Breakout Sessions

2018 Plenary Presentations: Tim OmerMichael WestCamila Lajolo


Tim Omer Empowered Citizen "Health Hackers": We Are Not Waiting!

Thursday, January 1st | -

Listen to Tim’s presentation on your phone! Download the mp3 version here, or listen to it below. (Right-click the link and choose “Save Link As”)


Michael West Compassionate and Collective Leadership for High-Quality Health Care

Thursday, January 1st | -

Listen to Michael’s presentation on your phone! Download the mp3 version here, or listen to it below. (Right-click the link and choose “Save Link As”)


Camila Lajolo Tales from the Field: What Disasters Can Teach Us About Resilience

Thursday, January 1st | -

Listen to Camila’s presentation on your phone! Download the mp3 version here, or listen to it below. (Right-click the link and choose “Save Link As”)


Board and Executive Quality Learning Series: BEQLS


BEQLS Board and Executive Quality Learning Series

Thursday, February 22nd | 10:00 - 11:00

By invitation.


Breakfast Meetings: Breakfast MeetingBreakfast MeetingBreakfast Meeting


Breakfast Meeting A Clear Way Forward for Our Residents

Thursday, January 1st | -

Passionate about improving the quality of care in long-term care? Interested in learning how others are doing it? Sharpen your skills and boost your energy by hearing motivating stories about how care homes across BC have successfully improved the quality of life for residents (and staff!) by tackling issues like communication with families, prescribing practices and staff teamwork. Meet some great innovators who can support you in your quest!

Hosted by the BC Patient Safety & Quality Council’s Clear team, which is supporting long-term care homes to reduce their use of antipsychotics


Breakfast Meeting Need a Boost? RRRRev Your Own Engine

Thursday, January 1st | -

Calling all change agents! Are you a change agent at heart yet feeling a little fatigued? Need a little boost in your change agent energy? Then this is the breakfast session for you! Join us to connect with kindred spirits from across the province to Reenergize, Recharge and Replenish. We’ll explore tools and strategies to ignite and Revitalize your passion!

Hosted by the Change Ambassadors Network of BC


Breakfast Meeting Surgical Optimization & Care Pathways

Thursday, January 1st | -

Building on the success of the BC Summit on Surgical Improvement, this breakfast session offers an opportunity for surgical teams, primary care providers and patient partners to connect and hear the summarized results of the working session at the Summit. This session is open to anyone who would like to join, even if you weren’t able to attend the Summit.

Co-hosted by the BC Patient Safety & Quality Council and the Joint Clinical Committees


Breakout A: A1A2A3A4A5A6


A1 Pursuing Quality through an Indigenous Lens

Thursday, February 22nd | 10:00 - 11:00

This session will explore what is possible when we blend our perspectives of quality care to provide health services to diverse Indigenous peoples. We will examine the current colonial state and the need for increased access to culturally-safe care. Using examples of community-driven quality solutions, we will also consider some of the core values of Indigenous health and wellness – including relationship-building, care sharing and collaborative practice – and how they may be measured and incorporated within mainstream health to better serve our populations.

 

Carolyne Neufeld
Director, Health & Social Development
Seabird Island Band

Alexis Grace
Director of Health, Kwikwetlem First Nation
Council Member, Seabird Island Band


A2 Detecting Residents’ Early Health Decline

Thursday, February 22nd | 10:00 - 11:00

The PREVIEW-ED© tool is a simple way to identify subtle changes in resident conditions that may lead to health decline. Designed by Marilyn El Bestawi through the Canadian Foundation for Healthcare Improvement’s EXTRA program, specifically for health care assistants working in long-term care to complete daily, the one-page document focuses on the main reasons why residents are transferred to the emergency department and leverages a powerful instrument: the observational skills and familiarity of direct care staff. Join in a hands-on overview of the tool and a deep dive into Fraser Health’s experience implementing, sustaining and spreading its use.

Catherine Kohm
Project Director, Residential Care Integration
Fraser Health

Mike Mutter
Clinical Nurse Educator, Residential Services
Fraser Health

Gina Kuipers
Registered Care Aid, Fraser Health

Diana Sarakbi
Improvement Lead
Canadian Foundation for Healthcare Improvement

 


A3 Stigma: Confronting an Invisible Barrier to Service

Thursday, February 22nd | 10:00 - 11:00

High quality health care cannot flourish under the weight of judgement, blame and discrimination. In this session we will unpack stories that illustrate the meaning of stigma and the importance of addressing it at an individual and organizational level. Leave with new tools and strategies that can be applied within health centres and across communities to help avoid harm and ensure that compassion and respect remain at the heart of every health care interaction.

Penny Jones
Community Outreach & Assertive Services Team, Mental Health & Addiction Services
Northern Health

Marika Sandrelli
Leader, Knowledge Exchange, Mental Health & Substance Use
Fraser Health

Mary van Osch
Clinical Nurse Specialist, Emergency Network
Fraser Health


A4 Exploring Novel Ideas: The Strength of Mind, Body & Technology

Thursday, February 22nd | 10:00 - 11:00

Implementation of Novel Cognitive Aids for Malignant Hyperthermia

Malignant hyperthermia (MH) is a rare, life-threatening reaction to volatile anesthetics. Treatment of MH is labour intensive and requires collaboration between all members of the Operating Room (OR) Team. With prompt coordinated treatment, MH resolves; without it, it is usually fatal. The current MH protocol for most ORs is a complicated management sheet that is difficult to follow – especially in a crisis situation. We set out to trial a new approach to MH management using a series of task-oriented cards outlining individually-tailored objectives (the goal being to improve the efficiency of MH treatment, to encourage teamwork and communication, and to ensure that no important steps in management are left out). The task cards were developed from an Australian MH Resource Kit and adapted to fit the needs of our OR. To assess their effectiveness, we ran two low-fidelity simulations with a teaching mannequin as our patient. We assembled two multidisciplinary teams to participate, including anesthesiologists, nurses, anesthesia assistants and ward aides. Evaluation forms were distributed to the 14 participants, allowing them to share their thoughts and provide constructive feedback. Common themes that were communicated to us: 1) the task cards represented a welcome change to the MH protocol; 2) the simulation allowed participants to practice responding to a rare event they were previously unprepared for; 3) the task cards foster excellent interdisciplinary collaboration; and 4) responses to a future MH crises will be more effective as a result of these simulations. We now have new MH posters in every OR, and the finalized task cards are ready to replace the previous MH protocol. Our future directions are to disseminate this new protocol to all OR staff, to run regular multidisciplinary MH simulations, and to begin implementing these task cards at neighbouring hospitals. As well, we envision the task card concept being extended to other intra-operative emergencies.

Trina Montemurro
Anesthesiologist Lead for Quality & Safety
Providence Health Care

Paul Yen
Medical Student
University of British Columbia


Anatomy-Based Yoga for Stress Management in First Year Medical Students

Stress in medical education is pervasive, and strongly associated with negative repercussions – ranging from reduced productivity to anxiety and depression.

A needs assessment conducted in the Royal College of Surgeons in Ireland demonstrated that first year medical students experience high levels of stress, 48% reporting their self perceived stress to be ≥7/10. Additionally, students lack adequate stress management strategies and have low physical activity hours (39% with <3 hours per week). The poor management of stress in this class suggests that current resources intended to help manage student stress and protect mental health are inadequate.

Taking inspiration from the successful trial of an integrated anatomy-physical activity program in the Mount Sinai School of Medicine, we propose the incorporation of a weekly anatomy-based yoga series into the medical curriculum. The series would be interactive, didactic, and intended to promote mindfulness. Primarily we aim to reduce self-perceived stress as per the Maslach Burnout Inventory – Human Services Survey, and secondarily we expect to facilitate student’s learning of functional anatomy and improve levels of physical activity. We also postulate that through the implementation of this programme, student grades would improve through the reduction of stress along with the introduction of a novel modality of anatomy teaching. To this end we propose to measure anatomy comprehension with regular anatomy in-class assessments.

This proposal merges mindfulness, physical activity and body awareness into the medical curriculum in what is a novel way of addressing the mental health needs of medical students. The potential benefits of the program are multifaceted, but most critically it should help mitigate student stress levels. It is hoped that this quality improvement proposal will be received as a potential solution to a pervasive problem that urgently demands innovative solutions.

Alexa Higginbotham
Medical Student
Royal College of Surgeons in Ireland & McMaster University

 


Digital Proximity-Based App for Identifying Patient Risks & Information

Innovation and continuous improvement are elements embedded in the contract between Providence Healthcare and Crothall Healthcare regarding environmental services. The two organizations continuously explore ideas and opportunities to test. Leveraging a strategic partnership with Apple, Providence and Crothall conducted a collaborative workshop to bring healthcare leaders within their organizations together to define key business problems within hospitals, and seek a solution that can quickly and easily solve a pressing problem prioritized during the workshop. At the end of the initial workshop, the key problem leaders wanted to solve was, “how can healthcare staff be alerted to specific patient characteristics such as aggression, fall hazards, or isolation precautions, without knowing the patient or having their patient chart on hand.” The current practice is very much paper-based, where isolation precautions are posted on patient doors, aggressive patients are identified by a small purple dot placed on the patient’s chart, and fall hazard signs are pinned above the bed. That is not much use when the patient is not in their rooms, and leaves healthcare staff unaware of the patient’s risk as patients move throughout the hospital. After one month of solution-seeking, Apple brought forward three potential companies that pitched their solution in a Dragons-Den style fashion, and the stakeholders selected the most fitting option. The solution leverages iPhones loaded with an app, and attaches a digital tag (iBeacon) to patient wristbands loaded with the patient’s information. As patients walk around the hospital, staff within 10 meters of the patient wristband automatically receive a pop-up on their iPhone showing the patients basic information and any precautions. Employees, without knowing the patient, can now be made aware of any precautions to take before interacting with patients, and improve interaction by knowing key information about any nearby patient.

 

Amritpal Brar
Business Transformation Manager
Crothall Healthcare & Providence Health Care

Camille Ciarnello
Corporate Director, Quality, Patient Safety, Risk Management, Patient Relations & Infection Prevention & Control
Providence Health Care


A5 Thinking Outside-the-Box to Achieve Team-Based Primary Care

Thursday, February 22nd | 10:00 - 11:00

Evolution of BC’s Primary Care Team Model – CHANGE BC

In looking at optimal Patient Medical Home team models, the Pacific Northwest Division of Family Practice Board of Directors reviewed a growing body of medical evidence that shows the progression of metabolic syndrome is the best predictor of pervasive, chronic conditions, including diabetes, cardiovascular disease and hypertension. Six PNW family physicians leads:

  • Dr. Wouter Morkel, Smithers
  • Dr. Onuora Odoh, Houston
  • Dr. Matthew Menard, Masset, Haida Gwaii
  • Dr. Jocelyn Black, Masset, Haida Gwaii
  • Dr. Brenda Huff, Pacific Northwest

have formed CHANGE (Canadian Health Advanced by Nutrition and Graded Exercise) BC, to help to form a model, the first of it’s kind in BC that includes a Dietitian (RD) and Kinesiologist (KIN) to work closely with family physicians to provide customized, made in BC, evidence based lifestyle supports for patients. The physician leaders have partnered with Metabolic Syndrome Canada a nationally recognized, evidence based organization linked with top academic leads from 6 Canadian universities to bring the best science forward in the development of an optimal model to support GPs in addressing metabolic syndrome.

UBC has recently developed an innovative, cross faculty training site to help train inter-professional teams of GPs, KINs, and RDs, and has expressed an interest to work collaboratively in the development of CHANGE BC.

CHANGE BC is an emerging initiative that is too young to have results, however a March 2017 in CMAJ Open article that looked at CHANGE in 3 other provinces saw, after 12 months, 19 % of patients with complete reversal of Metabolic Syndrome, while 42% saw of a decrease in the number of Metabolic criteria, and the 10-year risk of heart attack was reduced for patients, on average, by 17%.

Presenters will discuss planed measures of Quality of Life perspectives from patients, cost effectiveness; the potential impact of CHANGE BC is significant in terms of both health systems savings, and improving quality of life and longevity for patients.

Brenda Huff
Board Director
Pacific Northwest Division of Family Practice

Wouter Morkel
Board Director and Treasurer
Pacific Northwest Division of Family Practice

Onuora Odoh
Board Director
Pacific Northwest Division of Family Practice


“If My Doctor Sent You, He Must Really Care” – Meeting Patients at Home

As leaders working towards optimizing medication regimens of frail seniors, a strategic partnership was formed between Abbotsford’s Division of Family Practice, community physicians, Fraser Health Authority (FHA), and the Home Health (HH) Clinical Pharmacist. To date, 3 improvement cycles have occurred, 4 family physicians have become involved, and 70 patients have been seen.

Family physicians identify complex patients who could benefit from a medication review by a pharmacist (e.g. frail seniors, >70 years, polypharmacy, and patients with low health literacy). The pharmacist’s home visits of 60-90 minutes are booked for patients by the clinic’s MOA. A case discussion/ sharing of evidence based information with the physician follows within 1 week. The pharmacist accesses both the physician’s and FHA electronic medical records (EMR) to review patient information and document case discussions either on site or remotely using VPN networks. The pharmacist follows up with patients and collaborates with their community pharmacist or HH clinicians.

