Winter 2013

4 Progress on the Strategic andOperational Plans

A C C E S S

7 Janeway Lifestyle ProgramTeaming Up to Promote Healthier, Happier Kids

S U S T A I N A B I L I T Y

10 Groundhog Day:Managing the Drug Shortage Crisis

P O P U L A T I O N H E A L T H

14 Preventing Baby Flat HeadJaneway Physiotherapy Team Take on a Growing Concern

Q U A L I T Y & S A F E T Y

17 ASIST!First Aid for the Suicidal

20 Healing Hands

M Y S T O R Y

26 Seeking the Next AdventureOne Paramedic’s Experience in the Field

Connect is published by the CorporateCommunications department of EasternHealth.

Connect is printed internally by PrintingServices.

Please address any comments orsuggestions to Susan Bonnell, Editor:

Corporate CommunicationsAdministrative OfficeWaterford Bridge RoadSt. John's, NL A1E 4J8

(709) 777-1412susan.bonnell@easternhealth.ca

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Cover Photography by Phil SimmsOn the Cover: Shawn Layman and Karen Hanrahan

Contributors

1 Jackie O’BrienCorporate Communications

2 Phil SimmsCorporate Communications

3 Deborah CollinsCorporate Communications

4 Melisa ValverdeCorporate Communications

5 Angela LawrenceCorporate Communications

6 Stephanie BarrettCorporate Communications

7 Marie DuffetPlanning

8 Susan BonnellCorporate Communications

9 Zelda BurtCorporate Communications

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Already, the organization is mid-way throughOperational Plan 2011-14. What did we promise and howare we doing? Although not all-inclusive, the followingprovides a snapshot of great work happening in EasternHealth and demonstrates that together, we can!

Quality and Safety

Eastern Health promised to increase quality andsafety of programs and services for all who enter ourcomplex world. Many programs have implementedcomprehensive safety plans covering a wide range ofissues such as threat risk assessments in emergencydepartments, hand hygiene audits, working alonepolicies, and injury prevention initiatives for staff.

Numerous programs have begun to successfullyintegrate their clinical and administrative policiesacross the region, completing policy inventories,revising priority policies and auditing compliance topolicies, especially those relating to safety.

The office of the Medical Officer of Health isworking to update the pandemic response plan andProtection Services report improvement in fire drillcompliance. A safety program has been implementedfor personal care home operators focusing on improvedcommunication, injury prevention, and infectioncontrol.

Several programs are helping the organizationimplement Accreditation Canada’s requiredorganizational practices (ROPs) and auditing todetermine compliance. Examples include the fall riskstrategy, employee roles and responsibilities for safety,violence in the workplace, and medicationreconciliation.

Management Engineering Services is dealing withincreased requests for Failure Modes Effects Analysis(FMEA) for specific projects, indicating that programsare looking proactively to identify process andproduct problems before they occur. This isimportant when assessing risk in ahealthcare environment.

Progress on the Strategic and Operational Plansby MARIE DUFFETT

Eastern Health’s Strategic Plan 2011-14: Together We Can, outlines the organization’spriorities: Quality and Safety, Access, Sustainability, and Population Health. Whilethe strategic plan identifies broad issues and goals, the operational plan gives actionto the strategic plan through the combined efforts of more than 50 programs.

5Winter 2013

Eastern Health is engaged in a number of SaferHealthcare Now! initiatives aimed to reduce avoidableharm. Examples include prevention of ventilatorassociated pneumonia, use of safe surgery checklists,improved care for myocardial infarction (heart attack)patients, and prevention of infections associated withcentral intravenous catheters. These successfulevidence-based initiatives help save lives and reducecomplications associated with health care delivery.

Many programs chose clinical audits as a priorityin their operational plans. They are working to improveauditing procedures and processes and using auditresults to make continuous improvements.

Access

Eastern Health pledged to improve access toprograms and services. Many have introducedcommunity – wide scheduling and /or central intakeprocesses to manage waitlists. For orthopedic patients,central intake has decreased the median wait time by70 per cent for highest priority and 20 per cent for lowerpriority.

Diagnostic Imaging has implemented strategies todecrease wait times for non-urgent CT scans,ultrasounds, and MRIs. “No- show” rates are being

monitored and improvement noted in several areas. The Emergency Program reports a 50 per centdecrease in the percentage of patients who

leave without being seen (LWBS) by aphysician (city hospitals). LWBS rates

outside of the city are also beingexamined.

