clinical quality programs - northern health...facility implementation of the new regional bfi...
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the northern way of caring
Jordan Oliver, RN Executive Lead, Emergency and Trauma Program
Dr. Patrick Rowe Medical Lead, Emergency and Trauma Program
CLINICAL QUALITY PROGRAMSFebruary 2019
Emergency and Trauma Program
• NH was awarded ‘Distinction in Trauma Services’ and successful trauma centre designations for all NH acute care facilities
• Participated in the Accreditation Canada, Trauma Distinction Program in October 2018
− Accreditors were impressed with the work and effort from all involved in the trauma survey process and the shared commitment to the continuous improvement of trauma care
• In April 2019, we will begin implementing EmergCare — a quality improvement and transformation project to standardize NH
emergency department clinical processes, clinical practice, documentation and reporting, and to help with implementing the enabling IT tools/electronic medical record
• Together with the planning and performance improvement team, we have created a three year service action plan with five priority areas of focus:
1. Establish a regional approach to improve patient access and flow
2. Establish continuous quality improvement initiatives in all service areas
3. Strengthen relationships between emergency services, primary care, and community services
4. Expand the use of technology in the delivery of emergency and trauma services
5. Meet Accreditation Canada standards and performance indicators
For more information, contact: [email protected]
CLINICAL QUALITY PROGRAMS NEWSLETTER | February 20192
Perinatal Program
Vanessa Salmons Executive Lead, Perinatal Program
Dr. Bill Kingston Medical Lead, Perinatal Program
• Since June 2018, established the Perinatal Program Council and held 3 meetings to establish the strategic priorities and goals for the program
• Formed a regional development team in partnership with NH Education Services to support a strategy framework and recommendations for perinatal nurse education in the north
• Collaborating with the Mental Health and Substance Use Program and Child and Youth Health Program to establish an overarching MHSU strategy for the North that is inclusive of the perinatal and young family population
• Collaborating with Optimal Birth BC to determine induction of labour and fetal health surveillance as clinical focus areas for quality improvement and monitoring
• Working on the Baby Friendly Initiative (BFI) 10 Steps Standardization — supporting site/facility implementation of the new regional BFI Clinical Practice Standard in selected sites
• Completed MOREOB Plus milestone 13, goal planning, for all 11 Core Teams in the north
• Working on the midwifery review
− The purpose of this review is to conduct regional, community and provider consultations in support of low risk obstetrical services in a rural and remote geography and collaborative models of maternity care delivery
• Encouraging primary care providers to support patient enrollments in SmartMom Prenatal Text Messaging Project: www.smartmomcanada.ca
For more information, contact: [email protected]
CLINICAL QUALITY PROGRAMS NEWSLETTER | February 2019 3
Professional Practice
Cat Martin Lead, Professional Practice Nursing
Suzanne Watson Lead, Professional Practice Allied Health
Cathy CzechmeisterLead, Professional Practice Nursing
• Welcome to Cat Martin, Lead, Professional Practice — Nursing, for the Northeast/Northwest
• Cathy Czechmeister and Cat Martin provide regional leadership for professional practice of nurses, and Susanne Watson for allied health professions
• Current work includes the initial management of anaphylaxis by nurses and advances in the role of nurses in the management of wounds
• The interprofessional admission assessment and plan of care have been improved and standardized across all NH acute care sites
− Ongoing work continues to revise these tools and encourage uptake
• NH executive has approved a proposal to develop a Regional Rehabilitation Services Strategy. This work will focus on identifying key priorities and actions that will improve the quality, coordination, and integration of rehabilitation services across the region
− An advisory group will advise Northern Health on rehabilitation services; human resources; clinical leadership and quality; and key rehabilitation initiatives such as pre-surgical optimization and community based cardiopulmonary rehabilitation programs
For more information, contact: Professional Practice
CLINICAL QUALITY PROGRAMS NEWSLETTER | February 20194
Mental Health and Substance Use Program
Michelle Lawrence Executive Lead, Mental Health and Substance Use
Dr. Gerrard Prigmore Medical Lead, Mental Health and Substance Use
Dr. Barb Kane Medical Lead, Mental Health
• Welcome to Dr. Fredeen, Medical Lead for Addiction Medicine NI; Dr. Ohiaeri, Medical Lead for Addiction Medicine NE; and Dr. Page, Medical Lead for Addiction Medicine NW
− Recruitment underway for Medical Lead for Addiction Medicine NI Rural
• Welcome to Nick Rempel, Strategic Lead, Regional Substance Use Program
• The Mental Health and Substance Use (MHSU) Business Owner Working Group is continuing the ongoing regional work arising from the Northern Shared Care Psychiatry Collaborative and the implementation of the MHSU Service Model
• Continued implementation of the opioid response plan is focused on:
− Enhancing drug checking and overdose prevention opportunities throughout the North through education and training
− Expanding Opioid Agonist Therapy (OAT) prescriber numbers throughout the north
− Residency program — Dr. Prigmore has been working with the University of British Columbia to coordinate a mandatory addiction medicine rotation with the residency program
− Support for professional education and training for physicians and health care providers to increase substance use capacity within NH
• The Program and Northern Health Indigenous Health worked with the First Nations Health Authority to develop a proposal to the Joint Project Board (JPB). The proposal is for the creation of Mobile Support Teams to provide Mental Health and Addictions services to First Nations people both on and off reserve.