Key Learnings include: (1) Favourable response of patients/caregivers to this partnership. (2) Types of medication-related issues in patients. (3) Communication of findings/recommendations verbally/in writing to physician. (4) Documentation of process/content. (5) Evidence based resources to support physicians. (6) Initiate and pilot access to physician EMR from FHA computer using PSP and knowledge of IMIT systems. (7) Establish memoranda of understanding between physician and FHA to clarify roles and responsibilities. (8) Develop clear logistics of appointment booking from multiple perspectives. (9) Integrate use of interpreters. (10) Opportunity for holistic medication assessments in patient homes.

Next steps include: (1) Opportunities to collaborate strategically with community retail pharmacists. (2) Use of a wireless modem to access EMR. (3) Administrative support.

Lori Blain
Clinical Pharmacy Specialist, Frail Seniors
Fraser Health

 

Raminderjit Sandhu
Family Physician


Martin Street Outreach Centre: Innovative Partnerships at One-Stop Mental Health & Substance Use Clinic

Since its doors opened two years ago, Martin Street Outreach Centre has attached more than 750 people dealing with Mental Health and/or Substance Use (MHSU) issues in the South Okanagan Similkameen.

In true team-based care, four primary care physicians, a Social Worker, a team of Interior Health clinicians including a psychiatrist, a STOP HIV nurse, a Drug and Alcohol Counsellor, a Harm Reduction coordinator, a Diabetes nurse, and other health professionals all work in one low-barrier location.

Martin St. has quickly became a community hub for this vulnerable population who relies on our team-based care to address both primary care and psychosocial needs.

This presentation will address:

1) The innovative, collaborative approach used to develop Martin St. Outreach Centre. This includes speaking about building relationships, equal partnerships and project management, which helped the team overcome many challenges such as integrating information systems, unionized and non-unionized staff and different billing systems

2) The need to simultaneously address social determinates of health and primary care for this population in a patient-centred, whole person approach

3) The importance of communication amongst all personnel. For example, discussing how a case worker, physician, social worker share care

4) Sustainability issues we face when providing primary care to this population under the current fee-for-service system

As many team-based care sites, there are many challenges still to overcome but there is cause to celebrate our successes and share our learnings.

Aarin Frigon
Project Manager
South Okanagan Similkameen Division of Family Practice

Deb Salverda
Team Leader & Knowledge Coordinator, Mental Health & Substance Use Services
Interior Health


A6 Co-Design: Shaping Improvement Together

Thursday, February 22nd | 10:00 - 11:00

“Megamorphosizing” Residential Care: Shifting From An Institutional to a Social Model QUALITY AWARD WINNER

This rapid-fire session will be streamed on Facebook Live!

Providence Health Care (PHC) has provided compassionate residential care (RC) for decades; however, with aging infrastructure and increasingly complex residents, we have been unable to provide the vibrant home environment that brings quality to people’s lives. To address this, PHC RC embarked on a human centred design initiative called Residential Care for Me. Following months of insight gathering, ideation, and testing, it became clear that something creative was needed to shake loose the institutional routines developed over the years. Megamorphosis (MM) is a term invented to describe the culture shift to a social model of care at our homes. It consists of: 4 weeks of pre-work activities to build compassion, team relationships and a shared vision, as well as 2 weeks of rapid-cycle testing during which staff, residents and families work together to enhance the physical environment and try new ideas that create time for emotional connections. Ideas are tested then evaluated daily with residents, families and staff, then adapted and re-tested based on feedback. MM has started at 2 of PHC’s 5 homes: Youville (YOU) and Brock Fahrni (BF). Successes at YOU were not all easily translatable to BF. Adjustments to the MM process were required to work with the different environment and staff culture at BF. Nonetheless, the impact of MM at both sites included deep engagement of residents and families. Daily huddles focused on uncovering the life stories of residents. Residents could be seen enjoying conversation and meals with staff, or helping with ironing and painting. Interactions between staff and residents are shifting to become more positive and social. Long-term success will be evaluated using the Provincial Quality of Life Survey. MM is the brainchild of leaders who have failed to create significant, lasting change using other quality improvement methods. MM is a nimble, easy-to-adopt, wildly creative approach focused first on people.

Sonia Hardern
Performance Improvement Consultant
Providence Health Care

Jo-Ann Tait
Program Director, Elder Care & Palliative Services
Providence Health Care


Provincial Health Services Authority Patient & Family Engagement Framework

This rapid-fire session will be streamed on Facebook Live!

Context and Relevance: Accreditation’s new language of patient and family centered care had been embedded in all Standards. In preparation for PHSA’s Accreditation, there was great work already occurring, but a framework was required to collate and share how we engaged patients/families with staff, providers and leaders. The aim was to identify strategies for obtaining input, co-designing and partnering with patients, families and the public.

Intervention: A gap analysis was conducted, and best practice literature reviewed to create the PHSA Patient and Family Engagement Framework, embedding the IAP2 Spectrum of Engagement, Accreditation’s approach and PHSA Values. Strategies included:

1. Co-Design:

  • Strategic Planning and Community & Stakeholder Needs Assessment (World Cafe or Community Town Hall)
  • Redevelopment of New Hospital
  • Hand Hygiene & Emotional Support Campaign

2. Input from patients/families:

  • Patient & Family Advisory Committees
  • Satisfaction Surveys/Comment cards

3. Partnership with:

  • Improved ways to ambulate patients
  • Transition from incarceration to community
  • Emailing/texting with clients in downtown Eastside

Measurement: BC Children’s, BC Women’s Hospitals and BCCDC received Accreditation with Exemplary Standing. Surveyors commented that Patient Centered Care is part of their DNA. BCCA Emotional Support Campaign resulted in increased patient perception of emotional support from 49% to over 90%. Pre-implementation, there was no consistent way of receiving patient feedback. Post-implementation, patients and families are utilizing comments cards in all depts and trends are shared to staff and patients/families to see.

Lessons Learned: Creating and communicating a patient and family engagement framework unifies the organization’s approach. Increased awareness and desire to involve patients/families as new services are developed or changes made to existing services are now our new way of working.1

Sue Fuller Blamey
Corporate Director, Quality & Safety
Provincial Health Services Authority

Debbie Johannesen
Director of Quality, Safety & Accreditation
Provincial Health Services Authority

Suzanne Steenburgh
Director of Quality, Safety & Accreditation
Provincial Health Services Authority


Engaging & Empowering Teams to Create & Shape Their Future

This rapid-fire session will be streamed on Facebook Live!

The BC Women’s Neonatal Intensive Care Unit (NICU) is moving from a 60 open bay nursery to 70 single family rooms designed within six pods. This move is happening October 29, 2017. To prepare staff to safely work in the future pod designed structure many of the changes to the new workflows need to be implemented while still in the current familiar NICU environment. The project goal was to implement an operational new pod structure (with new work processes) into the current NICU footprint. In June 2017 a multidisciplinary team designed the new pod structure that would be implemented into the current NICU footprint. Prior to executing the change staff attended workshops to review and provide feedback on the pod structure and new supporting processes (standard work for new roles, staffing allocation guidelines, and communication processes). The pod structure was implemented in July 2017 with the following supportive activities: a) daily leadership walk-a-rounds with staff to problem solve identified issues; b) weekly updates to inform staff of resolved issues; and c) further workshops are planned to provide staff with information and/or skills still required to work in the pod structure. The key measures for this project are: a) reducing the number of patient moves currently showing a decrease from 10-12 moves per week down to 0-3 moves per week; and b) tracking the number of issues raised versus number of issues addressed with at one month 80% of issues addressed. In this project creating opportunities for staff to design and revise the new pod structure and work processes and participate in problem solving identified issues helped to establish “Leaders for the Change”. Everyone involved in the change kept central a simple question: What impact does not changing “now” have on providing safe patient care later on once in the new NICU environment? Repeated emphasis on the need for change energized the program to make improvements to be ready to move to the new NICU.

Valoria Hait
Quality & Safety Leader, Neonatal Program
BC Women’s Hospital & Health Centre

Ronnalea Hamman
Leader, Quality, Safety & Improvement
BC Women’s Hospital & Health Centre


Breakout B: B1B2B3B4B5B6


B1 People-Powered Digital Health

Thursday, February 22nd | 11:30 - 12:30

You are invited to join a more intimate chat with plenary speaker Tim Omer regarding the #WeAreNotWaiting movement. This audience-driven session will be an opportunity to dive deeper into a few example projects and equipment used by the community to highlight some of the key principles driving this work. Let’s consider the implications and opportunities for advancing patient-centred digital health in the province together.

Tim Omer
Senior IT Professional, Citizen Health Hacker & Type 1 Diabetic Rebel


B2 Trauma-Informed Care for Residents with Dementia

Thursday, February 22nd | 11:30 - 12:30

Let’s have a conversation about Trauma-Informed Practice (TIP) in residential care. This interactive session will encourage you to recognize the impact of a resident’s trauma history on dementia-related behaviours. A case study will be reviewed using the principles of TIP and practical care planning tools will be discussed.

Alicia Vicic
Clinical Practice Educator, Mental Health and Substance Use, Tertiary Mental Health
Interior Health

Amanda Brown
Regional Knowledge Coordinator, Complex Cases, Residential Care
Interior Health


B3 Catching It Early, Getting It Right! New Guidelines for Treating Sepsis

Thursday, February 22nd | 11:30 - 12:30

Sepsis has one of the highest in-hospital mortality rates in Canada, but if caught early it can be treated effectively. In 2017, revised screening and treatment guidelines were released and a toolkit created for management of sepsis in hospitals. This session will explore these best practices for prompt recognition and timely management of sepsis across an expanded context including community, primary care, long term care, as well as acute care settings. Take home practical tips for recognizing sepsis and learn about the simple therapies that save lives.

David Sweet
Clinical Lead, Sepsis
BC Patient Safety & Quality Council
Critical Care & Emergency Medicine Physician


B4 Enhanced Recovery & Beyond: Advancing Surgical Optimization

Thursday, February 22nd | 11:30 - 12:30

Can We Better Prepare Patients Prior to Major Oncology Surgery Within an ERAS Program?

Enhanced Recovery After Surgery (ERAS) protocols improve care and decrease complications which have been validated in our hospital. Preoperative risk factors such as anemia, transfusion and hyperglycemia are associated with increased morbidity & mortality and length of stay.

The preoperative period is an optimal time to review these modifiable risk factors, which protect physiologic reserves in the face of a surgical insult. This strategy is referred to as prehabilitation.

To further improve our ERAS patient’s experience & outcomes, we plan to adopt patient-centered care practices and improve our prehabilitation process with inputs from all key stakeholders.

Our baseline data (2013-2017) on preoperative risk factors for patients undergoing major oncology surgery (colorectal surgery-CR N=422, radical cystectomy-RC N=222, gynecology oncology-GO N=143) showed that preoperative anemia is common (29.1%), and the requirement for a transfusion was significantly higher in the anemic patients, 38.9% RC, 34% GO, 21.4% CR vs. 26.6% RC, 14% GO, 8.8% CR in patients with hematocrits > 36 for women and > 39 for men. . Smoking incidence was >10%. The incidence of “undernutrition” using markers as low BMI, recent weight loss, was not as common. Recent measurement of HbA1c in all ERAS case found that 8.3% ( 6/72) of cases had unrecognized diabetes( HbA1C > 6.0). 15% of all cases were diabetic (N=139), with 50.4% of these cases had preoperative HbA1C > 7.0, and 13.7% >8.5.

A significant proportion of patient could benefit from prehabilitation, which is a missing piece in our successful ERAS program. We currently have limited tools to assess nutritional and fitness status preop. We plan to focus on the management of anemia & diabetes, and engage patients in the benefits of smoking cessation using a multidisciplinary team approach.

Kelly Mayson
Director of Quality Assurance & Patient Safety, Department of Anesthesia & Perioperative Care
Vancouver Coastal Health

Tracey Hong
Quality & Patient Safety Coordinator
Vancouver Coastal Health


Nutrition Screening for Elective Colorectal Surgery Patients at St. Paul’s Hospital

Malnutrition has been associated with a number of poor outcomes in hospitalized patients, including increased rates of infection and poor wound healing. Nutrition screening can help identify patients at risk for malnutrition who would benefit from nutrition therapy to optimize surgical outcomes. Multiple factors need to be considered in implementing nutrition screening in this population. These include the simplicity of the nutrition screening tool, conducting the screen at an appropriate time preoperatively for the patient, and the availability of a registered dietitian for individualized nutrition therapy. The Malnutrition Screening Tool (MST) includes three simple questions pertaining to recent poor intake and weight loss. These questions were integrated into an existing health history questionnaire completed by patients during their first visit with the colorectal surgeon at St. Paul’s Hospital (SPH). Patients identified as medium or high risk (MST score of ≥ 2) are referred to the outpatient dietitian at SPH prior to their surgery. Patients with a body mass index (BMI) of <19 and >36 are also referred as they may be at risk for surgical complications due to being low weight or obese. Between July 2016 to July 2017, thirty-seven patients were identified as at risk using MST and BMI cut-offs. Thirteen of these patients (35%) had an in-person or telephone consult with a dietitian prior to surgery. Reasons for patients not being seen included patient refusal or appointment cancellation, being unable to contact the referred patient, and imminent surgery. Many colorectal cancer patients may only be seen by their surgeon a few weeks before their surgery date, which presents challenges in scheduling a dietitian appointment that will provide adequate time to make meaningful nutrition changes. Further work is underway to optimize the timing of nutrition screening and also to improve communication with patients around the importance of nutrition in the preoperative period.