In 2009, EasternHealth was provided

with over 900 recommendations to identifyopportunities to enhance patient flow throughout cityhospitals: almost 70 per cent are complete!

The Long Term Care Program has identified areasfor improvement in their placement process, anddrafted information brochures for clients and familiesabout access to long term care.

Research and Knowledge Transfer, ManagementEngineering, Decision Support, and Health ServicesInformatics are working with clinical programs to assist withdata collection and analyses to help improve wait times.

Sustainability

This priority refers to making the best use of fiscaland human resources. Achieving a balanced budget isparamount and most programs chose this as a goal fortheir operational plans, reporting varying degrees ofsuccess.

Several programs have developed workforce plansto ensure qualified individuals replace those nearingretirement. Use of bursaries, sign-on bonuses, andmarket adjustments is helping with hard-to-recruitpositions.

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Various programs have developed healthyworkplace plans and increased efforts to improveemployee engagement. In June 2012 Eastern Healthheld its second annual Employee Recognition weekalong with the CEO Awards of Excellence. This eventhas been received positively and it is obvious thatemployees appreciate and are proud of being recognizedfor their hard work and dedication.

Organizational and program specific scorecardshave been developed by Decision Support incollaboration with many departments and services.Scorecards help align program activities to EasternHealth’s vision and strategic plan and are a good way tomeasure performance against benchmarks and targets.

Population Health

Eastern Health programs are working to achieve thebest possible health outcomes for individuals, groups,

and even communities. Indeed, this is whatpopulation health is all about!

The Chronic Disease Preventionand Management Strategy was

launched this past summer.Workshops are offered to

help individualsbetter manage

their chronic

conditions, develop problem-solving skills, and learn tobe healthier.

A Health Status Report, released in June 2012 andavailable on the Eastern Health webpage, provides asnap shot view of the health of the population in theeastern region.

In July 2012 the Trinity Conception CommunityHealth Needs Assessment report was released, the fifthand final report for the region. Available on the EasternHealth webpage, these reports tell not only how peoplein the various communities view their health needs butalso their recommendations to help meet those needs.

A breast screening program has been developedwith a plan to expand province-wide. Work alsocontinues on a provincial Colorectal Cancer ScreeningProgram.

Several programs have introduced healthy livinginitiatives for staff. Health Promotion is working withEmployee Communications to develop content onpopulation health to be placed on the Eastern Healthintranet and internet. Health Promotion is also workingwith the Eastern School District and other agencies topromote healthy eating, sexual health, and theimportance of being smoke-free. The Public HealthProgram is increasing efforts to promote breastfeedinginitiation and support new parents to achieve longerbreastfeeding duration rates.

Efforts continue to increase uptake of seasonalinfluenza vaccination among health care employees,

young children, seniors, and those with chronicillnesses. �

To learn more about the progress of the Strategicand Operational Plan, visit Eastern Health’s website

click on About Us/Strategic Priorities

Janeway Lifestyle ProgramJaneway Lifestyle Program

A C C E S S

For nearly 15 years, Dr. Tracey Bridger hasworked with children who have been identifiedas having risk factors for the development of

chronic disease. A Pediatric Endocrinologist withEastern Health’s Children’s and Women’s HealthProgram and the Medical Director of the JanewayLifestyle Program, Tracey sees young patients with awide range of lifestyle issues, such as those living with,or who have a family history of having high cholesterol,high blood sugars, liver disease, or weight concerns.

“Since 2006,” says Tracey, “the Janeway LifestyleProgram in St. John’s has sought to address variouslifestyle challenges for children by providing parents,caregivers and their children with family-centeredtreatment and activity options, which are facilitated byour highly motivated, interdisciplinary team.

“Our team is committed to work with and teach ourpatients how to live healthier,more active lives, through variousfun-filled activities andinitiatives,” she says.

Currently, the JanewayLifestyle Team consists of apediatrician, two psychologists, adietician, social worker,

physiotherapist, recreational therapist, and a researchanalyst. Any healthcare professional can refer a childto the program if the child has at least one of thefollowing conditions / meets one of the below criteria: • abnormal lipid profile;• hypertension;• signs/symptoms of insulin resistance (i.e.

impaired glucose tolerance, type 2 diabetes,polycystic ovary syndrome);

• fatty liver; and• BMI greater than 95th percentile.

The Janeway Lifestyle Team uses an innovativeapproach to help encourage and motivate patients todevelop self-awareness and build a positive body imagethrough the creation of healthy lifestyle habits.