− Ten communities in the North have been identified to be served by Mobile Support Teams (MST) to provide MHSU services to 43 of the 54 First Nations communities
− The Mobile Support teams deliver mental health and substance use clinical services in First Nations communities, and link with primary care homes and interprofessional teams
− Funding is in place for the Mobile Support Teams to create 26 MHA nurse and clinician positions. The teams are being established in three phases to provide outreach to First Nations communities:
• North West: Hazelton, Terrace, Haida Gwaii, and Dease Lake
• Northern Interior/Central: Burns Lake, Fort St. James, Quesnel, and Prince George
• North East: Fort St. John, and Fort Nelson
− Seven of ten Mobile Support Teams are currently delivering services throughout the North
CLINICAL QUALITY PROGRAMS NEWSLETTER | February 2019 5
Physician Quality Improvement
Candice Manahan Executive Lead, Physician Quality Improvement
Dr. Anurag Singh Co-Chair, Regional Physician Quality Improvement Steering Committee
Dr. Ian Schokking Medical Lead, Continuing Medical Education
Dr. Jamil Akhtar UHNBC Physician Quality Improvement Mentor
• Within the portfolio is the Continuing Medical Education (CME) program. The program medical lead is Dr. Ian Schokking and he works in partnership with Heather Gummow.
• Within the Physician Quality Improvement Program, the regional steering committee co-chair is Dr. Anurag Singh and the UHNBC Physician QI Mentor is Dr. Jamil Akhtar
• Program was established in 2015 to help facilitate a vision for co-leadership and to help engage physicians in quality improvement
• One of the key activities for Physician Quality is collaborating with the Specialist Services Committee and Shared Care Committee to deliver various programs within our health authority:
1. Health Care Redesign: allows NH to compensate physicians at the sessional rate for participation in time-limited, project-based, system redesign work within NH.
2. Physician Leadership and QI Training: supports physicians to attend external leadership training, such as the UBC Sauder Business School Physician Leadership course or the Canadian Physician Leadership conference.
3. Physician Quality Improvement: this team provides training and support to physicians, through technical resources and expertise, to lead quality improvement projects and build QI capacity among physicians.
4. Facility Engagement: in partnership, we support the ongoing collaboration between the health authority and physicians at both the site and regional levels. Through these efforts, we consistently monitor our commitment to physician engagement set out in the Memorandum of Understanding.
For more information, contact: [email protected]
CLINICAL QUALITY PROGRAMS NEWSLETTER | February 20196
Child and Youth Health Program
Dr. Matthew Burkey Medical Lead, Child and Youth Health Mental Health
Jennifer Begg Executive Lead, Child and Youth Health
• Welcome to Dr. Matthew Burkey, Medical Lead, Child and Youth Mental Health
• The Child and Youth Health Program has created this newsletter to bring you the best resources and practice tips to support children, youth and families with mental health issues.
For more information, contact: [email protected]
CLINICAL QUALITY PROGRAMS NEWSLETTER | February 2019 7
Surgical Services Program
Shelley Hatcher Executive Lead, Surgical Services
Dr. Jim Dunfield Medical Lead, Surgical Services
• Welcome to Dr. Jim Dunfield, Medical Lead for the Surgical Services Program
• Priorities include the implementation of the Ministry of Health Surgical Action Plan and initiatives related to the Surgical Council’s 3-year plan
• The Ministry of Health’s surgical action plan focus is on ‘improving timely access to appropriate surgical procedures’ and ‘improving patient experience.’ Wait time targets have been provided for total hip and knee arthroplasties and dental procedures. A hip and knee replacement program has been established at UHNBC this year.
• Partnering with the Ministry of Health and other BC health authorities to develop a virtual self-management program for patients waiting for surgery
• Working with the Ministry of Health to develop and implement a provincially lead PREMS (patient reported experience measure) and PROMS (patient reported outcome measure) survey. Total joint arthroplasty patients will be the first focus group to receive the survey.
• Focusing on the development and spread of standardized pathways
− Standardized pathways include Enhanced Recovery after Surgery (ERAS) for colorectal surgeries, Fractured Hip and Total Hip and Knee arthroplasties
• Ongoing work between the Surgical Program, Perinatal Program and Medical Directors to plan and support the Rural Surgical and Obstetrical Networks (RSON) across the north.