Vanessa Lewis
Clinical Dietitian – GI/General Surgery, Palliative
Providence Health Care


Adherence to ERAS Protocol & Impact on Elective Gyne Oncology Surgical Patients

Early recovery after surgery (ERAS) principles were designed to accelerate recovery, reduce morbidity and shorten length of stay (LOS). In November 2016 formal ERAS protocols were initiated for all patients at VGH undergoing elective gynecological oncology surgery.

Compliance with ERAS elements and patient outcomes within 30 days of surgery were measured between Nov 2016- April 2017 (N=193). Chart reviews were conducted to audit compliance with pre-operative, intra-operative and post-operative ERAS components. Patient outcomes measured including LOS, readmission rates, and morbidity rates based on National Surgical Quality Improvement Program (NSQIP) definitions. These outcomes were compared to pre-implementation data from December 2011 to March 2016 (N=450). Data for open and minimally invasive (MIS) procedures were analyzed separately.

Results demonstrated compliance (defined as >80%) with the majority of ERAS components with the exception of: pre-operative completion of counseling and carbohydrate loading, intra-operative goal directed fluid therapy and post op provision of boost. Overall morbidity has not yet decreased with implementation; 5.3% vs 8.3% (p=0.0863) for open procedures and 2.1% vs 5.8% (p=0.1904) for MIS. In terms of LOS in days, the mean for open procedures post implementation was slightly lower at 2.91 vs 2.95 (p=0.8568) although not significant. LOS for laparoscopic (1.4 vs 1.31, p=0.6238) was not significantly decreased.

The introduction of ERAS for Gynecology oncology has not yet shown dramatic decreases in LOS or morbidity. This may reflect the need for further adherence to the ERAS components, higher co-morbidities in the post ERAS group and/or the need for a larger sample size to observe significant statistical differences as LOS and complication rates are already relatively low for gyne oncology procedures. We will continue to audit and collect data and work on increased adherence to all the ERAS components.

Christa Lepik
Resident
University of British Columbia

Kelly Mayson
Director of Quality Assurance & Patient Safety, Department of Anesthesia & Perioperative Care
Vancouver Coastal Health


B5 Caring for Young Minds: Spelling Out the CYMHSU Collaborative

Thursday, February 22nd | 11:30 - 12:30

How To Build A Community InPatient Model

TBA

TBA

 


Crisis Response Protocol Development for CYMHSU Patients & their Families

The Context and Relevance: In 2010, there was a lack of a coordinated response to mental health crises for children and youth in Kamloops. Patients and their families were sent to the ER for all severities of mental health crisis with misdirected use of ER and inpatient services and lengthy waits in ER. Subsequent follow up post ER presentation was not coordinated between agencies. The opportunity arose to present these findings through a Patient Journey Mapping report to the Deputy Minister of Ministry of Children and Family Development (MCFD) and, as a result, a commitment to start the BC Child and Youth Mental Health and Substance Use (CYMHSU) Collaborative was made.

Intervention: The members of the CYMHSU Collaborative Thompson Local Action Team, along with key mental health service providers, focused on collectively revising and building three protocols to ensure that children and youth have timely access to services when in crisis situations. The protocols developed are: 1) Kamloops Community Crisis Response Protocol, 2) School Suicide Protocol Agreement, and 3) RIH ER/Child Psychiatry Access and Flow Algorithm.

Measurement: The Interior Health Parkview Program tracked the efficacy of the acute crisis Protocols and funding of dedicated in-patient beds. The results demonstrated increased rapid access to psychiatric care and referrals to appropriate community mental health services. Acute care admissions and re-admissions were also being avoided.

Lessons Learned: Collaborative relationships between leadership of the various agencies and grassroots staff are critical. Also, essential for sustainability is a commitment for regular protocol updating. Provincial oversight is needed over information-sharing; and public education and professional development is needed and should align with the development of local pathways to care. Clearly defined roles and responsibilities, and effective communications between all agencies is key to success.

Shirley Sze
Co-Chair & Family Physician
Thompson Local Action Team for Child & Youth Mental Health & Substance Use

Raj Chahal
Manager, Parkview
Interior Health


The Child & Youth Mental Health & Substance Use Collaborative: The Legacies

The largest change initiative in BC history – with over 2,600 participants – the Child and Youth Mental Health and Substance Use (CYMHSU) Collaborative has improved support and care for children, youth and families across the province, and left many important legacies.

Jennifer Mervyn
Practice Initiative Lead
Child & Youth Mental Health & Substance Use Collaborative

Nikita Soares
Senior Project Coordinator
Shared Care Committee


B6 Share, Listen, Act Towards Indigenous Cultural Humility

Thursday, February 22nd | 11:30 - 12:30

What's the Harm? Examining the Stereotyping of Indigenous People in Health Systems

Colonization is recognized as a root cause of health inequities experienced by Indigenous people in Canada. The health gaps between Indigenous and non-Indigenous/Settler Canadians is further exacerbated by ongoing institutional racism and discrimination towards Indigenous people, as well as colonial ideologies that are deeply embedded in our healthcare system today. As a result, when Indigenous people access health services they often ironically experience harms in the form of prejudice, stereotyping and bias, which contribute to further access barriers.

The PHSA San’yas Indigenous Cultural Safety training program was created as an intervention to promote culturally safe practices among healthcare employees. In the San’yas training, participants are asked to discuss examples of Indigenous-specific stereotyping and discrimination. Through this intervention, San’yas participants have collectively provided thousands of examples of Indigenous people being stereotyped and harmed in the healthcare system. This narrative data provides a glimpse into the harms that Indigenous people experience on a daily basis when trying to access health services.

With the aim of deepening an understanding of stereotyping harm and how racism plays out in health care, a mixed methods study was designed to analyze this data and provide insight into ways of promoting culturally safe organizational practices and improving quality of care for Indigenous people. A Qualitative Inquiry approach was used to undertake a thematic analysis of the narrative data and measure frequencies of recurring themes.

Results from this analysis will be presented, including preliminary findings on the where harm tends to occur within the health system. Insights will be shared on how Indigenous cultural safety training can play a key role in an organizational framework to address Indigenous-specific racism, contribute to transforming workplace culture and improving quality of services.

Laurie Harding
Integration Lead
Provincial Health Services Authority


The P’ápayek Way of Learning

P’ápayek is a Squamish word that when translated means “Getting Better.” Yúustway Health Services (YHS) embodies a P’ápayek health service delivery model with these core elements. We: 1) are intentional about P’ápayek, 2) take a community member focus when making improvements, 3) support teams with space and time to work together on P’ápayek, 4) are courageous and allow for problems to be uprooted, and 5) do not focus on “who” was involved, but rather “why” the incident occurred. Our challenge was that we had an informal, non-standardized process for tracking unusual incidents. We created a reporting policy and procedure and trialed it. Our learning was that the Department Head for YHS became “Complaint Centre Central” as people submitted reports of unusual incidents without thinking through contributing factors and possible solutions. We also learned that our staff did not fully understand the purpose of the process and limited their participation to simply reporting and waiting for response/recommendations. As a result, we changed our approach and created space for learning from unusual incidents. We developed a structure which allowed for team-based learning in a supported environment. Resources to support this include: 1) P’ápayek Learning Policy and Procedure, 2) P’ápayek Documentation Form, and 3) P’ápayek Learning Tool (incorporates a problem-solving framework). We are still learning from our new approach and initial results show that staff are interested and engaged in learning and problem-solving. By stepping back and listening to the needs of our team, we were able to accomplish: 1) creating a way of learning from incidents, 2) creating a framework and resources to empower our staff to participate, 3) creating safe space where teams can reflect, have open discussion, trial solutions and learn from outcomes, and 4) enhanced support for improved safety and quality of care.

Kim Brooks
Department Head
Yúustway Health Services


Integrating Cultural Humility into Health Care Using a Video on Indigenous Health

This rapid-fire session will be streamed on Facebook Live!

Context: When Indigenous patients request Traditional Practitioners while receiving medical treatment in BC, health professionals (HCPs) are called upon for navigation support and authorization. However, many HCPs are not equipped to make an informed decision. Nonetheless, Indigenous communities, policy-makers and HCPs support the integration of traditional practices into care.

Intervention: UBC Digital Emergency Medicine partnered with Traditional Practitioners, Ministry of Health, and Vancouver Coastal Health Authority to co-create a video and facilitation guide featuring First Nation Traditional Healers in 2016 called A Coming Together of Health Systems: First Nations Traditional Practitioners in Health Care Settings. This educational video and guide (available at iconproject.org) support HCPs to understand the role of Traditional Healers, and encourages viewers to consider ways to improve access and integration of traditional healing into their health care context.

Measurement: Through a series of workshops, the video was shared with First Nation community members, Traditional Healers, Elders, HCPs, administrators, policy-makers and other stakeholders, and the discussion guide served to invite participants to share experiences. Findings from workshops demonstrate a strong interest for modified policies and practices, incorporating traditional medicine into BC’s health system. Meanwhile, since 2016 the video has been viewed >630 times on YouTube.

Lessons Learned: At the Forum, examples will be shared to illustrate our workshop’s approach to cultivate an open and positive environment where participants authentically shared, engaged, listened and practiced cultural humility. This safe space enabled constructive dialogues and ideas to take place so as to identify tangible health system improvements through diversity of stakeholder engagement.

Elizabeth Stacy
Research Coordinator, Digital Emergency Medicine
University of British Columbia

Kendall Ho
Professor & Lead, Digital Emergency Medicine
University of British Columbia


Breakout C: C1C2C3C4C5C6


C1 Taking Care of People Who “Ask So Little and Give So Much”

Thursday, February 22nd | 14:30 - 15:30

The organized Ground Search and Rescue (GSAR) service in British Columbia has evolved over the past 60+ years into a network of 80 community-based groups with approximately 2,500 volunteer members who respond to over 1600 incidents annually – which is more than the rest of Canada combined. Volunteers are deployed in a variety of terrains and conditions, and are often involved in large scale civil emergencies such as the recent wildfires events. This session will offer strategies for taking care of those working at the point of care – by looking at how GSAR prepares its people for the physical risks and emotional tolls of responding to critical incidents and providing support for those who suffer injuries.

Jim McAllister
Director at Large
British Columbia Search & Rescue Association

Greg Miller
Steering Committee Chair & Human Resources Advisor
British Columbia Search & Rescue Association


C2 Appropriateness in Surgical Care: Asking the Right Questions

Thursday, February 22nd | 14:30 - 15:30

Patient reported outcomes and experiences are being collected by more and more surgical sites, but how are we going to use them? This session will explore the different ways in which PROMs and PREMs can be collected, ask participants to consider why PROMs are important at their site and discuss the larger purpose of measuring appropriateness in surgical care.

Lena Cuthbertson
Provincial Executive Director, Office of Patient-Centred Measurement & Improvement
Ministry of Health

 

Kimberly McKinley
Patient Services Manager
Vancouver Coastal Health


C3 Discovering the Extraordinary Value of Routine Monitoring

Thursday, February 22nd | 14:30 - 15:30

Do you really know if your program or service is delivering high-quality care? This session will explore routine performance monitoring, from defining a suite of indicators to practical considerations that you should address. It will also help distinguish when you need to react – and, more importantly, when you shouldn’t react – to issues identified through your monitoring so that you can confidently state that you are delivering high-quality care.

Andrew Wray
Director, Learning & Strategic Initiatives
BC Patient Safety & Quality Council


C4 Diverse Approaches to Addressing the Opioid Crisis

Thursday, February 22nd | 14:30 - 15:30

Opioid Substitution therapy: An Emergency Room Response to the Fentanyl Crisis

This rapid-fire session will be streamed on Facebook Live!

The current fentanyl drug overdose death epidemic is the largest healthcare crisis in Canada today.

There were 956 overdose deaths in BC in 2016 representing more than 3X the total number of automobile deaths annually. The crisis is rapidly worsening with 1400+ deaths projected for 2017. More than 80% of patients who died in 2016 had prior medical encounters leading up to there death with the majority being in the ER.

Emergency Departments have an opportunity and obligation to think outside of the box of traditional ER care to proactively take steps to help these most vulnerable patients avoid overdose deaths. Opioid addiction is a chronic, frequently fatal disease presenting to emergency department acute care. Most opioid addicted patients need to use several times per day. Most previous attempts at intervention have failed as referrals to addiction services from community emergency departments do not show for appointment. The traditional ER focus has therefor been on treating complications of opioid use such as overdose, infectious, social and mental health complications. In July 2016 the BCCPS made changes to allow all physicians to use the opioid substitution medication Suboxone (buprophenone and naloxone in a sublingual tablet). This partial agonist is a safer treatment for withdrawal and ongoing substitution and has the best evidence behind it to help opioid use disorder patients recover from their disease. We aim to provide 100% of opioid use disorder patients presenting to Island Health emergency departments rapid access to addictions treatment and the option to use Suboxone to help them to achieve this. Piloted at RJH we partnered with community addictions clinics to standardize streamlined referral and Suboxone starts from the ER. Early learnings included the utility of nurse initiated referral, engagement of peer support organizations for patients and the potential for home Suboxone initiation… Culture shift in the ER is hard but necessary.