According to Anne Wareham, Program Leadand Psychologist with the Janeway Lifestyle Program,it’s all about fun. “Through education, clinicalintervention and fun activities, such as plays, foodchallenges, and group-oriented physical activities, wepromote the importance of eating well, being active,and most importantly, ensuring that our patients feelproud about who they are,” she says.

Teaming Up to Promote Healthier, Happier Kidsby ZELDA BURT

7Winter 2013

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A C C E S S

Once children areaccepted into the program,parents or caregivers areinvited to a 90-minuteorientation session within sixto eight weeks.

“During orientation,parents will learn more abouthow our program aims toengage children in healthy,active living,” adds Anne.“Parents who commit to havetheir children participate inour program are given anappointment for a clinicalassessment at the end of theorientation session. There,the child will see all of ourclinical experts for a medical, nutritional, physical andpsychosocial assessment/screening.”

Following the assessment process, the child andparent(s) will be invited to the group program, whichruns for 11 weeks. Children are divided into groupsbased on grade-level, which includes preschool,primary, elementary and junior high. Areas ofdiscussion for both parent and children groups includelabel-reading, eating out, a guide to food and fluids,body image, physical activity, screen time (TV,

computer, video games), parenting and discipline,stress, time management, and emotional eating.

“After our clients finish the program, our teamcontinues to see the children until their eighteenthbirthday,” says Anne. “Follow-up support is provided inboth individual and group settings.”

Nurse Kim Peddle recently completed the weeklyprogram with her son Kamren, and she speakspositively about the wealth of knowledge the programprovides.

“Without a doubt, this program has positivelyinfluenced both my son and our family life,” says Kim.“Kamren is more interested now in doing the physicalactivities he enjoys - activities we can do together as afamily - like white-water rafting.

“This program taught him to be more self-confident,” she says, “and helped our family come torealize the importance of good nutrition and healthychoices. I would encourage my colleagues and friendswith school-aged children to seriously consider thisprogram.”

Our team is committed towork with and teach our patientshow to live healthier, more activelives, through various fun-filledactivities and initiatives.

““DR. TRACEY BRIDGER AND ANNE WAREHAM

9Winter 2013

R E D U C I N G W A I T T I M E S

“We have received a tremendous amount of supportand gratitude from parents and caregivers,” says Anne.“It’s great to know that our program helped theirchildren grow to become more healthy, self-confidentyoung men and women, both physically andemotionally.”

As part of the Provincial Government’scommitment to promote the health and well-being ofpeople in the province, Budget 2011 provided $477,700,to help expand the Janeway Lifestyle Program acrossNewfoundland and Labrador.

Over the next year, the members of the JanewayLifestyle Program will be traveling to regions across theprovince to meet with other health care providers andgroups to discuss barriers as well as existing assetsavailable in communities, such as physical activity,healthy eating and mental health resources.

“These meetings will help us gain insight into whatservices are available, what services are needed, andhow our program can be adapted to help address theunique needs of each region,” adds Anne.

Meetings in communities throughout the regionwill help the program identify how it can work inpartnership with the community to help families livehappier, healthier, and more active lives.

Expanding the Janeway Lifestyle Program alignsclosely with Eastern Health’s strategic plan for 2011-14,Together, We Can, where the health of wholepopulations has been identified as a key priority.

“Thanks to the commitment and dedication of theJaneway Lifestyle Team, Eastern Health is able to carryout its vision of healthy people, healthy communities,”says Beverley Clarke, Vice President responsible forthe Children’s and Women’s Health Program at EasternHealth. “By sharing knowledge on how to live healthier,active lives, and in partnership with parents andcaregivers, we can bring about change to help improvethe health and wellbeing of the children in ourprovince.” �

The Jelly Bean CruA fun activity carried out by the Janeway LifestyleProgram was the Jelly Bean Cru, where the goal was toteach theatre, drama skills and team building.

The plays performed taught children that character ismore important than physical appearance. Theseactivities helped illustrate the importance ofindependent thinking, team work, respect, kindness,and diversity.

Fruit and Veggie ChallengeEvery year, the Janeway Lifestyle Programteams up with the Heart and Stroke Foundation for theFruit and Veggie Challenge, where all Grade 4 childrenand their parents across the province are encouraged todiscuss and learn more about the importance of eatingfruits and vegetables, increasing physical activity intheir child’s life, and feeling good about themselves.

