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INSIDE THIS ISSUE President’s Message.......................................1

Dynamic 2016...... ..........................................2

Hospital Spotlight ..........................................3

Charity Partnership........................................4

Practice Highlights ........................................4

Current Critical Research...............................4

Upcoming Events and Conferences...............5

Executive Team 2016-2017 ..........................5

Contact US........... .........................................5

TORONTO CHAPTER NEWSLETTER

President’s Message I hope that many of you are reading this & had the opportunity to

attend Dynamics 2016 in PEI. Dynamics is a great venue to refresh,

renew your knowledge, make new friends and is a fun and

stimulating conference to attend. Please see Teresa’s summary of

Dynamics 2016.

Toronto will be the host city for Dynamics 2017, thus the decision was made not to host a 2017 Evolutions Conference. Our next Annual Evolutions Conference will be held on Monday, May 1st/2018. Our annual 2016 Evolution Conference was another successful

educational event. We focused on evidence-based topics of present

and future practices which will enhance your clinical practice,

leadership, education and research in your critical care setting. We

also hosted two successful review workshops, facilitated by

Michelle Cleland. We are looking forward to another exciting year for the Toronto Chapter. The Executive is hard at work on the following new & exciting initiatives:

Partnering with the following two non-profit organizations:

1) Canadian Food for Children

ww.canadianfoodforchildren.net 2) Sleeping Children Around the World

www.sleepingchildrenaroundtheworld.com

Four new Sponsored Lunch & Learn sessions between January & March 2017, at the following locations; Lakeridge Health Oshawa, North York General Hospital, Scarborough General Hospital & South Muskoka Memorial Hospital Site. We will be utilizing Web & Video Teleconference to reach a broader audience who cannot attend in person. Stay tuned for further details!!

New & improved changes to our chapter website

More informative & educational content in our Newsletter such

as:

Toronto Chapter Hospital Spotlights-We want to highlight

all the awesome hospitals within our chapter boundaries

Articles & links to current research in critical care

Starting up a Critical Care Nursing Journal Club more

information to follow

Road Show aiming to hit all of our local member hospitals in our chapter boundaries focusing on retention, recruitment & creation of hospital representative from each hospital to improve communication & awareness of what CACCN is about

Practice Updates

I would like to see our critical care members connect, support, learn and network from each other. We all have so much knowledge, skills and expertise to share amongst us. Let’s all come together and explore our ever expanding knowledge base.

We as critical care nurses are a dynamic force with strong voices that need to be heard, please support your Executive committee in attending the best educational sessions, updates, and issues surrounding current trends in critical care. We want to hear from our members and non-members either through offering your voice through our newsletter, which will now be distributed quarterly, Twitter or e-mailing at ingrid.daley@uhn.ca or caccn.executive@gmail.com Please continue to support our Chapter and we encourage all our colleagues to join CACCN-Toronto Chapter. As a critical care community we really need to work together and support each other to keep us strong and updated. I would to like to introduce everyone to our hard-working 2016/2017 Toronto Chapter Executive Committee Members: Veronica Dekker, Christine Wong, Audra Huxtable, Jo-Ann Fernando, Teresa Robitaille, Karen Dryden-Palmer & Raaj Sekon. “The possession of knowledge does not kill the sense of wonder and mystery. There is always more mystery.” Anais Nin (1903-1977).

Thanks Ingrid Daley, President

Welcome to Fall 2016 Edition of Critical Connections

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The warm September weather drew critical care nurses from across the country to join together for the annual CACCN Dynamics 2016 Conference, where critical care nurses provided a forum to share ideas and experiences. Dynamics 2016 was held in the beautiful city of Charlottetown, PEI. To a theme of “Changing tides in Critical Care Nursing: “Riding the Waves Together to Provide Quality Care”.

CACCN Theme quote: “Nurses are forever experiencing an aging population, increasing complexity of disease and treatments, rapid advances in technology and environments of care, funding limitations and shifting societal expectations are forces that drive this tide to change and test our capacity to lead and adapt.” Dynamics 2016 illustrated how these tides rise and recede.