Jason Wale
Medical Director of Emergency Medicine
Island Health


Responding to Urgent Healthcare Needs: Provincial Opioid Addiction Treatment Support

This rapid-fire session will be streamed on Facebook Live!

Context: Opioid use disorder is a major driver of the recent surge in illicit drug overdose deaths. In the context of the current public health emergency, there is an urgent need for a provincial evidence-based education for health professionals on the full range of therapeutic options for the optimal treatment of opioid use disorder.

Intervention: UBC’s Division of Continuing Professional Development (UBC CPD), in partnership with the BC Centre for Substance Use (BCCSU), developed an accredited 24-module online course with six different education streams for BC physicians, nursing and allied health professionals, and other care providers involved in the treatment of opioid use disorder. The project launched six months from first meeting and involved a team of over 45 contributors. The course articulates the BCCSU Opioid Use Disorder Guidelines through interactive content, videos, animations, and case studies that keep learners engaged and reinforce learning in varied and memorable ways.

Impact: Completing the online course is the first step in the authorization process for those seeking an exemption to prescribe methadone. It was designed with busy healthcare professionals in mind. The 8-hour course was previously only available to physicians who attended in-person sessions presented by the College of Physicians and Surgeons of BC that were held at specific locations and times. By creating the course online, it is available at no cost to healthcare providers when and where they need it. Learners can complete it at their own pace and the material remains available as a reference tool post-course.

The modules launched July 10, 2017 and as of September 1 there are 272 registered participants. The project mobilized quickly and effectively disseminated provincially in response to an urgent and emerging healthcare need by utilizing educational technology and online learning.

Kate Campbell
Senior Instructional Designer
University of British Columbia Continuing Professional Development


A Pilot Project on Improving Mental & Substance Use Disorder Care in Acute Settings

This rapid-fire session will be streamed on Facebook Live!

Patients with co-existing substance use and mental health disorders (concurrent disorders) have complex and challenging care needs, especially in acute care psychiatric inpatient settings. Acute psychiatric care plays a vital role in mental health service delivery and there is evidence that nurses working in these settings often have unmet learning needs regarding concurrent disorder care, posing a challenge to nursing practice. The purpose of the pilot project was to develop an educational module to equip nurses with the skills and knowledge required to deliver evidence-based concurrent disorder care in acute psychiatric settings. A survey of 74 acute care psychiatric nurses was initially completed to identify their learning needs and challenges. This was followed by a comprehensive review of evidence from literature to identify knowledge, skills, and competencies needed to deliver concurrent disorder care. Content for the educational module was then validated by a panel of experts. In all, 35 items within 13 content areas were identified and validated to be used in an educational module for acute care psychiatric nurses delivering concurrent disorder care. Evaluation received from 51 attendees of the educational session, reports improved knowledge, skills and confidence to deliver evidence-based care. Despite some few challenges, this project translates evidence into practice, contributes to the body of knowledge on concurrent disorder care, provides nurses with the knowledge that will improve their confidence and competency in delivering evidence-based concurrent disorder care, and has the potential to improve patient care outcomes and experiences.

Kofi Bonnie
Clinical Nurse Specialist
Providence Health Care

Emily Jenkins
Assistant Professor
University of British Columbia


C5 Making Care Better for Those with Chronic Conditions

Thursday, February 22nd | 14:30 - 15:30

Heart Failure Care in the Home Innovation Program

Heart failure (HF) is a complex chronic condition which places unsustainable strain on patients and our health care system. The Canadian Heart and Stroke Foundation’s 2016 Annual Report highlighted that prevalence of HF has reached epidemic status. Our aging population is living longer with HF becoming, progressively debilitated as the disease progresses. HF is challenging to manage; patients are frail and often miss clinic appointments. This delays treatment and creates inefficiencies in the clinic workflows. Delayed treatment leads to worsening symptoms and unscheduled visits to the emergency department. Strategies to support HF patients in their home would help reduce emergency visits and would go a long way to improving their quality of life.

The Nurse Practitioners (NP) at VGH Cardiac Function Clinic implemented a novel strategy to support frail elderly patients who were not able to attend regular HF clinic appointments. NPs brought multidisciplinary clinic expertise to the patients at home every one to three weeks, with frequent phone consults in between. The goals of this initiative were to improve the patient’s ability to self-manage and their quality of life and to reduce emergency visits.

This novel approach validated a patient-centered model of care. Process measures included a standardized minimum data set for HF assessment, assessment of home care needs, medication reconciliation and self-management education teaching. Outcome measures included standardized medication use, HF readmission rates, improved self- management skills as measure by Self Care HF Index and overall decrease in health care utilization. Some qualitative data was also collected.

The year-long pilot project was completed May 2017. Data analysis revealed these patients fit a typical HF patient profile, were motivated to self-manage and had reported an improved quality of life. Clinic workflows improved as a result of fewer missed appointments and increased clinic capacity.

Suzanne Nixon
Clinical Nurse Specialist, Regional Heart Failure
Vancouver Coastal Health & Providence Health Care

Leah Christoff
Nurse Practitioner, Cardiac Function Clinic
Vancouver Coastal Health & Providence Health Care

Nancy Gwadry
Nurse Practitioner, Cardiac Function Clinic
Vancouver Coastal Health & Providence Health Care


Implementing Emotional Wellness Screening in a Cystic Fibrosis Clinic

Ongoing health demands are emotionally taxing for people with Cystic Fibrosis (CF) and their caregivers, who experience higher rates of anxiety and depression than the general population. As mental health issues can lead to poorer health outcomes, BC Children’s Hospital’s CF team undertook Emotional Wellness as a QI initiative.

Aim: To identify anxiety and depression in CF patients (pts) and caregivers, and provide support, education and resources in order to optimize health and quality of life (QOL).

Guided by a CF consensus statement¹ the QI strategy included: a parent survey on the perceived need/ best process; a family letter describing emotional wellness screening (EWS); an algorithm to guide practice, and mental health handouts (MHH). Annual EWS for CF pts ≥12 years (yrs) old, and parents of CF pts ≤2 yrs old, commenced January 2017 using validated GAD-7 and PHQ-9 tools to assess for anxiety and depression. Pts/parents under psychological care were not screened.

Results:

CF Pts ≥ 12 yrs:

  • 24/28 (86%) eligible screened (1 declined, 3 missed)
  • Anxiety & Depression Scores were identical: 79% normal range; 17% mild (MHH given; rescreened [ReS] at next clinic visit with 1 missed ReS); and 4% moderate (physician referral).

Parent(s) of ≤ 2 yr old Pts:

  • 13/17 (76%) eligible screened (2 declined, 3 missed)
  • Anxiety Scores: 75% normal range; 25% mild (MHH given; ReS at next clinic)
  • Depression Scores: 69% normal range; 25% mild (MHH given; ReS at next clinic); 6% moderate (MHH given; advised to see GP for MH referral; due for ReS at next clinic).

A high screening rate of eligible pts/ parents was achieved but it is too early to determine if EWS will have a positive impact on mental health and QOL over time. Preliminary results show that parents of young children may be at higher risk for depression but more evidence is required. After 1 year the process will be evaluated including parental/ pt feedback.

¹Quittner A et al. Thorax 2016; 71:26-34.

Anna Gravelle
Cystic Fibrosis Nurse Clinician
BC Children’s Hospital


Hospital 2 Home: A Collaborative Approach to Improving Care for Patients with COPD

Between 2014-15, the Canadian Foundation for Healthcare Improvement (CFHI) worked with 19 multi-disciplinary teams, in every province across Canada, to implement the INSPIRED (Implementing a Novel and Supportive Program of Individualized Care for Patients and Families Living with REspiratory Disease) COPD (chronic obstructive pulmonary disease) Outreach Program™. This year-long collaborative used an all teach, all learn adult-learning style to support teams in their change process. The collaborative led to skills acquisition in quality improvement and evidence-based medicine. Teams reported a deeper knowledge of the complexities of COPD care and optimized patient care. 17 of the teams cited at least one example of organizational culture change. Improvements in quality of care included an 80% drop in hospitalizations (tapering to 40-50% in 6 – 12 months post-INSPIRED). Teams also reported reductions in ED visits and length of stay. Patients reported increased self-confidence, symptom management and return to daily activities. Families reported greater ease with hospital to home transitions. According to data from RiskAnalytica, every $1 spent on INSPIRED, could save $21 in costs through reductions in ED visits, hospitalizations, and length of stay. Based on the success of this collaborative, CFHI is now supporting an 18-month scale collaborative designed to enable teams to reach even more patients who stand to benefit from this program. Formally launching in October 2017, this initiative will include scaling at both regional and provincial levels. This session will present an overview of the findings from the 2016 collaborative summative evaluation and two peer-reviewed publications. The session will report on improvements in quality of care, and provide insights into the barriers and enablers to quality improvement through a collaborative structure. The session will conclude with an overview of preliminary work that has been undertaken in the scale collaborative.

Jenny Buckley
Senior Improvement Lead
Canadian Foundation for Healthcare Improvement


C6 Innovative Care for Residents

Thursday, February 22nd | 14:30 - 15:30

IlluminAID: Lighting for Residential Care Homes

Falls and quality of sleep are a major concern for seniors living in residential care homes. For the illuminAID project, the Health Design Lab (HDL) at Emily Carr University is working with Providence Health Care (PHC) and the residents, family and staff at Brock Fahrni to develop a working prototype of a lighting system to address these challenges.

In September of 2015, the PHC Research and Design team approached the HDL to design short-term and long-term physical and environmental improvements to their residential care homes in order to create a more home-like environment. One of the key opportunities identified was the need to improve the lighting in existing facilities for evening and night time use. The current lighting system at Brock Fahrni is very limited: when the lights are off it is too dark for residents to be able to safely navigate to and from the washroom independently, however, when the existing lights are turned on by residents or staff they are very bright and disruptive to other residents who are sleeping.

In 2017, PHC received funding from the Canadian Center for Aging and Brain Health to collaborate with HDL on the development of an under-bed motion activated lighting system. Currently, the HDL team has developed a functional prototype which is undergoing user-testing at Brock Fahrni. The intention has been to develop a modular lighting system that can easily be installed in any existing facility without requiring major changes facility infrastructure while improving the sleep and safety of residents and staff. This project has utilized human-centered design methods to gain an understanding of the problem space and develop a solution that addresses the complex needs of residents and staff. HDL used overnight shadowing, role-play, and rapid prototyping methods to develop the lighting solution. This project demonstrates the value of multi-disciplinary collaboration between healthcare professionals and designers to improve care delivery.

Caylee Raber
Director, Health Design Lab
Emily Carr University


Factors that Influence a Successful Care Conference in Residential Care

The development and delivery of new care models for older people living in residential care homes is necessary to ensure high quality professional care is delivered with dignity and compassion. Cheam Village and Glenwood, located in Agassiz B.C., are two residential care homes that provide publically funded complex care to older people. Since 2011 we have focused on quality improvement as a strategic imperative in the delivery of all health, care and well-being services. A key initiative was a complete re-design of the resident and family conference which is held within six weeks of admission and at least on yearly basis afterwards. A collaborative team approach was developed and the physician and facility leadership team are now present at every care conference. We work in partnership with Residents and their families to discover “what’s important to you.” The focus of the care conference is on functional ability and quality of life; not disease and medical diagnoses. We have developed a clear format to guide discussions while still allowing significant flexibility in format depending on the individual resident and family circumstances. And we believe that a successful resident and family conference is a key requirement for any proposed quality improvement initiative in Residential Care. At Cheam Village and Glenwood Care Centre this intervention has greatly contributed to sustained improvements in the areas of antipsychotic use from 25% to approximately 5%; reduction in polypharmacy to an average 5.1 medications per resident and reducing unscheduled emergency department transfers to an average of 4.5% per quarter. This presentation will look at how to effectively address the challenges of developing collaborative team based care; explore how to fully engage with families and residents; and examine the barriers and challenges to innovation in the Residential Care setting.

Ann Marie Leijen
Executive Director
Cheam Village


Demonstrating Improvement in Pain Management through International Collaboration

In January 2014, the Seniors Quality Leap Initiative (SQLI), a committed and highly motivated collaborative of 12 long term care/post-acute providers across Canada and the United States, identified an opportunity to improve pain management for residents in long term care. SQLI acknowledged the importance of not only reducing the variation between organizations on a number of pain indicators, but also saw the opportunity for individual organizational improvement. At baseline, many of the SQLI organizations performed worse than the US reference median on the percent of residents with worsened pain, one of the key performance indicators. Together, the SQLI embarked on designing a collaboratively derived structured improvement process, which included:

  1. Identifying organizational gaps in pain management practices based on established evidence (InterRAI clinical assessment protocols)
  2. Selecting and targeting specific evidence-based practices to address specific organizational gaps
  3. Testing and evaluating interventions
  4. Sharing resources and networking with peers to share lessons learned
  5. Reporting on performance and progress

Using the evidence based InterRAI Clinical Assessment Protocol (CAP) for pain as well as the Registered Nurses Association of Ontario (RNAO) best practice guideline for pain, the SQLI developed a method to conduct an in-depth gap analysis based on best practice to develop an improvement plan based on individual gaps. This novel, collaborative approach is the first of its kind in the long-term care sector.