ActivitiesOther activities supported by the Janeway LifestyleProgram include hiking, Zumba, badminton, bowling,karate, geocaching, orienteering, and ball hockey.

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S U S T A I N A B I L I T Y

by SUSAN BONNELLPhotography by Phil Simms

Groundhog Day: Managing the Drug Shortage Crisis

In February, Susan Gladney-Martin received a noticethat she will never forget; Sandoz Canada would bereducing its production of injectable medications,

and hospitals all across Canada would be negativelyimpacted for 12 to 18 months.

“Sandoz had to re-engineer its processes to meetnew global standards,” explains Susan. “But all I couldthink was, how are we going to manage this one?”

Drug shortages are not a new phenomenon. In fact, Pharmacy Services is used to dealing with

shortages in one drug or another. However, thisparticular situation is unique because so many drugsare being impacted at the same time. Sandoz Canada is

the major supplier for over 150 drugs, ranging from thecommon - like dimenhydrinate - to the critical –including epinephrine, propofol, demerol, nubaine andmorphine. With capacity at its Quebec plantsignificantly reduced to reengineer processes to meetnew global standards, the Sandoz drug shortage createsa significant issue for our organization.

“This is the worst I’ve ever seen in 31 years.” saysKen Hand

““This is the worst I’ve ever

seen in 31 years.

11Winter 2013

M A K I N G T H E B E S T U S E O F R E S O U R C E S

Since the unanticipatedannouncement in February, theleadership team in PharmacyServices has been meeting everyweek to manage this andsubsequent crises in the drugsupply.

In a small meeting room in thebasement of the Health SciencesCentre, Director Gary Peckhamand Managers Susan Gladney-Martin, Ken Hand and RickAbbott crowd around a smalltable and dial in Norm Lace andMarvin Butler.

“We’ve always had drugs onbackorder,” says Ken Hand, “butwe’ve managed those shortages,and no one has ever even knownabout it.

“But this here, this is theGroundhog Day of drug shortages.You relive it every day.”

In the movie Groundhog Day,the main character wakes up everymorning and repeats the same day,over and over.

Rick Abbott agrees: “This hasbeen a crisis for 36 plus weeks; it’sjust that it has been a simmeringcrisis. What our team has done isto keep it from boiling over.”

“Dealing with this crisis hasrequired exemplary teamwork,”says Katherine Chubbs, theVice-President responsible forPharmacy Services. “Nearlyeveryone in our organization - andacross the province for that matter- has had a part to plan in

managing this difficult issue. Theleadership and work of thepharmacy team especially has beenparamount in ensuring ourpatients continue to get the bestpossible pharmaceutical care.”

To help manage this crisis, theleadership team pulled togethersome critical resources, led by twoClinical Pharmacists with strongskills and diverse backgrounds:Shawn Layman is the ClinicalPharmacist III at the Janeway, withregional responsibilities forOccupational Health and Safety,and Karen Hanrahan is theClinical Pharmacist III at St. Clare’sand the Waterford who supports,among other things, the Home IVProgram.

RICK ABBOTT. SUSAN GLADNEYMARTIN, GARY PECKHAM, LACEY WHITE, NORM LACE

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S U S T A I N A B I L I T Y

“Shawn and I have been working onthis every day since the end ofFebruary,” says Karen. “In the earlydays, we were here from eight in the

morning to nine at night – 12 to 14hour days some days. At the start of this,

I remember I worked 14 days straight.”“It is better than the first eight weeks,” adds

Shawn with a grin, “but there’s not much down time, isthere Karen?”

Shawn adds, “At times, even two lead pharmacistsare not enough. Elizabeth Reelis and RebeccaTobin have helped us significantly, as have our othercolleagues.”

Shawn and Karen work with a dedicatedteam of technicians and pharmacists fromaround the region, trying to maintain astable supply of drugs in Eastern Healthpharmacy departments.

“Every day, we’re faced with a different drug issue,”says Shawn. “Sometimes it could be the same drug asyesterday, but oftentimes it’s something new, somethingrandom.”

“From the moment you walk in the door, it’s a goodhour first thing every morning responding to questions,seeing what’s new, finding out who has an issue that daythat we need to deal with,” explains Karen. “And wespend a lot of time planning. Every Tuesday, the supplierupdates come out and we find out what drugs there maybe issues with.”