The three day conference commenced with a warm and spirited opening ceremony with a little P.E.I. flare. The National CACCN Board of Directors and Planning Committee for Dynamics 2016 were introduced and welcomed the delegates from across Canada.

Keynote Speaker Dr. Beth Henneman, an Associate Professor in the College of Nursing at the University of Massachusetts’s in Amherst, kicked things off with a talk about the historical success of critical care nurses transforming the care of patients and their families through research and applying evidence-based practices. As a delegate in the audience I could see many heads nodding in acceptance, and many whispering words of affirmation to one another. Dr. Henneman’s words re-ignited that little flame that burns within every critical care nurse- to advocate for their patients and their families even when that invisible wall is erected in front of them when they are voicing concerns for the safety of their patient(s). Dr. Henneman presented past evidence and current patient safety strategies, and offered suggestions for new practices for the future, that we as nurses can control in both clinical and educational settings. Dr. Henneman’s title- “Creating a Sea of Change in Patient Safety: The Role of the Critical Care Nurse-Past, Present and Future”, started the thread for the many other sessions that followed.

The break-out sessions and poster presentations were congruent with this year’s conference theme. The presentations illustrated that no matter what province, territory, city or town we are from, every critical care unit, nurse, advance practice nurse educator and nurse leader experience change. But the outcomes remain the same across Canada-nurses prevail as leaders who are tested and adapt to provide exemplary care now, and build for the future of critical illness care.

As a delegate at the conference many sessions illustrated how nurses became leaders in critical care when faced with changes in protocols, increasing complexity of disease and treatment, rapid technological and environmental advancements, decreased funding, daily nursing shortages, and the shift towards patient centered care. Now the tides have changed. Critical care nurses have had to embrace the new face of critical care illness- collaboration with the extensive health care team which now includes the patient and family members.

Karen McQuillan, the plenary speaker who discussed Courageous Care, said “Courageous care requires critical care nurses to care with compassion, renew themselves, maintain a sound knowledge base, and serve as leaders”. She discussed the importance and described key nurse behaviors of

compassionate care and discussed what vulnerabilities nurses face- compassion fatigue, moral distress, burnout and change fatigue. This resonated with other sessions that too discussed these issues. The key point that speakers and delegates surmised is that burnout is happening in every critical care unit and if not resolved, this complex issue will continue to threaten the quality of care that is provided.

This year the conference provided Mastery Sessions that offered educational member engagement and participation. I for one was thrilled to have experienced this, and it echoed through the hallways as delegates excited the rooms of five different mastery sessions.

At the end of this day when some retreated to their rooms for the much needed rest, others enjoyed the P.E.I. Beach Party with real sand in the hotel party room that was hosted by the Dynamics 2016 Planning Committee. It was a fun filled night in shorts, tank tops, sunglasses and flip flops; even if the weather outside dictated the need for warmer clothing.

The last day of the conference ended with closing speaker, Colleen Breen a critical care nurse from London, ON, who eloquently spoke of Suffering: A Gift or a Burden by using her own health crisis as an example of how she was able to explore and find new meaning and share it with us. Delegates were taken back with her story and how she turned this life changing experience around to something positive in her practice and shared it to enlighten others.

The Toronto Chapter would like to congratulate the following members who received awards at Dynamics 2016.