This session will present the results of this improvement project. Results include improving the average performance on the % of residents who experience continuous pain by over 10% and improving the % of residents with moderate or severe pain by 17%.

Cyrelle Muskat
Program Director, Elder Care & Palliative Services
Providence Health Care

Jo-Ann Tait
Program Director, Elder Care & Palliative Services
Providence Health Care

Heather Mak
Clinical Nurse Specialist
Providence Health Care


Breakout D: D1D2D3D4D5D6


D1 Rallying Around Youth at Risk: Community Supports for Suicide Prevention

Thursday, February 22nd | 16:00 - 17:00

Suicide is the second leading cause of unnatural death for youth between 16 and 24 years of age in British Columbia, with our First Nations communities rising rates among the highest in the world. Building upon the work of the BC CYMHSU Collaborative, this session will explore the essential role of community in preventing suicide among our young people, through efforts such as addressing adverse childhood experiences to offset risk and build resilience, as well as new changes in practice in emergency departments. Participants will take away tips and tools to increase community awareness and respond effectively to mental health crisis and suicidal ideation.

Jennifer Mervyn
Practice Initiative Lead, Child and Youth Mental Health & Substance Use Collaborative
Doctors of BC

Justine Thomson
Executive Director, NEED2 Prevention Education & Support
Project Lead, Salt Spring Island Local Action Team

Kirsten Funk
Youth


D2 A Tale of Two Communities: The North Island Hospital Transition

Thursday, February 22nd | 16:00 - 17:00

In 2012, both a new 95-bed hospital in Campbell River and a new 153-bed hospital in the Comox Valley were approved, intended to work in unison to support the health of the population throughout the North Island. One hospital, two campuses, two communities, two employers, two provincial ridings, three First Nations cultural family groups, four municipalities, and 2,100 staff, physicians and volunteers serving a population of 123,000…opened over three weeks in the fall of 2017. How hard could it be?

Dermot Kelly
Executive Director, Integrated Health Services, Geography 1
Island Health

Jeff Beselt
Executive Medical Director, Integrated Health Services, Geography 1
Island Health


D3 Open Your Eyes to a New “Safety”

Thursday, February 22nd | 16:00 - 17:00

Are you ready to think differently about patient safety? What does safety mean to you now, and how might you broaden your thinking around this essential component of our work in health care? The Vincent Framework for Measuring and Monitoring Safety – originally developed and tested in the United Kingdom, and now being trialed in Canada – offers important insights about safety that may spark your interest. The framework considers not just the absence of harm, but explores how we can foster the presence of safety now, as well as into the future. If you want to stretch your thinking around safety and converse with others keen to do the same (no matter what role you are in), join us for this session. Together, let’s challenge the status quo and see where it takes us!

Mita Rychkun
Licensed Practical Nurse, Ridge Meadows Hospital
Fraser Health

Sarah Grummisch
Clinical Nurse Educator, Ridge Meadows Hospital
Fraser Health

Colleen Kennedy
Director, Innovation & Engagement
BC Patient Safety & Quality Council


D4 Meds 'R' Us

Thursday, February 22nd | 16:00 - 17:00

The ABCD’s of How to Not Mess Up the Discharge Prescription

In 2016 the Thompson Region Polypharmacy Risk Reduction Project Group developed a Patient Medication Process Map to support the project team’s ability to identify current challenges and determine an area of work. The project group included a specialist, two hospitalists, a family physician, two pharmacists (community and acute), a unit clerk, two nursing students, a quality improvement consultant, and a project lead. The map highlighted the medication flow from entry to the ED, to an in-patient medical unit, and the transition of a patient to a community pharmacy.

The map uncovered 32 major polypharmacy challenges, including the need to develop a process for medication reconciliation at discharge. Through multidisciplinary discussion these principles were identified:

1. Facility based physicians acknowledged that they have to take ownership for the quality of the medication discharge prescription

2. Unit clerks could support physicians by providing the best possible and current medication lists at the same time

3. Processes need to be simple and straight forward

The project team created two processes to support the physician’s to complete a discharge prescription:

1. ABCD’s for Physicians: How to Not Mess Up the Discharge Prescription

2. ABCD’s for Unit Clerks: How to Help the Physician Not Mess up the Discharge Prescription

In 2017 the physician lead presented the processes to Royal Inland Hospital Physician Medical Staff Association and brought four specialists on board. The quality improvement consultant presented the processes to unit managers and brought four medical units on board. This fall the ABCD processes will be trialed with four specialists on four medical units.

Post-trial an evaluation will be conducted with participating physicians and unit clerks to capture the project’s successes and challenges. The team intends to bring learnings to RIHPA, Interior Health Administration, the Division and to the Provincial Polypharmacy Committee.

Laura Becotte
Project Lead
Thompson Region Division of Family Practice

Joslyn Conley
Shared Care Physician Specialist Lead
Interior Health

Jacqueline Pelton
Professional Practice Leader, Pharmacy
Interior Health


To Pee or Not to Pee: Medication Safety for Renal Patients

The “To Pee or Not to Pee” project is a quality improvement project at Royal Inland Hospital initiated by the Renal Program in October 2016. The project involved units that care for renal patients. The goal was to decrease adverse medication events for renal inpatients with a GFR <30 ml/min, by increasing nursing knowledge and awareness of renal specific medications. The problem was identified by Renal nurses whose patients were not receiving certain medications, receiving the wrong dosages, receiving too much fluid, or receiving medications at the wrong time. Medical unit staff did not always know what the medications were for or why they might be important.

A staff survey showed an improvement in confidence when managing medications for renal patients. The percentage of those who did not feel confident dropped from 38% to 19%, those who felt somewhat confident increased from 59% to 69%, and those who felt confident increased from 0% to 12%. The baseline survey showed an overwhelming 98% interest in more education.

Short, on-the-fly education sessions were held on medical floors where it was convenient for unit staff, educators and charge nurses to attend. Lanyard cards and large posters were developed to remind staff to think critically about fluid and medications for their renal patients, among other safety issues. The follow up survey showed the posters were well received.

Short, stand-up sessions on units while staff are working were much more successful than longer sessions held elsewhere. Having a take-away, like the lanyard card, was helpful and having a poster with more details helped give staff a reference they could go to after the education session. Educating nursing educators was important for sustainability because they continue to support staff and add the information to orientation for new staff. Involving the renal educator helped keep the information up-to-date and ensured renal staff were aware of the education, too.

Lesley Thellend
Registered Nurse
Interior Health

Joslyn Conley
Nephrologist
Interior Health


Medication Wastage in Residential Care Facilities

In 2016, our Residential Care quality improvement team discovered significant medication wastage at residential care facilities stemming from the unnecessary return and subsequent discarding of patient medications. Initial pharmacy estimates cost this wastage as $5-10M in BC.

Current practice dictates that one medication order change results in up to a week’s worth of medications being thrown out. Two main factors lead to this wastage:

1. Medicines in many facilities are delivered in weekly multi-dose packages

2. Physician medication orders are STAT by default

To quantify the cost of medication wastage, our team collaborated with a pharmacy to track the cost of medication discarded when there were changes to a medication order. Costs from 10 facilities were studied over 4-weeks.

In this study, it was found that 13% of residents had medication discarded each month. Province-wide this extrapolates to a potential of 50,000 mid-week multi-dose strips returned yearly and 2.5 million individual pills incinerated. The cost of these discarded medications is estimated to be $550K/year in BC.

Our study also revealed that there were costs to nursing time, packaging, and a possibility of medication error under the current practice. The study was adapted to develop a cursory understanding of the labour costs and increased medication error associated with this practice.

All members of our interdisciplinary team agreed that medication wastage is a significant issue and needs further study to explore full costs and solutions at a provincial level. A potential solution that merits further study is a change in practice so residential care medication orders are implemented as ‘next pack day’ by DEFAULT unless overridden by a physician.

Our team also recommends the establishment of a working group of provincial pharmacy leads.

This presentation provides a forum to discuss a comprehensive, multidisciplinary team approach to an important practice re-design opportunity.

Tracy St. Claire
Executive Director
South Okanagan Similkameen Division of Family Practice

Bob Mack
Family Physician
South Okanagan Similkameen Division of Family Practice


D5 Improving Access, Overcoming Distance

Thursday, February 22nd | 16:00 - 17:00

Text-Messaging Enhanced Primary Care: The Haida Gwaii Experiment

Primary care is centered on the face-to-face visit: provider and patient. Despite a digital revolution in methods of communicating, healthcare remains anchored to in-person visits, shackled by privacy concerns and antiquated billing policies. Though the quality of care is high and includes a physical exam, visits entail advance bookings, travel, sitting in a waiting room, and work absences. Many problems can be safely dealt with through alternatives when strong primary care relationships exist.

In spring 2017, the providers at Haida Gwaii Hospital & Health Centre (HGH) launched a pilot, where care is offered via a web-based texting application called Weltel®. Patients have the ability to text our Primary Care Nursing team for health advice and assistance. Registered patients receive an automated, weekly text asking “How are you doing?” Responses are categorized by a web-based platform and a nurse or nurse practitioner triages during weekday clinic hours. Responses are tailored to need and may include a text message, phone call, or an appointment with a healthcare provider.

We seek to understand how this service impacts health-related quality of life, the patient-provider relationship, interoperability and use of emergency services. Patient X was experiencing numbness in their hand. Via text communication, the nurse was able to rule out symptoms requiring an emergency visit and refer to a specialist. Our implementation strategy is unique to a rural and remote clinic; its launch is the first emergence of two-way texting in primary care nationwide.

At present, 5% of our patients are enrolled and all have used it. Users include teens, mothers, and grandmothers. The addicted, depressed, marginalized. Hypertensives, diabetics, and asthmatics. Texting shares results, books appointments, monitors symptoms and treatment, adjusts dosages, and offers advice to the worried and blue. Texting is bringing the clinic out of the clinic to where and when people need it.

Tracy Morton
Family Physician
Northern Health

Alissa MacMullin
Project Manager & Researcher
Northern Health


eCASE: Connecting Providers through Technology

The patient journey is often fraught with unnecessary waits and transitions, while providers often work in silos and may not be optimally supported. The Providence Shared Care team previously implemented the RACE telephone line for urgent advice. However, a non-urgent method of communication for issues requiring more depth was lacking. eCASE, electronic Consultative Access to Specialist Expertise, is a non-urgent email advice service that will streamline the patient journey by avoiding unnecessary referrals and supporting primary care in the community.

Focus groups were held with Family Physicians (FPs), specialists, and patients to gain input into the model and ensure eCASE is acceptable from all perspectives. Patients, FPs, specialists, and administrators formed a Working Group to guide prototype development and maximize project success. eCASE went live in April 2017 across Vancouver Coastal Health using the ‘dr2dr’ Secure Messaging Platform, and turnaround time has averaged 2 days. Uptake is increasing as more specialty services are added.

Formal evaluation is framed around the Quadruple Aim concept. Providers and users are surveyed after each eCASE interaction and interviews at six month with specialists and FPs will be performed to gain further feedback and inform change ideas. Finally, the patient perspective will be elicited by FP users at follow-up appointments. Data based on 65 initial interactions show that 54% of questions avoided a referral, while 84% of specialists and 90% of FPs would recommend eCASE.

Future directions include increasing usership by FPs, adding subspeciality areas, advocating for fee codes, and working to embed eCASE as a managed service within FP and specialist EMRs. eCASE and RACE are complementary ways of supporting FP practice in the community through specialist advice.

Nico Miraftab
Project Leader, Patient Transitions
Providence Health Care

Robert Levy
Shared Care Specialist Lead
Providence Health Care

Nardia Strydom
Regional Medical Director, Primary Care
Vancouver Coastal Health & Providence Health Care


First Nations Telehealth Expansion Team

The expansion of telehealth services to First Nations communities within the province of British Columbia arose from the 2006 Transformative Change Accord: First Nations Health Plan, a 10-year plan focused on closing the socio-economic gaps between First Nations and non-First Nations people in British Columbia. Action Item Number-23 of this plan, to ‘create a fully integrated clinical telehealth network’, provided the impetus to initiate the First Nations Telehealth Expansion Project (FNTEP). The FNTEP aimed to increase First Nations access to health and wellness services previously out of reach due to geographic constraints. Ambitious in approach and scope, this project engaged with 45 First Nations communities across all five health regions within which telehealth capacity was developed and implemented over a two-year period. The purpose of this presentation is to provide an overview of the FNHA Telehealth Model and share our successes, challenges, and steps taken to move forward into future expansion.

Eyrin Tedesco
Director, Clinical eHealth Initiatives
First Nations Health Authority


D6 People Matter: Creating a Culture of Collaboration & Compassion

Thursday, February 22nd | 16:00 - 17:00

Capturing, Sharing & Recognizing the Compassion in our Care

Context & Relevance: Patient- and family-centred care is a part of direct and non-direct care provided by Vancouver Coastal Health (VCH) staff. It was recognized that the challenge, however, is the ability to recognize and articulate how it is incorporated in their daily work. There was no formal process to recognize, share and celebrate the simple and complex stories of how staff provide patient- and family-centred care, and go above and beyond for patients and families. Having a process broadly demonstrates the value of patient- and family-centred care, provides important validation and acknowledgement of staff, and enhances a culture of compassionate care from board to ward.