“My to-do list is always a couple pages, every day!”Karen and Shawn are quick to recognize the

KRISDINA PYNN, SHAWN J. LAYMAN, RHONDA WISEMAN, KAREN HANRAHAN, JILL GULLIVER

““We all remember 9/11. We remember

H1N1. And in this department, we willremember the Sandoz drug crisis.

13Winter 2013

M A K I N G T H E B E S T U S E O F R E S O U R C E S

importance of the staff in purchasing and receiving whowork alongside them in the pharmacy. “All of thosefolks, their workload has increased as well,” says Karen,“and there are days they come to us and say they needa little extra help that day, so then you’re trying to pullin help from wherever you can.”

“Our goal,” she says “is to be as normal inoperations as possible. It isn’t easy, and you know wedon’t typically pat ourselves on the back, but thiscertainly has been a stressful situation, and I think we’vedone a good job.”

“It could be a lot worse,” adds Shawn. “There couldbe a lot of fear out there. Patients have enough stresswithout having to worry about this. That’s what’simportant to us.”

Eastern Health’s spends just under $46 milliondollars annually in drugs, and with over six milliondoses of medication being dispensed each year in thecity alone, the impact of this drug shortage can’t beunderestimated.

“There are very few instances where apatient walks through the door of ourfacilities and they don’t receive anymedication,” says Susan. “We are a coreservice, and I think this crisis hasdemonstrated that fact.”

“But,” says Gary, “it’s business as usual.Despite the drug shortage, everything inEastern Health is ticking along as pernormal. All the open hearts are happening,accreditation is coming up, other issuescontinue, and all the other balls have to stayup in the air, too.”

That’s why, according to Gary, havingthe support of Katherine Chubbs, the othermembers of Executive Team and all theclinical teams in the organization has madethe management of this issue much easier.

“Setting up an EOC (Emergency

Operations Centre) really took a lot of pressure off us.Before that, we were bearing most of the burden for theproblem. So by setting up the EOC some of that gotspread around and helped us a great deal.”

As for Katherine, she is proud of the outstandingefforts being demonstrated during this crisis. “Thissituation demonstrates that together we can achievegreatness!” she exclaims.

The team is also grateful for the work that wasinitiated here in our organization to support ethical-decision-making right across the entire province.

“The ethics team and the ethics framework hasbeen an important collaboration,” says Rick, addingwith a laugh: “Ken calls it the easy button! Of course,there’s nothing easy about making these kinds ofdecisions, but what the frameworkdoes is make difficult decisions alittle easier to make.”

“We’ve been throughsituations in the past,”says Rick, “where it isvery difficult to put inplace rationalizations onthe use of a particulardrug. The framework hasmade that a verystreamlined and formalizedprocess. There’s no one person orgroup holding all the accountability orresponsibility for the decision.

“It makes it collaborative.”Collaborative. That’s the perfect word to use to

describe how the team is approaching the drugshortage, or what Rick calls “the new normal.”

And it’s the one positive thing the teamacknowledges has come from managing this issue.

“I’ve learned the importance of teams,” says Shawn.“I can’t imagine doing it alone. It just wouldn’t work todo this by yourself – it would be impossible.” �

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P O P U L A T I O N H E A L T H

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by JACKIE O’BRIENPhotography by Phil Simms

olleen Jones Down is a physiotherapist with aneye on trends, and one trend that she and hercolleagues have noted over the last decade is an

increasing number of referrals to treat baby flathead. Since January 2012 alone, over 350 babies have been

referred to the Janeway Physiotherapy Program throughfamily physicians and nurse practitioners to be treatedfor flathead, a preventable condition that occurs whenthere is pressure acting on an infant’s skull, resulting inthe flattening or deformation of the skull bones.

Janeway Physiotherapy TeamTake on a Growing Concern

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15Winter 2013

P R O M O T I O N A N D P R E V E N T I O N

151515SUSAN BAIRD, ANDREA HANN, COLLEEN JONES DOWN

Alarmed by the rising number of referrals, itbecame clear to Colleen that something needed to bedone to raise awareness about baby flathead and toeducate new parents on the ways it can be prevented.

“Babies are most susceptible to develop babyflathead within the first four months of life, since theyare not yet strong enough to rollover or change theirposition independently,” says Colleen. “The goal of thiscampaign is to provide new parents with informationabout baby flathead and preventative activities at thecrucial earliest stages of their baby’s life, before flatheadbecomes a diagnosis or concern.”