Canadian Intensive Care Week Spotlight Challenge Award: Elizabeth Layden, Brampton, ON CACCN Educational Award-Fall 2015 Julie Ann Airth, Toronto, ON CACCN Educational Award-Winter 2016 Diana Heng, Toronto, ON

Dynamics 2016 Poster Award-First Place Francis Cacao, Maria Fatima Diego, Mamta Modgil, Thanusah Sanmugavadivel, Manpreet Kainth, Patricia Collantes, Sarah Luckhardt, Yemi Adebayo, Jane Cornelius, Maria Vaglica and Cecile Marville-Williams-Humber River Regional Hospital, Toronto, ON Dynamics 2016 Poster Award-Second Place Melissa Guiyab, Nancy Rudyk, Mary Mustard, Joyce Grandy, Debbie Snatenchuk and Pamela McLachlan-St. Michael’s Hospital in Toronto, ON

Dynamics 2016 Poster Award-Electronic Poster Mary Mustard, Darren Day and Ellen Lewis -St. Michael’s Hospital in Toronto, ON Dynamics 2016 Poster Award-Delegate’s Choice Melissa Guiyab, Christine Leger, Orla Smith, Mary Mustard, Vasuki Paramalingam, Prafulla Savedra and Shannon Smith-St. Michael’s Hospital in Toronto, ON

On behalf of the Toronto Chapter, I would like to thank the Dynamics 2016 Conference Planning Committee for their hard work in making this year’s conference a huge success. The Dynamics 2017planning committee is looking forward to seeing everyone in Toronto, Ontario next September.

Thanks, Teresa Robitaille, Membership Coordinator

DYNAMICS 2016

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Hospital Spotlight

Lakeridge Health is a large community based organization within Durham Region with two Medical Surgical Critical Care (CrCU) sites, a Level 3 CrCU 27 bed unit at Oshawa and a Level 2 CrCU 6 bed unit at Bowmanville. These units hold a closed unit philosophy of having an Internivist Lead Program.

Currently, we have two new initiatives that the CrCU staff have developed. Recently implemented is the Transfer of Accountability at the Bedside with Patient/Family Presence. This working group has formulated a Standard of Practice that highlights safety and the patient and/or family experience.

An interprofessional working group - the CrCU Palliative and Compassionate Care Working Group, has developed how to support the patient and family during the end of life process. This working group designed an Evidence Based approach on assessing, treating, and supporting the patient and family during this difficult time.

There are several services that Lakeridge Health CrCUs bring to our committee, such as Continuous Renal Replacement Therapy, a Critical Care Outreach Team, and endorsed as part of the Heart and Stroke Accredited facility for Best Practice in Stroke Care.

Lakeridge Health is also recognized as leaders in the Heart and Stroke Resuscitation Strategy in which our Nurses and Registered Respiratory Therapists are ACLS and Interosseous certified through our in-house training.

What some may not know is that Lakeridge Health CrCU is closely affiliated with Queens University and have several Residents who support our larger CrCU, mentor nursing students through UOIT and Durham College Critical Care Certificate Program, as well as other interdisciplinary programs.

Thank you CACCN for highlighting our Critical Care facilities at Lakeridge Health.

Thanks, Sherry Campbell RN, BScN, Bach. Ed. (Adult), MScN Patient Care Specialist

Trillium Health Partners is a three-hospital group comprising the Credit Valley Hospital, Mississauga Hospital, and Queensway Health Centre (formerly the Queensway General Hospital) serving the diverse communities of Mississauga, the Halton-Peel region, and Toronto. Trillium Health Partners is Canada’s largest community-based, academically affiliated hospital, and has the largest Emergency department in Canada. Trillium Health Partners is affiliated with the University of Toronto and has jointly created the Mississauga Academy of Medicine. Trillium Health Partners was formed with the amalgamation of the Trillium Health Centre and the Credit Valley Hospital on December 1, 2011. Trillium Health Partners' work of providing health care is supported by the fundraising efforts of the Trillium Health Partners Foundation, which was formed through the merger of the Credit Valley Hospital Foundation and the Trillium Health Centre Foundation in 2013.