Intervention: In August of 2016 the “I Made a Difference” contest was developed to promote the core value of compassionate care through the engagement of all staff, to provide a process to acknowledge and celebrate exemplary patient- and family-centred care, to connect all staff regardless of role with our shared value of patient- and family-centred care, and to provide an opportunity for staff to recognize and share their experience of compassionate care.

Measurement: 350 submissions were received over a three-month period. The contest received such a positive response that it was extended twice and expanded from one to three prize winners to appropriately acknowledge the submissions.

Lessons Learned: VCH staff appreciated the invitation to share their stories and be acknowledged for this part of their work. As entries were shared throughout the organization, the submission rate increased as people were inspired by their colleagues. The contest connected us with the common value of compassion. The submission from the CEO inspired, as did the submissions from our ICU physicians, staffing clerk and Starbucks barista. The 2017 contest is underway and we are working with our partner health authorities to share our work, ideas and experiences.

Lisa Stewart
Quality & Patient Safety
Vancouver Coastal Health

Sheri Johnson
Social Worker
Vancouver Coastal Health


Shifting Culture of Care to Improve Hydration of Rehabilitation Hospital In-Patients

Holy Family Hospital, a facility within Providence Health Care (PHC), is a 65-bed in-patient rehabilitation hospital providing care to 500 patients yearly. Literature shows that rehabilitation patients are not drinking the minimum 1.5 L of daily fluid, with many drinking only 975mL – 1.2L daily, affecting patients’ sense of well-being, functional capacity, and health outcomes.

Our in-house hydration audit revealed daily fluid intake ranged between 837–1448 mL with an average of 1155mL, 355mL short of recommendations. Patient surveys revealed that patients wanted to be better hydrated, while expressing interest for increased bedside hydration.

Our aim is, through PDSA cycle, from the period of June 2017 to August 2017, ensure 100% of eligible patients will consume the minimum of 1.5 L of fluid daily.

Hydration campaign was promoted by the site-leader, doctors, nurses, kitchen staff, and dietitian. Through iterative learning, we finalized on a suite of interventions: nurse-led hydration rounds twice daily where coffee/tea/water on a trolley is offered to eligible patients, a new filtered-water station, and integrated physician hydration orders as one of the vital signs.

Twenty total patients were monitored, our interventions demonstrated 33.2% improvement from baseline as daily fluid intake increased to 1245-1810 mL with an average of 1538 mL per day.

As promoted by IHI, we learned that successful quality improvement goes beyond structural and process changes by involving cultural change. Through the commitment of allied health, we shifted the culture of care to assure a basic need of patient well-being is met. We are also excited to see a shift in patient self-motivation towards hydration, as many patients are monitoring their own daily fluid intake. We believe this cultural shift cultivates a sustainable and scalable improvement as adequate hydration is integrated into standard practice. We are aiming to spread this project to other PHC sites.

Jiwei Li
Hospitalist
Providence Health Care

Liz Ong
Clinical Nurse Leader
Providence Health Care

Stephanie Bury
Registered Dietician
Providence Health Care


Randomized Coffee Trials – Creating Connections at Island Health!

When the Island Health Quality & Patient Safety Consultant (QPSC) team first learned about Randomized Coffee Trials (RCTs) in 2015, they were both intrigued and energized to try a series of RCTs across Island Health with the aim of providing informal opportunities for staff, physicians, patients/families and volunteers to connect. The QPSC team believes that a connected organization leads to a positive workplace culture, which in turn is associated with improved patient outcomes. RCTs provide an innovative vehicle for connecting staff across the vast and diverse Island Health region and starts to breakdown silos by bringing people together in a casual setting. While deceptively simple, RCTs aim to increase overall engagement and get staff talking and learning from one another.

The QPSC team offered 3 series of RCTs across Island Health between October 2015 and October 2016, for a total of 8 different hospital sites and 348 participants (including 10 virtual RCT pairings). Each series of RCTs was planned to maximize engagement and feedback was requested from all participants for post-event review. Through thematic analysis, the resounding feedback was that Island Health staff appreciated the fun and informal opportunity to connect with each other and discuss what patient safety and continuous quality improvement meant to them. Participants indicated they also took away a new understanding and appreciation of the diversity of professions, backgrounds, and skills among the Island Health community.

A fourth series of RCTs is planned for October 2017, which will align with the BCQPSC Change Day campaign. This upcoming series aims to double participation and will attempt to move the previous format of in-person RCTs to solely virtual “coffee date” pairings. By making this format change, the hope is that staff will be more likely to connect with others outside of their own site and will engage more staff who are based in the community or have irregular schedules.

Xela Rysstad
Quality & Patient Safety Consultant
Island Health

Sonya Chandler
Consultant, Quality & Engagement
Island Health


Breakout E: E1E2E3E4E5E6


E1 Making Engagement Meaningful through Analysis & Action

Friday, February 23rd | 09:45 - 10:45

As one of the biggest buzzwords in human resources, the term ‘engagement’ can get a bad rap as being ‘fluffy’ or ‘feel good fodder’. In this session, we’ll discuss the importance of employee engagement for meeting your team’s goals, and discuss ways to elevate its status to an operational metric. This will include best practices in engagement survey analysis, taking action on the results that come forward, as well as the top leadership behaviours to boost engagement in your team. The sessions is suitable for anyone who needs to inspire those around them to achieve objectives as a group.

Stephanie Hallett
Manager, Retail Recruitment & Retention
Save-On-Foods


E2 Measuring the Value, Impact & Return on Investment of Our Improvement Endeavours

Friday, February 23rd | 09:45 - 10:45

Looking to prove the value of a program or project? This hour will provide a methodology to credibly evaluate improvement initiatives. Learn the 10 Step ROI Methodology as it is applied to health care programs and initiatives; how to isolate the impact of programs and initiatives from other influences; and how to enhance program quality, results and return on investment.

Suzanne Schell
Chief Executive Officer
ROI Institute Canada


E3 Transitioning to Legal Cannabis

Friday, February 23rd | 09:45 - 10:45

Cannabis legalization and regulation in Canada have us and our patients heading into unchartered waters. Grounded by an overview of the current state, and latest evidence, and potential directions for BC, this session will provide time for a conversation about how the health system is looking to respond. Medicinal and non-medicinal use and prevention of harms will be discussed, as well as exploring together what this new landscape means for those working and receiving care within the BC health system.

Additional Resources:

Handout 1

Handout 2

Article

Gerald Thomas
Director, Alcohol, Tobacco, Cannabis & Gambling Policy & Prevention
Ministry of Health

Brian Emerson
Medical Consultant
Ministry of Health


E4 Going the Distance for High Quality Rural Care

Friday, February 23rd | 09:45 - 10:45

Increasing Access to Physiotherapy Services for Chronic Pain in Rural Communities

This rapid-fire session will be streamed on Facebook Live!

1 in 5 British Columbians live with chronic pain. To improve quality of life and promote a return to function, people in pain need access to evidence-based multimodal treatment including physiotherapy, counselling, and pharmacology. Unfortunately, many people in pain have difficulty accessing non-pharmacological therapies due to their high costs and/or lack of availability in rural and remote areas of the province. Restricted access to evidence-based non-pharmacological alternatives has led to an overreliance on medications, which can result in poor pain relief, adverse side effects, and substance misuse.

Pain BC is collaborating with communities to improve access to physiotherapy, a pillar of best-practice pain care that can help improve function and lessen reliance on pharmaceuticals. The Gentle Movement and Relaxation Program was co-developed by Pain BC, Vancouver Island Health Authority, physiotherapist Carley Grigg, and pain expert/physiotherapist Neil Pearson. The program was piloted in 2016 to communities on the West Coast of Vancouver Island, including Tofino, Ucluelet, and boat-access First Nations communities Hitacu, Ahousaht, and Ty-Histanis. It was free to participants and led by a community physiotherapist, who otherwise would not have been able to provide care due to extensive service waitlists. In the first round of classes, participants reported less pain, greater range of motion, more function, and rated the program’s “helpfulness” as 8.2/10. Since the initial pilot, the program has been run in the spring and fall of 2017 with similar results.

The seven-week program consists of 90-minute classes held once a week. Each class is led by the physiotherapist, with 2 supporting instructors (yoga teacher/shiatsu practitioner) to allow the physiotherapist time to recommend personal adjustments to each participant. While the classes focus on safe exercises, everyday movements, and breath work to manage pain, there is also a large educational component.

Jamie Ignacio
Community Engagement Lead
Pain BC


Supporting Rural Maternity Services Through Telehealth: An Integrated Systems Perspective

This rapid-fire session will be streamed on Facebook Live!

The attrition of rural maternity services in BC is well documented, as are the consequent maternal-newborn outcomes for mothers who have to travel to access care. It is a provincial and professional mandate to support maternity care “closer to home” for rural women and their families, although this is not without challenges in low-volume and isolated settings. The Mobile Maternity project, funded by the Specialist Services Committee, set out to use technology to bridge the distance between rural women needing specialst obstetrical care and their provider but has expanded to include creating a virtual support system for care providers in low-resource environments. This latter application can been seen as one part of a larger systems approach to sustaining and growing rural generalist maternity services.

This presentation, based on our experience with the MOM project, will look at the use of telehealth in supporting rural maternity care and discuss its importance in sustaining isolated rural practices within the context of other system supports. Through a rural lens, we will consider the role telehealth has in enhancing generalist – specialist relationships, in being a conduit for continued medical, midwifery and nursing education, allowing specialist oversight in high acuity transport situations and other applications that strengthen the confidence and competence of isolated providers. We will conclude the systems perspective on the use of telehealth by reviewing tensions caused by its introduction and the implications on other parts of rural health care.

Jude Kornelsen
Associate Professor Department of Family Practice
University of British Columbia & Centre for Rural Health Research


E5 Blanket of Care for Those with Dementia

Friday, February 23rd | 09:45 - 10:45

Using Social Robots to Reduce Loneliness in Dementia Care

Research shows that boredom and lack of meaningful engagement can be detrimental to people with dementia. They may negatively influence mood and increases loneliness, anxiety, agitation and psychological symptoms of dementia (BPSD). BPSD may lead to the inappropriate use of antipsychotics, which may consequently result in a decrease in cognitive, physical and social functions, as well as increase the risk of falls and mortality. Animal assisted therapy has demonstrated some success in caring for people with BPSD. However, access to appropriate animals and safety concerns makes this therapy challenging to implement. Recently, we have introduced social robots including a seal (PARO) and a therapy companion cat into dementia care in Vancouver General Hospital as an alternative. This pilot project is to explore the potential of using social robots in dementia care. New research published this month involved 450 people with dementia supports the efficacy of the social robot, PARO, in reducing BPSD and improving mood within 28 long-term care settings in Australia.

Our study involves a qualitative video ethnographic approach nested within a three-year clinical research project examining the use of technology with people with dementia in Vancouver Coastal Health. Video recordings will be made of using social robots to engage patients in a Tertiary Older Adult Mental Health Unit, Willow5. We will conduct systematic video-analysis with the assistance of digital software, NVivo11 and Final Cut Pro. We will present our findings on the impact of using social robots in dementia care related to engagement, socialization, and mood as well as their feasibility in the hospital setting. We will engage conference attendees in dialogue about acceptability and challenges in sustaining this novel idea in practice. We believe there is potential for the use of social robots in supporting the social and emotional needs of people with dementia in VGH and beyond.

Lillian Hung
Clinical Nurse Specialist
Vancouver Coastal Health

Andy Au-Yeung
Occupational Therapist
Vancouver Coastal Health

Mike Wilkins-Ho
Physician
Vancouver Coastal Health


Using Personalized Music to Improve the Quality of Life of Residents in Long Term Care

The Alzheimer’s Society of Canada estimates that 546,000 Canadians live with dementia. Behaviors associated with dementia including aggression and agitation can decrease quality of life (QOL) and are often treated with antipsychotics, which can have harmful effects.

Studies show that introducing personalized music into the lives of dementia residents significantly reduces agitation. Music has profound effects as it evokes emotions associated from memories, strengthens emotional bonds, and improves mood.

The aim of this project was to implement a personalized music program at two VantageLiving residential care sites. The goals of this project were to reduce agitation of dementia residents, reduce the use of inappropriate antipsychotics, and improve QOL for the residents.

The interdisciplinary team selected residents for the program by looking at prescribed antipsychotics, and at behaviors. Preference of music for selected residents was assessed by using the Assessment Of Personal Music Preference (APMP) tool. A music playlist for each resident was then made; music was downloaded, and then applied to iPods. Staff was educated to use the intervention when the resident exhibited early signs of agitation.

The following tools were used for monitoring progress: Cohen-Mansfield Agitation Inventory (CMAI), Agitation Quality Improvement Monitor (AQIM), Individualized Music Program: Behavior Monitoring Tool, and the Antipsychotic Tracking Form. The AQIM and APMP were retrieved from Gerdner’s (2001) article. The CMAI is a validated tool used to assess for agitation. Staff satisfaction and understanding of the program was assessed through surveys that staff anonymously completed.