Understanding the IssueWhy has baby flathead become a larger

problem in more recent years? What has changed?Colleen explains that the need for a baby flathead

awareness and prevention campaign is largely due tomedical advancements and the evolution of babyequipment.

Cases of baby flathead began to rise after theAmerican Academy of Pediatrics and the CanadianPediatric Society launched the Back to Sleep campaign

in the 1990s in an effort to help reduce the occurrenceof Sudden Infant Death Syndrome (SIDS). Research hasshown that allowing babies to sleep on their backs canhelp reduce the occurrence of SIDS. And while the rateof SIDS has decreased significantly in recent years,infants are now more likely to develop baby flathead.

In addition to babies sleeping on their backs, theyare also spending more time in baby equipment thatlimits and restricts their movement, such as car seats,swings or bouncy chairs.

The goal of this campaign is toprovide new parents withinformation about baby flatheadand preventative activities at thecrucial earliest stages of their baby’slife, before flathead becomes adiagnosis or concern.

““

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P O P U L A T I O N H E A L T H

“These advancements are a step forward, but weneed to ensure that parents are actively engaged inactivities to help prevent baby flathead, ” says Colleen.“With the necessary education and resources, parentscan help prevent this condition by giving their babiesmore ‘tummy time’ while they are awake, alternatingthe position of their babies’ heads each time they go tosleep, ensuring their babies can turn their necks fullyin both directions, and by limiting the amount of timethat their babies spend in equipment.”

To get the word out about baby flathead, theJaneway Physiotherapy Program created newbrochures, posters and an informative webpage toprovide tips and education to new parents on ways toprevent baby flathead. These materials will beavailable at family physician offices and throughcommunity health nurses, both of which frequentlyencounter new parents while the baby is still veryyoung.

Community Health Nurse Shelley Gouldingis thrilled to see these new resources. “Our nursessupport parents in engaging in activities with theirbabies that will prevent baby flathead,” she says.

“This campaign provides us with an extraresource to share with parents and an opportunity tostart a dialogue about the condition,” adds Shelley,“which will hopefully reduce the number of cases wesee during our next visit with the child.”

From the moment their baby enters the world,parents are flooded with questions about how theycan help their child grow up to be healthy and happy.There is a lot to know, but luckily for new parents,Eastern Health has experts like Colleen Jones Downand Shelly Goulding that can provide the necessaryinformation to help alleviate their worries and answertheir questions, all while supporting the healthydevelopment of their new addition! �

ASIST!

17Winter 2013

Q U A L I T Y & S A F E T Y

ASIST!

ASIST!

FIRST AIDFOR THE

SUICIDAL

Even in Canada’s so-called “happyprovince,” no one is immune tothoughts of suicide. Did you know

that an average 5000 people show up eachyear in mental health crisis at thePsychiatric Assessment Unit at theWaterford Hospital and the HealthSciences Centre Emergency Department?

They come from all walks of life, are allages and their issues are as individual asthey are. And at least 20 per cent of them

cite thoughts or intentions of committingsuicide as their chief complaint.

The number is actually higher thanthat: during their psychiatric assessment,even those who have not expressedthoughts of suicide are often revealed to beat risk for it. And those are just the peoplewho appear on our doorstep. An additional

by DEBORAH COLLINSPhotography by Phil Simms

PAUL MARCH, CHERYL NORRIS, BEVERLY CHARD, CARL ROBERTS

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Q U A L I T Y & S A F E T Y

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10,000 people will call EasternHealth’s Mental Health Crisis Line.

Enter ASIST - Applied SuicideIntervention Skills Training - atwo-day, interactive workshop thatteaches suicide first aidinterventions. An internationally-recognized workshop, it’s offeredby - and to - a variety of groups inthe province. At Eastern Health, it’srequired training for all clinicalstaff in the Mental Health andAddictions Program.

Beverly Chard is a mastertrainer and workshop coordinator.A clinical educator with EasternHealth, she describes the workshopas ‘first aid for mental health.’

“Just as health professionals actquickly to perform CPR whensomeone suffers cardiac arrest,

once we recognize the signs thatsomeone is at risk for suicide, wemust intervene quickly to help leada person to safety,” Beverly says.

“When a person expressesthoughts of suicide, we often usethe analogy that they are in a ‘riverof suicide,’ heading for a waterfall.Though some manage to make it toshore by themselves, some peoplewill need to be given help to get outof this dangerous current beforethey reach the falls,” she explains.