For more information, contact: [email protected]
CLINICAL QUALITY PROGRAMS NEWSLETTER | February 20198
Primary and Community Care Program
Pam Mulroy Executive Lead, Primary and Community Care
Dr. Paul Murray Medical Lead, Primary and Community Care
Helen Bourque Nurse Practitioner
• Great progress has been made to recruit and retain nurse practitioners (NP)
− This includes 3 recent hires for Prince Rupert, Coast Tsimshian and Fort St. John
• Two Resource NPs are assisting with NP leadership in the North, coordinating orientation for new hires, supporting new hires in their clinical areas, and contributing to the strategic development of the NP role
• Working on the ongoing integration of NPs as members of the Northern Health Medical Staff
• As we continue with the transition to primary and community care, focused work is underway to clarify the mandate of diagnostic and treatment centres.
− We are hosting discussions with communities to gain an understanding of the daily operations and challenges or any barriers that sites with diagnostic and treatment centres may experience
− Learnings from these site discussions will be used to focus support and shape a forum to allow for an opportunity to share learnings and experiences
• The Community Health Record Working Group supports the implementation of the electronic medical record through a coordinated approach
− Recent implementations include Terrace, Dease Lake and the Prince George Mobile Support Team
• The program is working together with other program areas through the Business Owner Working Groups (BOWGs) to document the service areas and relationships between primary and community care and specialized community services.
− The initial areas of focus are services for people experiencing mental health and substance use concerns and for seniors experiencing frailty
For more information, contact: [email protected]
CLINICAL QUALITY PROGRAMS NEWSLETTER | February 2019 9
Pharmacy Services
Do not use Correct termU, IU, u, or iu unitOD, QD, or qd dailyQOD or qod every other dayAbbreviated drug name Generic drug nameD/C Discharge/discontinuecc mLµg mcg/microgram@ at> or < Greater than or less thanTrailing zero (x.0 mg) No zeros after decimalLack of leading zero Use zeros before decimalsOS, OD, OU Left eye, right eye, both eyes
Dana Cole Regional Director, Pharmacy Services
• NH supports a focused project to ensure all acute and long term care facilities in Northern Health have a fully developed medication reconciliation process across all transitions of care including admission, transfer and discharge. This project has been underway since June 2017.
Progress to date
− Supporting documents and tools have been revised by interprofessional working groups to better meet patient care needs and health professional needs
− Education materials for nurses and physicians have been developed or revised, including a CME lunch-and-learn module
− Two patient partners from Patient Voices Network worked with the consultants and the interprofessional development team to ensure the patient experience is at the forefront of discussions. They have been instrumental in the development of a “Know Your Medications” patient and family information page on the NH website
− A phased approach has been followed for implementation of the improvement work and new processes have been fully implemented at five hospitals and one long term care facility. In addition, five hospitals and four long term care facilities are in active stages of planning.
Next Steps
− Local improvement implementations will continue in a phased approach. Accreditation Canada will be surveying NH for primary and community care in the spring of 2020 and MedRec is a requirement. This improvement work will begin following completion of the acute care project.
• Pharmacy also prioritizes safe medication order writing (SMOW)
− Safe medication order writing is an Accreditation Requirement for all health authorities, nationwide. Staff can find the following SMOW courses on the Learning Hub:
• NHA – PHAR – Safe Medication Order Writing for Prescribers
• NHA – PHAR – Safe Medication Order Writing for Non-Prescribers
− Using unacceptable abbreviations when writing orders in the chart is known to have a high risk of causing harm or death to patients nationally
− Further details on safe medication orders are in the Clinical Practice Standard – 1-20-6-4-010 Safe Medication Order Writing available on the OurNH website.
For more information, contact: [email protected] [email protected]
CLINICAL QUALITY PROGRAMS NEWSLETTER | February 201910
Critical Care Program
BethAnn Derksen Executive Lead, Critical Care
Dr. MJ Slabbert Medical Lead, Critical Care
Identified priorities are:
1. Standardized Documentation
2. Standardized Admission/ Discharge criteria
3. Electronic Documentation
4. Repatriation processes
• The Critical Care program has two program goals and one sustainability goal:
1. Sepsis: improve and maintain the use of the sepsis protocol in all emergency departments and in-patient units through the development and implementation of a sepsis protocol audit tool
2. Improve care for patients experiencing pain, agitation and delirium in intensive care units: improve care for patients in intensive care units with pain, agitation and delirium (PAD) through the development and implementation of leading practice protocols.
3. Sustainability goal: transfer of care documentation
• Critical care network development:
− Critical Care program executive and medical leads completed site visits at each of the NH critical care sites to talk with staff and medical leadership to seek input and establish a collaborative working relationship with the physicians and clinical leads. The program wants to ensure the work is reflective of the needs of the local teams and move towards a standardized approach to critical care service delivery.