Twelve residents were selected. 58% of the residents were on an antipsychotic at the start of the project. Data continues to be analyzed, however,preliminary trends indicate positive effects of the program, such as an overall decrease in agitation by 85% when music was implemented.

Niki Kandola
Summer Student Intern
Vantage Living and BC Patient Safety & Quality Council

Jannah Mitchell
Education & Professional Practice Specialist
Vantage Living


Home-Based Memory Rehabilitation in Dementia - A Scotland-Wide Improvement Journey

Scottish Government strategy commits us to providing personalised post-diagnostic support (PDS) so people living with dementia (plwd) can remain at home for longer with a good quality of life. Occupational therapy (OT) for PDS is recognised as key to maintaining people’s independence and valued roles. However a national scoping exercise revealed that plwd were not receiving equitable access to OT within the PDS period.

A strategic alliance was formed in order to build capacity for, and spread the OT Home Based Memory Rehabilitation Programme (HBMR), which had been tested and evaluated in one Board Area, with positive outcomes for plwd (including reduction in reported memory difficulties and maintenance of an increase in memory strategies).

Collaborative learning approaches have been utilised which involve clinicians, academic and policy-makers in national planning activities and small-scale local tests of feasibility.

Key methods:

  1. Sharing programme resources
  2. Skill mixed clinical-strategic-academic project team
  3. Collaborative decision making
  4. Multiple communication strategies for problem-solving
  5. Selecting and testing measures evaluating key outcomes
  6. Developing efficient programme monitoring infrastructure

Outcomes to date:

  • Therapists in 12 of Scotland’s 14 board areas now offer HBMR, improving consistency of access to OT
  • There is an online forum to share practice-learning and solve implementation problems (56 members averaging 23 posts monthly)
  • Selection of a range of measures to evaluate the impact of HBMR on ADL, cognition, and quality of life
  • Development of a monitoring and evaluation capacity so teams can access relevant information
  • Completed qualitative evaluations indicated benefits in various life areas

The success of the project to date has been due to a ‘ground up’ approach, with strong buy in from the clinician’s involved. National leadership and alignment with policy has also been a key enabler.

Alison McKean
Project Lead, Post Diagnostic Support
Alzheimer Scotland


E6 Redesigning for Optimal Outcomes

Friday, February 23rd | 09:45 - 10:45

Connect 4 Care: Redesigning Care Delivery for Patients with Complex Needs

In 2014, BC Children’s Hospital engaged in an Institute for Healthcare Improvement (IHI) collaborative: “Better Health and Lower Costs for Patients with Complex Needs: Triple Aim Collaborative”. With mentorship from IHI, a team of clinical, operational and quality improvement leaders studied complex populations served by our agency. They identified a group of children with significant complex needs high utilizers of the system and who appeared to be experiencing fragmentation in care across our agencies. A focused needs assessment that explored the child’s health journey, current models of care, and family experience identified 3 barriers within our current system: lack of coordination/collaboration among service providers, inappropriate utilization of services and long wait times.

Utilizing iterative design methodology, a new care delivery service has been co-designed with families. Co-design began with the first patient enrollment and has continued as the service has scaled up to serving more than 25 children/families. Supported by a care coordinator, the care pathway for the child is planned in collaboration with the family and tertiary/community health care providers and is based on an individualized family/child needs assessment. Families are actively involved in providing feedback on their care experience while receiving care and the team meets weekly to identify areas for process/system improvement which can be implemented immediately. An evaluation framework follows the Triple Aim outcome objectives of improving: patient experience, health outcomes and cost utilization. These outcome measures along with process measures such as staff satisfaction and enrollment data continue to inform ongoing service design as scale up continues. 100% of families surveyed indicated that Connect4Care provides a service that is not otherwise available in both tertiary and community care with improvements in coordination, information sharing and timely access to services.

Rita Janke
Manager, Quality, Patient Safety & Accreditation
BC Children’s Hospital – Sunny Hill Health Centre

Veena Birring Hayer
Project Manager
Provincial Health Services Authority


Improving the time to ECG in the Vancouver General Hospital Emergency Department

CONTEXT: For patients with chest pain, the target time from first medical contact to obtaining an electrocardiogram (ECG) is 10 minutes, as reperfusion within 120 minutes can reduce the risk of adverse outcomes in patients with ST elevation myocardial infarction (STEMI). In 2007, Vancouver Coastal Health (VCH) began tracking key indicators including time to first ECG. The Vancouver General Hospital (VGH) Emergency Department (ED) has had the longest door to ECG times in the region since 2014. In 2016, the VGH ED Quality Council developed a strategy to address this issue, with an aim of obtaining ECGs on VGH ED patients with active chest pain within 10 minutes of presentation. INTERVENTION: The VGH ED Quality Council brought together frontline clinicians, ECG technicians, and other stakeholders. Process mapping and root cause analysis determined two main barriers: access to designated space to obtain ECGs, and the need for patients to be registered in the computer system before an ECG could be ordered. The team identified strategies to eliminate these barriers, identifying a dedicated space and changing the workflow to stream patients to this space before registration. RESULTS: Our median times in patients with STEMI have gone from 33 minutes to 8 minutes as of June 2017. In all patients presenting with chest pain, we improved from 36 to 17 minutes. As of April 2017 we are obtaining an ECG within 10 minutes in 27% of our patients, compared to 3% in 2016. LESSONS: By involving frontline staff, and having champions providing real time support, we were able to make significant changes to the culture at triage. We cultivated sustainability by changing the workflow and physical space, and not relying on education. Implementing small changes and incorporating feedback has allowed us to identify new challenges early. While we have improved the times for our walk-in patients, we have not perfected the process when a patient moves directly to a bed or presents via ambulance.

Heather Lindsay
Associate Head & Associate Medical Director, Emergency Medicine
Vancouver Coastal Health


Improving Efficiency & Effectiveness of NICU Rounds: Changing a 25 Year Practice

The BCW Neonatal Intensive Care Unit is moving from a 60 bed open bay design to a 70 single family room design in October 2017. In preparation for this change, the team has done extensive work to design an integrated family-centred model of care which required significant redesign of information flow. One key process is the NICU patient rounds, currently provided daily by 3 care teams that travel to each bedside. Before the initiative, the median time for rounds from start to finish was 225 minutes. The length of rounds has been a source of family and staff dissatisfaction for many years. Changing the way rounds is conducted required changing a 25 year practice that is ingrained in the culture; the result being all other processes were designed around the 4h rounds. The primary aim of this improvement initiative was to redesign the rounds process in order to reduce the median lead time of rounds by 25% and improve family and staff satisfaction. An interdisciplinary team, including parents, redesigned the rounds process by removing activities that were not contributing to the objective of rounds. A definitive start time with a standardized preparation period was determined. A new model for structured patient reporting was introduced for staff and families to participate fully in rounds. For implementation, round facilitators (a clinical nurse leader and a nurse educator) were released from regular service to support the change to lead daily debriefs, provide coaching, and make necessary changes. At 3 months, the median rounds length was reduced by 55% to 125 minutes. Family and staff satisfaction improved significantly. A key lesson learned is that the rounds facilitators were successful but only a temporary aid to sustainment. At 6 months, the rounds time is increasing but start times, rounds structure and provider satisfaction have sustained. Our next efforts will focus on understanding and addressing issues that would facilitate sustainment of efficient rounds.

Ronnalea Hamman
Leader, Quality, Safety & Improvement
BC Women’s Hospital & Health Centre

Sandesh Shivananda
Medical Director, Neonatal Intensive Care Unit
BC Women’s Hospital & Health Centre

Valoria Hait
Quality & Safety Leader, Neonatal Program
BC Women’s Hospital & Health Centre


Breakout F: F1F2F3F4F5F6


F1 Linking Ideas to Action with Driver Diagrams

Friday, February 23rd | 11:15 - 12:15

Looking for a quality improvement tool that will help take your lofty aim and break it down into manageable change ideas? Need a method that will help move your team from vision to action? Searching for an approach that is agile and can change as rapidly as the complex, adaptive systems we work in? Then driver diagrams are the tool for you! In their simplest form, driver diagrams help link high-level improvement goals to specific project activities. In this interactive session, you will have an opportunity to learn more about this powerful tool and start to build the framework for your very own driver diagram.

Marlene Apolczer
Quality Improvement Lead
Northern Health


F2 Big Dreams for Big Data

Friday, February 23rd | 11:15 - 12:15

The convergence of powerful analytical technologies is rapidly redefining health care delivery and medical decision-making as a data-science. How will this new paradigm of data-driven medicine generate valuable insights and what effect will it potentially have on health and operational outcomes? Don’t let all the information overwhelm you – join us for a simple look at the opportunities and implications that matter to you.

Tyler Wish
Health Care Entrepreneur

Founder
Sequence Bio


F3 Transforming Primary Care in Scotland: The Journey So Far

Friday, February 23rd | 11:15 - 12:15

This will provide an opportunity to discuss the learning from the Primary Care Transformation Programme in Scotland, which supports the vision of general practice and primary care being at the heart of the health care system. It will be an interactive session where you will be able to consider how you could apply this learning to your own local context including the potential impact for patients, your service and the wider system.

Jennifer Wilson
Professional Nurse Advisor, Primary Care Division
Directorate for Population Health Improvement, Scottish Government


F4 All Hands on Deck: Peer-Powered Improvement

Friday, February 23rd | 11:15 - 12:15

The Other Side of the Desk - Integrating Peer Services on DTES Healthcare Teams

This rapid-fire session will be streamed on Facebook Live!

In December 2016 RainCity Housing (RCH) was invited to partner with Vancouver Coastal Health (VCH) in order to provide unionised Peer Specialist (Peer) services on 6 multi-disciplinary DTES teams. This role was one of a number of service improvements that were identified as part of VCH’s 2nd Generation Strategy, which is aiming to improve the system of care in Vancouver’s Downtown Eastside neighbourhood. The integration of Peers onto our care teams aims to increase social inclusion and attachment to care for clients, many of whom have significant histories of trauma and negative perceptions of clinical healthcare interactions, as well as to provide valuable insight to DTES healthcare providers regarding better practices of approaching clients in a collaborative and community-minded way. RCH has background in the grassroots of the DTES and a long history of Human Resource practices which value voices of lived experience, including the development and implementation of multiple Peer and Indigenous Cultural Liaison positions on internal staff teams. Evaluation is ongoing, and a 1 year report compiled of surveys and qualitative interviews with VCH clinical staff, RCH peer specialists and clients of DTES teams is expected for Spring 2018. Many learnings have already become apparent, including the value of the health authority/non-profit partnership to provide adequate support to both Peers and VCH teams, the need for well-defined job descriptions and roles/responsibilities of Peer Specialists on Clinical teams, the difficulty of culture shift between a non-profit support work focused workplace and a clinical setting, and the need for culturally appropriate supports and job-descriptions for Indigenous Peer Specialists. We hope to present on these learnings in a narrative style, and invite two of our Peer Specialists to co-present in their own voice.

Issac Malmgren
Manager-Peer Services & Community Development
Raincity Housing

Cailtin Etherington
Strategy Planner
Vancouver Coastal Health

Aaron Munro
Associate Director
Raincity Housing


Improving Public Engagement in Advance Care Planning through Peer-Facilitated Public Sessions

This session will be streamed on Facebook Live!

Patient-centred care puts patients at the forefront of their health care and improves all dimensions of quality in health care. Advance Care Planning (ACP) is a process that supports patient-centred care when individuals prepare for decisions about their health care by understanding and sharing their values, beliefs and wishes. Sharing what matters most then informs decision-making with health-care providers about treatment and care options to help them get the care that’s right for them.

Despite these benefits, public awareness of and engagement in ACP is low. To increase public engagement in ACP the BC Centre for Palliative Care partnered with community organizations to spread a community-based model of ACP education; peer-facilitated public ACP sessions. In these interactive sessions, trained peers guide public participants through the process of ACP. The sharing of stories encourages engagement by session participants, and begins the conversation. The sessions aim to empower participants and increase the comfort and readiness of participants to discuss ACP with their family members and health-care providers.

In over 40 sessions attended by over 800 participants in 23 communities throughout BC, our results demonstrate that peers are well suited to this role – sessions were well received and effective at promoting ACP engagement. Within 4-6 weeks of attending the session almost all participants (97%) had thought about their personal values, beliefs and wishes, and two thirds had had conversations with those close to them (a 76% increase from pre-workshop rates). There was also a 75% increase in conversations with health-care providers, and a 69% increase in creation of ACP documents. All organizations have continued to deliver sessions demonstrating sustainability.

Peer-facilitated ACP sessions are an effective strategy to increase ACP awareness and engagement among British Columbians.

Rachel Carter
Advance Care Planning Project Manager, Research Manager
BC Centre for Palliative Care

Eman Hassan
Director, Public Health Initiatives
BC Centre for Palliative Care


Fall-unteers: A Volunteer-Based Falls Prevention Strategy in Residential Care

This session will be streamed on Facebook Live!

