s, confident the work we have started together will continue long past my date of retirement, and that those I’ve worked with will continue to support our collective commitment to quality patient care through quality nursing.

Thank you for reinforcing St. Michael’s status as a leader in delivering compassionate, evidence-based care. Thank you for the opportunity to work with you to build a strong nursing and professional practice team.

It has been a privilege and honour to work with each and every one of you. Know that the good of nursing lives on in the 1,860 nurses working at St. Michael’s. What you bring every day to work is what makes it a great hospital, and that will not leave with me.

Wishing you all continued personal and professional success.

Ella Ferris, Executive Vice-President, Programs, Chief Nursing Executive, Chief Health Disciplines Executive

OPEN MIKE with

Follow St. Michael’s on Twitter: @StMikesHospital

Patients with COPD are fearful of becoming short of breath, she explained, and often arrive in the Emergency Department with an exacerbation, or a sudden worsening of symptoms.

“I see patients with COPD struggle every day,” she said.

The dietitian will work with patients to prevent or reverse malnutrition by implementing strategies to minimize weight loss and improve the ability to eat. The pharmacist will help with medication reconciliation, treatment optimization and patient education.

Garcia, who will be the COPD resource, and the Sumac Creek RN team will manage patient cases, ensure patients

have a good understanding of the disease process, refer patients to other allied health professionals, and connect patients to available community resources/services such as pulmonary rehabilitation and home care.

“Having a well-thought out collaborative plan of care can have a direct impact improving health outcomes and possibly decrease readmission to the hospital,” she said.

Jacqueline Chen, the clinical leader manager at Sumac Creek, said Garcia and the rest of the primary care team were well-positioned to provide tailored care to this patient population.

“With good, co-ordinated care and patient engagement, we can help prevent unnecessary visits to the Emergency Department,” said Chen.

COPD story continued from page 1

Happy National Nursing Week! Nurses: with You Every Step of the Way

MAY 2016 | IN TOUCH | 3St. Michael’s is an RNAO Best Practice Spotlight Organization

Anyone who has moved a piano knows it can’t simply be packed in a truck, transported to its new home and unloaded ready to play. A special mover is needed to transport it correctly and tune it on arrival. But if moving a piano is challenging, try moving an intensive care unit or ambulatory clinic.

As part of St. Michael’s 3.0, many units, clinics and offices are moving into renovated spaces inside the existing hospital or to the Peter Gilgan Patient Care Tower in 2017. Although some moves simply involve packing up computers, files and furniture, those that involve relocating patient equipment are more complex and require the assistance of the hospital’s Clinical Engineering Department.

The department is divided into two groups, biomedical and dialysis technology, and is responsible for applying medical technology to enhance patient care. While the dialysis team specializes in hemodialysis systems, members of the biomedical team combines their backgrounds in engineering, IT and physiology to understand and implement both the clinical needs and technological specifications of every apparatus in the hospital.

With the exception of medical imaging equipment, the department manages all phases of the life cycle of technical equipment in the hospital, from purchasing, to maintaining, to deciding when it’s time to replace. The biomedical team helps to determine technical specifications for new equipment before ordering, based on clinical needs. It also provides feedback and training to the people who will be using the equipment, such as clinical staff or the patient transport team. And, it plays a key role in relocating equipment in the hospital.

For any move, planning is key. Vincent Lam, manager of Clinical Engineering, said

By Kate Manicom

a huge amount of preparatory work takes place to ensure there are no impacts on patient care, particularly for equipment used in critical care, such as the monitoring equipment used in the ICU.

“We ensure that back-up equipment is already installed, tested and functioning,” said Lam. “Network connections, like those needed for monitoring equipment in the ICU, are established. Logistically, we coordinate with clinical staff to ensure the timing of a move works for them. And we work with the manufacturers of equipment to ensure everything is installed correctly.”

With planning in place, when it’s time for an actual move, the work is quite straightforward. Typically three to four technical staff are needed over a couple of days.

Lam is quick to acknowledge that they couldn’t do it without the support of many other groups in the hospital. Clinical staff, Infection Prevention and Control, IT, Planning and Housekeeping all have important functions in ensuring equipment is disinfected, connected and ready to be used in the right space.