Some people give signals whenthey’re contemplating suicide. Theytake a variety of forms, but mayinclude such things as isolatingthemselves, giving away theirpossessions or saying things like,‘people would be better off withoutme’ or ‘there doesn’t seem to be any

point in going on.’These actions are actually an

invitation to people to step in andhelp, according to Beverly. It isimportant to realize that anythingcan be an invitation and thosetrained to help need to be able toidentify it as such.

“It shows they’re ambivalent orundecided about taking their lives,”she says. “They have come up withreasons why they want to die - butat the same time are looking forreasons to live. Our goal as mentalhealth professionals is to hear theirstory about suicide and to supporta person to turn to safety for now.”

Participants learn thenecessary tools to create a ‘safeplan’ and ultimately prevent theimmediate risk of suicide. The goal

ASIST!

ASIST!

19Winter 2013

A R E N E W E D C O M M I T M E N T

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is that by the end of the workshop the participants aremore ready, willing and able to do life assisting, suicidefirst aid interventions.

In Newfoundland and Labrador, for the year 2010,there were a total of 63 suicides, as reported by theprovince’s medical examiner. Some 53 were male and10 were female; seven were youth.

According to Statistics Canada, suicide is the secondleading cause of death amongst 15- to 34-year-olds.

“We have identified quality and safety as a strategicpriority safety for Eastern Health,” says BeverleyClarke, Vice President with responsibility for MentalHealth and Addictions. “As such, we have an obligationto ensure that our staff can recognize when a person issuicidal and then able to intervene quickly andeffectively to lead them back to safety.”

Since the workshop was introduced in October2011, more than 200 nurses, social workers andpsychologists have taken part, with another 400 or soscheduled in the months ahead. Part of the traininginvolves facilitated discussion, structured exercises andhands-on participation to teach our health careprofessionals the appropriate interventions, which canthen be applied wherever a need is identified.

“There have been occasions, even in a social setting,when I have been asked to step in and provide assistanceto someone at risk for suicide,” notes Beverly. “Noteveryone will seek professional help, and this trainingallows Eastern Health employees to assist wherever andwhenever a need comes to their attention, very much in

keeping with our vision of healthy people and healthycommunities.”

Despite the progress that’s been made in de-stigmatizing mental health issues, people are often stillvery reluctant to voice suicidal thoughts or plans,according to Linda Conway, a nurse at thePsychiatric Assessment/Short Stay Unit at the WaterfordHospital, who has completed the ASIST training.

“Sadly, because of this stigma, some people remainreluctant to speak up when they are suicidal,” Lindaadded. “Often they feel a sense of shame about theirfeelings and may never reach out for help - which istragic. So how can you recognize a suicidal personwithout knowing what to look for and asking the rightquestions to find that out? ASIST focuses oninterviewing clients at risk for suicide and offers thetools to help them open up and receive the help theyneed.”

As vital as this intervention is to keep people safefrom self-harm, do those who do the interveningthemselves run the risk of being so ‘steeped in suicide’that their work environment becomes a negative one?

Not at all, according to Beverly. “Suicide intervention is actually a very hopeful

environment, in that we offer help and hope to thosewho desperately need it,” she says. “We are offering alifeline and helping to guide people back to mentalhealth and wellness – and that is a very positive thing.

“Ultimately, I believe that hope is contagious!” �

Do you know someone who needs help?Have you asked yourself some of the questionsraised in this article? Please reach out for help:

Eastern Health’s Mental Health Crisis Line 737-4668

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Q U A L I T Y & S A F E T Y

2020

HealingHands

by STEPHANIE BARRETTPhotography by Phil Simms

Don’t forget to wash your hands! How manytimes have we heard moms utter thosewords? As health care providers, we

shouldn’t need to be reminded to wash our hands…right? Wrong.

Across Canada, compliance by health careworkers with optimal hand hygiene is considered tobe less than 40 per cent, according to 2010 statistics.This is a staggering statistic considering globalresearch shows that improvements in hand hygieneactivities could potentially reduce health careassociated infection (HAI) rates by up to 50 per cent.

How do we measure up? Merlee Steele-Rodway, Director of the

Infection Prevention and Control (IPAC) Programexplains:

“An audit conducted at Eastern Health in June2012, showed that our hand hygiene compliancerates were 51 per cent,” she says. “That’s slightly lowerthan our results from last year.

“Maintaining the status quo at just over 50 percent is not acceptable given our target for compliancewithin Eastern Health is at least 80 per cent. Overallcompliance rates must go up.”