As a recognized leader in health innovation, Trillium Health Partners boasts a talented team of clinicians, administrators, physicians, staff and volunteers who offer a wealth of expertise across a wide range of topics. Our facility features some of the top medical professionals and administrators in the country, and is earning a solid reputation for its regional programs in highly-specialized

regional programs in Advanced Cardiac Surgery, Geriatric Mental Health Services, Hepato-Pancreato-Biliary Services, Neurosurgery, Cancer & Palliative Care, Primary Percutaneous Coronary Intervention, Sexual Assault and Domestic Violence, Specialized Geriatric Services, Stroke Accreditation, and Vascular Services. As health care evolves in Ontario, Trillium Health Partners will continue to challenge itself to innovate, set benchmarks, and deliver the services that best meet our communities' needs as we continue on our mission to transform the health care experience.

Trillium Health Partners has total 98 critical care beds distributed among CCU, ICU, CSICU and Neuro MSK ICU. The two Critical care units are all level 2 & 3 critical care patients. The Mississauga Hospital site has 31 intensive care beds and provides care for medical surgical vascular and neurosurgical patients. Mississauga Intensive care units provide closed unit support by intensivist lead team and provide specialized services in Continuous renal replacement therapy, Critical care response teams and are an active member of regional life or limb program. We provide educational opportunity to all staff including international, internal medical surgical nurses and new critical care graduates from various critical care programs.

Thank you CACCN for highlighting Critical Care facilities at Trillium Health Partners-Mississauga Site.

Best regards, Ida Bevilacqua RN, BScN, CNCC(c) Clinical Educator

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PICTURES

Current

Critical

Care

Research PROSPECT TRIAL – run under the auspices of the Canadian Critical Care Trials

Group. Looking at the use of probiotics for the prevention of ventilator associated pneumonia. Funded by CIHR. Dr. Deborah Cook and Dr. Jennie Johnstone

www.prospecttrial.com/probiotics/

EUPHRATES TRIAL - is a randomized, double-blind controlled, clinical trial that compares standard of care versus standard of care and Toraymyxin, directed by Spectral’s EAA™ Endotoxin Activity Assay. The target population is critically ill patients with septic shock and endotoxemia.

Currently closed to enrollment, the database is currently being cleaned with the hopes of a release of preliminary results in the fall of 2016.

www.spectraldx.com/euphrates-trial.html

CHARITY PARTNERSHIP

SLEEPING CHILDREN AROUND THE WORLD

We lead a 100% charitable global

community of volunteers & partners

who have transformed the l ives of

over 1.4 mil l ion children in

developing countries through a

good night’s sleep. To learn more

about this great organizat ion please

visit their website below.

www.sleepingchildrenaroundtheworl

d.com

Sleeping Children around the World is

excited to announce our first-ever Sleep

Day on Friday, November 4th. We

encourage all Canadians to participate by

going to school or work in your pyjamas in

preparation for the end of Daylight Saving

Time on Sunday, November 6th.

Please see flyer below and l ink to

more information on how to donate.

http://www.scaw.org/sleepday

Toronto Chapter wil l be partnering

with Sleeping Children around the

World to Fund raise for Bed kits to

benefit children around the world to

be delivered over Christmas. Our

goal is $500.00 but we would love

to raise as much as possible. Each

Bed Kit is worth $35.00. Further

details wil l be made available at the

Toronto Chapter website .

CANADIAN FOOD FOR CHILDREN

Toronto Chapter will also be partnering

with Canadian Food for Children. Please

visit their website for further information

about their organization.

www.canadianfoodforchildren.net

Toronto Chapter over the next few months

will be hosting a Food & Clothing drive to

support the needs of poor children around

the world. Further details will be made

available on the Toronto Chapter website.

PRACTICE HIGHTLIGHT MORAL DISTRESS IN ICU NURSES

Mealer and Moss (October, 2016)

The intensive care unit (ICU) is a stressful environment due to high patient mortality and

morbidity, daily confrontations with ethical dilemmas, and a tension-charged atmosphere [1].