In the Cardiac Intensive Care Unit, Vincent Lam, manager of Clinical Engineering, explains how equipment will be moved to the new Peter Gilgan Patient Care Tower when it is completed in 2017. (Photo by Yuri Markarov, Medical Media Centre)

Clinical Engineering: Where technology and patient care meet

“It’s like an assembly line,” said Lam. “Each person has their own role that’s coordinated well ahead of time.” - Vincent Lam, manager, Clinical Engineering

MAY 2016 | IN TOUCH | 4

THANK YOU ELLA FOR YOUR LEGACY OF LEADERSHIP, PROMOTION OF PROFESSIONAL PRACTICE AND

FOCUS ON QUALITY PATIENT CARE

Graduation from St. Michael’s

Nursing School 1974Ella and her husband Paul at the

Angel Ball gala

Ella with Bob Howard, Nursing Week 2014

MAY 2016 | IN TOUCH | 5

Ella with (right to left) Murray Krock, director of nursing practice and education; Lianne Jeffs, director of nursing/clinical research; and Bev Bulmer, director,

health disciplines, practice and education

Ella and her longtime executive assistant Susan Poole

Ella with Galo Meliton, renal transplant nurse co-ordinator, and Joyce Grandy, the nurse specialist, education, in the Perioperative Services Program, Nursing Week 2015.

MAY 2016 | IN TOUCH | 6

By Geoff Koehler

It’s a Thursday afternoon and Annie Gravely is hard at work in Dr. Jane Batt’s research lab. Gravely is part of a team of researchers sending worms into space. Unlike most students in Dr. Batt’s lab, Gravely doesn’t hold a PhD or a master’s degree. In fact, she doesn’t even have her high school diploma—because she’s only in Grade 9.

The 14-year-old is one of 10 students from the University of Toronto Schools working on the project, part of the National Center for Earth and Space Science Education’s Student Spaceflight Experiments Program. Students design and propose real experiments to fly in low Earth orbit, first aboard a space shuttle, and then on the International Space Station.

“Last year when we started the project, we had to come up with an experiment that would make a difference after being sent to space,” said Gravely.

Dr. Jane Batt reviews the results of a Western Blot test with high school student Annie Gravely. The test looks for a protein that Gravely, 14, believes may be linked to the muscle-wasting disease ALS. (Photo by Katie Cooper, Medical Media Centre)

“I was thinking about some of the issues astronauts have in space, like muscle atrophy, and thought this may link to the way muscle can waste away on earth. My grandpa had ALS and I wanted to do something that would help others like him.”

Their experiment aims to unearth a better understanding of the causes of muscle atrophy—a common contributor in Amyotrophic Lateral Sclerosis, sometimes called Lou Gehrig’s disease. The students are trying to assess which protein may play a role in the muscle loss that takes place in microgravity. Approximately 30,000 worms, each about 1 millimetre long, will be placed in an approximately 18-centimetre silicone tube housing the experiment.

Gravely’s mother, Dr. Marie Faughnan, is a respirologist at St. Michael’s Hospital, an associate scientist in the Keenan Research Centre for Biomedical Science and head of the hospital’s Hereditary Hemorrhagic Telangiectasia Centre, but Dr. Batt said Gravely coordinated the outreach herself.

“Annie sent emails constantly,” said Dr. Batt, who is the medical director of St. Michael’s Tuberculosis Program and a researcher with the Keenan Research Centre for Biomedical Science. “Our lab hosted the students and trained them on the techniques they’ll need to analyze the proteins in the worms that return from orbit, but the ‘space kids,’ as we call them, planned out this entire experiment. These are bright, driven kids.”

The worms are scheduled to blast off on June 24.

Gravely said the UTS students will be in Florida for the launch but when the tube returns to earth 10 weeks later, Gravely and her fellow students will be back in the Keenan Research Centre conducting the experiments they’d trained for and to see what mysteries the universe reveals.

The space kids

MAY 2016 | IN TOUCH | 7

The Allan Waters Family Simulation Centre has begun offering cardiopulmonary resuscitation and automated external defibrillator training to St. Michael’s patients and family members.