− A reference group met in May 2018 to collaboratively identify common areas of clinical practice needing clinical practice standards, order sets, joint mortality and morbidity rounds, clinical consultation across NH and “at the elbow” support.
For more information, contact: [email protected]
CLINICAL QUALITY PROGRAMS NEWSLETTER | February 2019 11
Elder Program
Aaron Bond Executive Lead, Elder Program
Dr. Dick Raymond Medical Lead, Elder Program
• Welcome to Aaron Bond who accepted the role of Executive Lead, Elder Program effective February 11, 2019; April Price left the role January 25, 2019 to pursue a joint consulting business with her husband
• The Elder Program Council has reconvened and is planning a second meeting for February 2019
• The Regional Geriatric Specialized Services Model first phase of implementation is underway in Kitimat, Chetwynd, and Fort Nelson
− Pre-planning for phase two implementation is underway in Prince George and Quesnel
• The home support redesign first phase of implementation is underway in Terrace and the Lakes Omineca area (Vanderhoof, Fraser Lake, and Fort St. James)
− Focused efforts have been on implementing the Contact RAI as a standardized screening tool in both communities
− Terrace will implement person-centered clustered care for provision of long term home support services as well as integrate short term rapid response home support functions to the interprofessional teams
− The Lakes Omineca area is transitioning home support to interprofessional teams
• Work is underway to identify and implement one electronic medical record for documentation in our long term care homes
For more information, contact: [email protected]
CLINICAL QUALITY PROGRAMS NEWSLETTER | February 201912
Medical Affairs
Gregory Marr Regional Director, Medical Affairs
Key focus areas for 2019 include:
1. Renewing the medical staff Health Human Resource 5-year plan
2. Improving the medical staff onboarding experience
3. Integrating nurse practitioners into the medical staff
4. Violence prevention training for physicians
• This program works with medical leadership work to support new, current, and future medical staff members (i.e. physicians, nurse practitioners, dentists, and midwives):
− Recruitment: The recruitment team works with medical leaders and other partners (such as the Divisions of Family Practice and municipal leaders) to lead or support retention and recruitment activities. Last year the team generated about 400 leads and referrals and conducted 45 site visits.
− Onboarding: This includes leading or supporting contract negotiations and subsequent offers, relocations, and setting up accounts and access to NH locations and systems. Improving the onboarding experience is a priority focus area.
− Credentialing and Privileging (C&P): In accordance with the NH Medical Staff Bylaws and Rules and applicable legislation, the C&P office is responsible for overall administrative management for medical staff membership (~1100 individuals).
− Supporting Sites and Programs: Local issues, needs, and opportunities shift and change and Medical Affairs staff provide support in data and analytics, business case development, setting up new services and programs, and providing advice. We also liaise with provincial partners such as the Ministry of Health and Doctors of BC.
− Retention: The team is increasing their retention efforts, and a comprehensive retention plan is in development, as part of the HR planning process.
− Off-boarding: When individual practitioners leave a community or program, in addition to completing the required access and systems close-outs, there is an opportunity to celebrate and recognize accomplishments.
For resources or more information, contact [email protected] or visit physicians.northernhealth.ca
CLINICAL QUALITY PROGRAMS NEWSLETTER | February 2019 13
Regional Chronic Diseases Program
Jessica Place Executive Lead, Chronic Diseases
Dr. Colin Phillips Medical Lead, Chronic Pain and Specialized Care
Dr. Devan Reddy Medical Lead, Chronic Pain Primary Care
Dr. Abu Hamour Medical Lead, HIV and Hepatitis C Care
Dr. Jaco Fourie Medical Lead, Cancer Care
Dr. Anurag Singh Medical Lead, Kidney Care
Dr. Haidar Hadi Medical Lead, Cardiac Care
• Welcome to Dr. Colin Phillips, Medical Lead, Chronic Pain Specialized Care and Dr. Devan Reddy, Medical Lead, Chronic Pain Primary Care
• The program provides strategic leadership and stewards NHs response to chronic diseases for the entire population of the North
• Supports the planning and delivery of services for those living with chronic diseases such as: cancer, kidney disease, heart disease, stroke, HIV and hepatitis C, diabetes, COPD, and chronic pain
• Initiatives include:
− Improving colonoscopy wait times
− Improving breast cancer diagnostic timelines
− Completing a community consultation on heart health including an action plan for cardiac care
− Improving supports for patients living with chronic pain and their providers
− Increasing HIV and Hepatitis C testing rates in primary care
− Sustaining access to interdisciplinary team-based specialized kidney care using Telehealth and reducing dialysis wait times
For more information, contact: [email protected]
CLINICAL QUALITY PROGRAMS NEWSLETTER | February 201914
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