The ICU is an especially complex and difficult work environment for critical care nurses. Critical

care nurses are repeatedly exposed to work-related stresses, including involvement in end-of-

life discussions, prolongation of life with artificial support device, and the potential for delivering

inappropriate care [2]. When confronted with these stressful situations, nurses may feel

powerless, unable to provide care according to their own belief system, and therefore prone to

develop moral distress.

http://link.springer.com/article/10.1007/s00134-016-4441-1

GUIDANCE ON NURSES’ ROLES IN MEDICAL ASSISTANCE IN DYING College of Nurses of Ontario (July, 2016)

Medical assistance in dying requires the involvement of an NP or a physician. An NP can

provide an eligible client with medical assistance in dying provided that it is done in accordance

with the law as well as any applicable provincial laws, rules or standards. Registered Nurses

(RNs) and Registered Practical Nurses (RPNs) can participate by providing nursing care and

aiding an NP or physician to provide a person with medical assistance in dying in accordance

with the law. In relation to clinician-assisted medical assistance in dying, the law only allows

NPs and physicians to administer medications to cause the death of a client who is receiving

medical assistance in dying. No other persons, including RNs and RPNs, are legally permitted

to administer medication for medical assistance in dying.

http://www.cno.org/globalassets/docs/prac/41056-guidance-on-nurses-roles-in-maid-july-4-vfinal.pdf SEPSIS UPDATE 2016 Assessment of Clinical Criteria for Sepsis Christopher, Seymour, Vincent et al. (February, 2016); The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) Singer, Deutschman, Seymour et al. (February, 2016)

JAMA has published updated articles on consensus document that has changed the definitions for sepsis and septic shock (severe sepsis no longer exits).SIRS criteria (WBC, RR, HR, Temp) are out and consensus is now qSOFA (Quick Sequential Organ Failure Assessment). A positive screen now means at least 2 of the following 3 are true: altered mentation (new or change), RR /= 22 & SBP/= 100. SIRS criteria were too sensitive as a higher percentage of patients were being screen yes for positive sepsis but were not which diverted limited resources for patients who were not ill. qSOFA identifies sicker patients and more specific as a tool in targeting the identification of the patients who were truly septic. http://jamanetwork.com/journals/jama/fullarticle/2492875 http://jamanetwork.com/journals/jama/fullarticle/2492881

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Thank Yous

Thank you for attending

Dynamics 2014

Health Achieve 2016

November 7th

to 9th

/2016 Metro Toronto Convention Centre Toronto Global Antibiotic Awareness Week

November 14th

to November 18th

/2016 5

th Annual Sunnybrook Education

Conference

Friday, November 18th

/2016

Sunnybrook Health Sciences Centre

Contemporary Cardiac Care Conference

November 19th

/2016 Four Seasons Hotel in Toronto IHI 28

th Annual National Forum on

Quality Improvement in Health Care

December 4th

to December 7th/2016

Orlando Florida

Canadian Critical Care Conference

March 1st to March 3

rd /2017

Whistler, BC

Lunch & Learn CACCN Toronto

Chapter & Molnlycke Health Care

Pressure Injury Prevention

March 2017 from 11:00-14:30-Date still

to be confirmed

Scarborough General Hospital

Lunch & Learn CACCN Toronto

Chapter

March 8th

/2017 from 11:00-14:30

Lakeridge Health Oshawa

22nd

International Conference on

Advances in Critical Care Nephrology

AKI & CRRT

March 7th

to March 10th

/2017

San Diego, California

NTI-American Association of Critical

Care Nurses

May 22nd

to May 25th

/2017

Houston, Texas

CACCN TORONTO CHAPTER EXECUTIVE TEAM 2016 -2017

Ingrid Daley President Christine Wong Vice President Evolutions/Education Coordinator Raaj Sekhon Secretary Veronica Dekker Treasurer Teresa Robitaille Membership Coordinator Karen Dryden-Palmer Pediatrics Consultant Jo-Ann Fernando Website Coordinator Audra Huxtable Newsletter Editor

CACCN TORONTO CHAPTER Mail: P.O. Box 79660 1995 Weston Road, Toronto, ON, CAN Email: caccn.executive@gmail.com Website: http://www.torontocaccn.ca