“We’ve offered lifesaving courses to our staff, including non-health care professionals, for quite a few years,” said Nazanin Khodadoust, the manager of the Simulation Centre. “But we wanted to extend this training to a group that was missing – our patients and their families and friends.”

The move was inspired in part by a cardiac arrest at a nearby health centre. A man suffered a cardiac arrest while playing squash. He was resuscitated using CPR and an AED, then brought to St. Michael’s. A member of the health centre contacted the Simulation Centre and requested CPR and AED training to

prepare for any future incidents.

This led the team at the Simulation Centre to think about the benefits that CPR and AED training could have for St. Michael’s patients and families.

“We thought about our patients from the heart and vascular program, and how scared their family members and friends must be, going home not knowing what to do if something happens,” said Khodadoust. “As a family member, I’d want to know what do to if my loved one just collapsed in front of me.”

Engaging patients and families is an objective of the Education Strategic Plan.

Two of the centre’s simulation specialists, Sue Zelko and Ashley Rosen, received certification to teach CPR in the community. Zelko and Rosen promoted a pilot session of the program

in the Victoria Lobby, and were met with a positive response.

“People felt this was a great initiative and thanked us for this training opportunity,” said Zelko.

Participants will learn basic resuscitation skills including early recognition of a cardiac arrest, how to call for help, chest compressions and how to use an AED. “This course is designed to bring basic life support knowledge to everyone in the community who is interested in learning the skills of CPR,” said Zelko.

The cost is $20. Participants receive a St. Michael’s completion card, a Heart and Stroke Foundation resource booklet and a portable face mask.

For any inquiries on this course contact CPR@smh.ca or 416-864-6060 ext. 77515.

By Greg Winson

Simulation Centre offers public peace of mind through lifesaving skills

Sue Zelko, a simulation specialist in the Simulation Centre, teaches CPR techniques to a student. (Photo by Katie Cooper, Medical Media Centre)

INTOUCH MAY 2016

In Touch is an employee newsletter published by Communications and Public Affairs. Please send story ideas to In Touch editor Leslie Shepherd at shepherdl@smh.ca.

Design by Lauren Gatti

Denise Fotopoulos, manager for health data and coding in Decision Support Services. (Photo by Katie Cooper, Medical Media Centre)

By Leslie Shepherd

Q: What does a coding specialist do?

The primary role of a coder is to tell a patient’s story by reading his or her chart and translating all the diagnoses and procedures done at the hospital into alphanumeric codes using the World Health Organization’s International Classification of Diseases. Coders collect a large amount of clinical and administrative data through discharge summaries, consultations, progress notes, OR procedure notes, and diagnostic reports. We must follow strict coding standards to ensure accuracy and consistency. We code all inpatient, day surgery and emergency care and visits to select clinics (dialysis, colposcopy and oncology).

Q: Why is coding important?

There is an increased focus on the importance of coding and data quality with the introduction of Health System Funding Reform in Ontario. Coded information is used to inform government funding decisions, but equally important, it is used internally and externally for quality and performance measurement, disease surveillance, research, planning, policy and resource management by hospital administration. It’s critical that our coded data is of a very high quality and reflects the complexity of our patients and the resources involved in their care.

Q: What does a typical day look like for you?

Every day is different. I manage a team of highly skilled health information professionals who must always stay up-to-date on data standards and reporting requirements. As a department, we must ensure data is submitted on time and passes our quality assurance checks. We work very closely with Decision Support Services, Finance, clinical programs and physicians to maintain the accuracy and integrity of patient data and to ensure standardization in coding practices. And of course we are always looking for ways to improve the quality of documentation within the health record.

Q: What is your background?

I knew from Day 1 that I wanted to work in health care. After completing my biology degree from McMaster University I studied chiropody at the Michener Institute. Preferring to work behind the scenes, I enrolled in George Brown’s Health Information Management program. I have worked in the field for a little over 16 years and I love it.

Q: What do you do in your spare time?

I have a 15-month-old son who just started walking, so I have no spare time! I’m enjoying being a new mom, but I do miss going to the movies. I’m a big documentary fan and hope to catch a flick or two at the Hot Docs Festival.

Q & A DENISE FOTOPOULOS