Audits for hand hygiene compliance focus oneffective hand washing both before and after contactwith either the patient or the patient’s environmentand include all healthcare employees who come incontact with the patient or patient’s environment.

Although the results were disappointing,according to Merlee some areas showed significantimprovements from the last audit.

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A R E N E W E D C O M M I T M E N T

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So what is hand hygiene?Hand hygiene refers to removing or killing micro-

organisms (germs) on the hands. When performedcorrectly, hand hygiene is the single most effective wayto prevent the spread of communicable diseases andinfections. Good hand hygiene is simple - use soap andrunning water or alcohol-based hand rubs (ABHRs).

If it so simple, why it is such a challenge withinthe organization?

It’s All in the TimingDr. Natalie Bridger, Clinical Chief with

IPAC, believes people may think they are practisingproper hand hygiene, but they are not.

“They are washing their hands,” says Natalie, “andthey are often washing them properly, but they are notwashing them at the right times.”

There are four moments for hand hygiene identifiedin health care:• Before initial patient/patient environment contact

- to protect the patient from harmful micro-organisms carried on your hands

• Before an aseptic procedure - to protect patientsfrom harmful bacteria entering their own body

• After body fluid exposure risk - to protect theenvironment from harmful patient micro-organisms

• After patient/patient environment contact - toprotect yourself and the health care environmentfrom harmful micro-organisms

“What we are seeing are people washing beforepatient contact but not after or vice versa. This is wherewe are falling down,” adds Natalie. “We must becomevigilant in technique and procedure so that we allexperience healthy, acceptable medical outcomes wecan be proud of administering.”

Natalie goes on to say that peer influence canimprove hand hygiene compliance rates: “We are all rolemodels. All our patients, clients and residents deserve tosee us clean our hands.

“Lead by example, and encourage every employeeto be accountable to our patients, and each other.”

MERLEE STEELERODWAY DR. NATALIE BRIDGER BRENDA EARLES

We need to create a culture thatsupports hand hygiene.

“

“

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Q U A L I T Y & S A F E T Y

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Have Sanitizers Close at HandPoint of care access has also been seen as an

obstacle to good hygiene That’s why providing easyaccess to hand hygiene materials has been a priority forIPAC.

“There are dispensers located throughout allEastern Health facilities and we have been working withInfrastructure Support to identify and install dedicatedhand hygiene sinks in new construction areas,” saysMerlee.

Ask a ProAside from increasing hand hygiene audits and

improved access to hand washing utilities, EasternHealth also employs several Infection ControlPractitioners (ICPs). Currently there are 14.5 positionslocated throughout the region.

ICPs are registered nurses who have advancedtraining in infection prevention and control and whomonitor and promote environmental cleanliness, foodsafety, air quality and general safety as part of their role.A large part of their focus is on hand hygiene. Theyserve as role models and provide guidance to otherhospital healthcare providers, support staff, patients andvisitors, promoting policies and procedures.

Brenda Earles, a registered nurse, is an ICPassigned to several programs in acute care at the HealthSciences Centre.

“We need to create a culture that supports handhygiene,” says Brenda. “To do this we encourage leadersto model and support it. It’s really important thateveryone participate in infection prevention andcontrol.

“It isn’t just one person’s job.”Brenda also encourages patients to be active

participants in their care. “Of course the onus shouldn’tfall on the patients to remind us to wash our hands. Butthey should feel comfortable in doing so.”

Just Do It!So what is the bottom line? With clean hands we

can save lives. Something so basic can have such atremendous impact.

Thirty seconds of your life could mean a lifetime tosomeone else. �

According to the CPSI andthe Public Health Agencyof Canada:• 80 per cent of hospital staff who dressed

wounds infected with Methicillin-resistantStaphylococcus aureus (MRSA) carried theorganism on their hands for up to three hours

• 60 per cent of hospital employees, within halfan hour of contact with patients with Clostridiumdifficile infection, were contaminated without evenhaving touched the patient… from merelyreturning drug charts to the ends of beds

• Health care associated infections affect more than220,000 people every year in Canada and killfrom 8,000 to 12,000 and is the fourth leadingcause of death

• HAIs lead to long-term disability, preventabledeaths, and an additional financial burden on thehealthcare system

• Proper hand hygiene, when demonstrated byleaders, has been shown to positively influence thecompliance of others by up to 70 per cent

— Melisa Valverde

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