Providence Health Care (PHC) has many fall prevention strategies in place, yet falls continue to be the most common event reported by staff in the BC Patient Safety Learning System. At Holy Family Hospital (HFH), one of PHC’s 5 Residential Care homes, falls are highest between 4 and 8 pm when there is a lower staff-to-resident ratio and fewer activities. HFH is home to 142 residents, all of whom are considered at risk of falling. With limited resources, HFH aimed to test the effectiveness of having volunteers check in on residents in an intentional rounding format: a “Fall-unteer” program. The goal of the study was to find out if using non-medically trained volunteers to provide supervision and focus on common risk factors can help reduce falls between 4 and 8 pm. Volunteers were assigned 2 hour shifts (4-6, 6-8 pm), provided with a checklist of falls risk factors and asked to focus on them as they walked through the home, monitoring residents in their rooms and common areas. Volunteers engaged each resident in a short conversation to make sure they had what they needed and checked that standard falls-prevention strategies were in place, paying closer attention to those identified by care staff as high risk. Staff were called if residents required assistance. Over 114 Fall-unteer shifts, there were 4016 interactions with residents. The most common interactions were to ensure the call bell is within reach (96%), ensure personal items are within reach (70%) and engage the resident in conversation (20%). Retrospective chart reviews comparing the year prior to and the year of the Fall-unteer program showed a trend towards reduced falls in areas of HFH where Fall-unteers were implemented as well as a trend toward reduced falls during Fall-unteer hours. Recruitment and retention of volunteers was challenging. The volunteer coordinator followed up with each volunteer to understand issues and a new group has been recruited to spread Fall-unteers to the rest of HFH.

Nadra Ali
Clinical Nurse Leader
Providence Health Care

Carrie-ann Longstaffe
Coordinator, Volunteer Services
Providence Health Care


F5 You Will be Seen in Two Weeks Now!

Friday, February 23rd | 11:15 - 12:15

Imaging Wisely: Reducing Inappropriate MRI Exams to Address Long Wait Time in BC

In the absence of red flag symptoms, there is no evidence of utility of advanced imaging in patients with significant osteoarthritis (OA). A new protocol was introduced at two acute hospitals in Vancouver Coastal Health where patients were assessed for advanced OA before proceeding to advanced imaging (MRI and CT arthrograms). In 2014 the study sites completed 836 MRI for the shoulder, hip, or knee for outpatients over 55 years of age; this population is at increased risk of co-existent OA.

The new protocol, introduced in October 2016, required recent radiographic images (acquired within 1 year) to be appended with the advanced imaging order for hip, knee or shoulder for patients over 55 years of age. The radiologists reviewed the images and graded the degree of OA using a validated tool, the Kellgren-Lawrence (KL) scale. In patients where the KL score >2, significant OA is present and advanced imaging was not approved. Significant workflow changes from community-based referring physicians, radiologists, and clerical staff were required to successfully implement the protocol.

We applied the Model for Improvement to the project. The first PDSA cycle highlighted workflow issues for clerks and radiologists. Value stream mapping helped identify value added and non-value times in the process. After several PDSA cycles on the workflow, processing time decreased from 57 to 15 days for the new protocol, as compared with a regular MRI booking process that would take 3 days. Nevertheless, the rejection rate was 38% as a result of avoiding unnecessary exams.

The two takeaways to share are: how continued involvement from clerks and radiologists is needed to collect data and generate ideas to eliminate non-value added delays; and the robust measurement process required to assess effectiveness of the implementation and the impact on referring orders. Such lessons are likely to be pertinent to other outpatient quality interventions, especially in lab and medical imaging.

Bruce Forster
Professor & Head, Department of Radiology
University of British Columbia

Vivian Chan
Physician Quality
Vancouver Coastal Health

Flora Dong
Program Advisor, Choosing Wisely
Vancouver Coastal Health


Are Wait Times Bad for Everyone? A Case Study of Inguinal Hernia Repair

Waiting for elective surgery is an expected reality for many Canadians. This has led to questions with respect to the effect of these wait times on patients’ health. The primary objective of this study was to test for a relationship between the length of time patients waited for elective hernia repair surgery and change in their self-reported health.

This study was based on a prospectively recruited longitudinal cohort of patients waiting for elective hernia repair surgery. Participants completed several patient-reported outcomes (PROs), including the: PHQ-9 (depression), PEG (pain), EQ-5D(3L) (general health) and the COMI-hernia (condition-specific health). These PROs were collected 1) upon being added to the surgical waitlist and 2) two weeks before surgery. Multivariate regression models explored associations between patient-reported outcomes and potential confounders, including age, sex, socio-economic status and medical comorbidities.

There were 118 participants and the modal age group was 61 to 70 years. The average wait time for participants was 22.5 weeks. There were no relationships between the duration of participants’ wait for hernia repair and the change in patients’ self-reported health for hernia-specific outcomes or overall health related quality of life.

There are gains in health-related quality of life to be realized by prioritizing symptomatic patients. Participants with greater pre-operative depression, pain and hernia-related symptoms experienced an improvement in health prior to surgery, though more clarity is needed on the mechanisms that led to improved health.

This study shows that duration of time on the wait list was not associated with change in hernia patients’ self-reported health.

Kate Redfern
Project Manager, VALHUE & Wait One
Vancouver Coastal Health

Ernest Lai
Research Assistant
Vancouver Coastal Health


Reducing Wait Times for Spirometry: The Fraser Health Experience

Spirometry is a painless, rapid test of lung function that is considered essential to the investigation of patients with respiratory complaints. It is essential for the diagnosis of COPD and asthma and the follow up of patients with established respiratory diseases. Wait time data for spirometry testing at Fraser Health (FH) Pulmonary Function (PF) Laboratories varied widely from 2 days to 98 days (median 43 days). The costs of spirometry testing were covered by service based funding via technical fees paid by the Medical Services Plan of BC. Given that there was no financial reason not to meet the demand for testing, this seemed an ideal QI project for a FH PQI Cohort 2 project. An improvement team at Ridge Meadows Hospital (RMH) was formed consisting of a respirologist, the lead respiratory therapist, the booking clerk, a Simon Fraser University volunteer student and a patient representative. The mean wait times for spirometry at RMH were reduced from 29 days to 14 days within three months and to 9 days within 9 months. A number of PDSA cycles were performed on the wait time operational definition and on data collection. FH Meditech data was found to be unreliable and a simple Excel spreadsheet data entry form was developed for completion by the booking clerk twice weekly. It was discovered that requisitions were being placed in a holding queue resulting in an underestimation of actual wait times. Once reliable wait time data was available for presentation, a business plan was presented to operational management empowering the booking clerk and lead RT to balance the staffing of the PF facility with the workload. The PF staff were kept updated with run charts of wait times. A survey of FH wide wait times and unbooked spirometry requisitions confirmed long wait times at most other FH sites. A presentation of the QI project to senior FH administration has led to a FH wide QI project aiming to reduce wait times for spirometry region wide by Q1 2018.

Frank Ervin
Respirologist, Regional Division Head
Fraser Health


F6 Everyone Can Prevent Infections, from Patients to Providers to… Dogs!

Friday, February 23rd | 11:15 - 12:15

Implementation of a Pharmacy Escalation Tool for Patients with Clostridium difficile

Infection Prevention and Control Practitioners (IPCPs) at Fraser Health review all toxin positive Clostridium difficile tests as part of routine surveillance to identify cases deemed likely to be an infection. If a patient with a confirmed Clostridium difficile infection (CDI) has a toxic megacolon and/or colectomy confirmed by a physician/CT scan, or a death associated with CDI, a related harm event is entered into the Patient Safety & Learning System (PSLS). In early 2017, a review of PSLS CDI-related harm events suggested that some patients might have benefited from early pharmacy intervention. There is currently no well-established mechanism for IPCPs to identify and request a review by the clinical pharmacist.

In partnership with the Antimicrobial Stewardship Program (ASP), a data collection form, database and algorithm were developed where IPCPs can escalate toxin-positive patients on potentially guideline-discordant therapy for pharmacy review. The tools were piloted across all acute sites in the spring of 2017. Three sites tested the escalation process. The objectives of the quality improvement project are to assess and determine:

1. If CDI pre-preprinted orders are on the chart and in use; and

2. Guideline-discordant antibiotic use to be escalated to a site pharmacist for further review.

Several challenges were identified early on. These included stakeholder engagement, limited resources, and integration with existing surveillance platforms. To mitigate these challenges, the project team actively engaged the IPCPs and sought opportunities for feedback and reduced administrative functions related to routine CDI surveillance.

This project allows IPC and ASP to better understand the number of and review the therapy for patients that may not be on appropriate CDI therapy within 24-48 hours of a positive lab result. Moreover, it aims to establish a formal process where IPCPs can request a clinical pharmacist review for CDI patients.

Elizabeth Brodkin
Executive Medical Director
Fraser Health

Katy Short
Epidemiologist, Infection Prevention & Control
Fraser Health

Colin Lee
Pharmacist
Lower Mainland Pharmacy Services


The Nose Knows: Sniffing Out C. difficile Spores in Our Hospitals

Issue: C. difficile (CD) spores are resistant to routine cleaning agents, and, depending on the conditions, can live in the environment for many months. Identifying and reducing environmental contamination is crucial to reducing C. difficile infection (CDI) transmission in hospitals.

Methodology: Canine scent detection provides a rapid and accurate method to detect CD environmental contamination. Vancouver General Hospital (VGH) has trained an English Springer Spaniel named Angus to detect CD with 97% accuracy. Identified contaminated areas are immediately cleaned and disinfected. Alert trends are used to identify and prioritize quality improvement initiatives.

Results: Since November 2016, 32% of completed searches (N=300) at VGH have identified CD contamination. Alert trends are consistent with results published in literature. 30% of alerts were reported in patient rooms that were occupied by a patient with CD. High touch surfaces, such as hand washing sinks, toilet paper holders, and hand sanitizers were routinely identified as sources of contamination. Angus also identified less predictable sources such as staff lockers, clean medical equipment, and patient belongings. VGH’s CDI rates have significantly decreased since late 2016. While we cannot directly link the canine scent detection program to the decrease in CDI, the significant decrease does coincide with the launch of the program.

Going Forward: Canine scent detection provides a type of environmental data that had previously been logistically unattainable to hospitals. This data has highlighted specific opportunities to improve our infection control and prevention practices. These include, but are not limited to, improvements in hand hygiene compliance, isolation precaution practices, patient education, and cleaning and disinfection training programs. Over the next year, VCH will continue to roll out quality improvement initiative

Teresa Zurberg
K9 Handler & Trainer, K9 C. Diff Detection Program
Vancouver Coastal Health


Riding the Cycle to Preventing Hospital-Acquired Infections One Patient at a Time

Hand washing for healthcare providers is a basic practice to prevent hospital-acquired infections (HAI). Our organization reinforces this practice through the Four Moments of Hand Hygiene initiative aimed at the healthcare provider. If HAIs are to be prevented, hand washing needs to be practiced not only by healthcare providers, but also our patients. Since our postoperative infection rates are higher than expected, we wanted to evaluate our surgical patient’s knowledge and compliance on hand washing with an aim to include them in their care. The plan-do-study-act (PDSA) cycle methodology was used to guide the project. In cycle one, nursing students reviewed the content of teaching pamphlets and assessed surgical patients’ knowledge using a questionnaire. A pamphlet explaining the Four Moments of Hand Hygiene was developed and trialed during one-on-one pre-operative teaching. Retention of knowledge was assessed after discharge using a questionnaire administered by phone. In cycle two, nursing students observed for hand washing compliance before breakfast and again after one-on-one teaching and posting visual cues. A review of teaching pamphlets showed only 8% contained information about hand washing. Data for two patient groups receiving any hand washing teaching was 67% and 13% respectively. These results supported our questionnaire findings that hand washing knowledge was inadequate. The use of visual cues accompanied by one-on-one teaching showed little difference for compliance. Hand washing compliance before breakfast dropped from 40% to 36%. This quality initiative has discovered that patient hand washing teaching is inadequate. One-on-one teaching combined with written information showed an improvement in patient knowledge. However, knowledge coupled with visual cues and access to already provided hand sanitizer pumps at the bedside did not increase compliance. A third PDSA cycle will begin September 2017 and findings will be shared at the Quality Forum.

Kim Beaudry
Surgical Clinical Nurse Reviewer (Retired)
Fraser Health


Breakout G: G1G2G3G4G5G6G7G8


G1 Patient Engagement Techniques: Determining the Best Approach

Friday, February 23rd | 13:30 - 14:30

Learn about the successes and challenges of some tried and true, as well as cutting-edge, patient engagement techniques. This session will include local case studies designed to explore approaches to engagement like advisory councils, simulation, storytelling and personas. You’ll also hear from special guests with experience in these techniques.

Jami Brown
Engagement Leader, Fraser Valley
BC Patient Safety & Quality Council

Jacquelyne Foidart
Engagement Leader, Thompson Cariboo
BC Patient Safety & Quality Council

Naomi Erickson
Manager of Quality Improvement & Patient Safety – IH West
Interior Health

Matthew Miller
Manager, Brand & Innovation
Island Health

Kyle Warkentin
Patient Partner, Fraser Valley


G2 Living & Learning: Becoming an Ally in Indigenous Health

Friday, February 23rd | 13:30 - 14:30

Working towards equitable health outcomes for Indigenous people requires action on everyone’s part, especially non-Indigenous people. But what does it mean to be a good ally working in Indigenous health? It can mean being willing to make mistakes – and keep going! Hear multiple perspectives in this engaging, interactive session that will leave you ready for action.

Sam Bradd
Principal
Drawing Change

Jan Christilaw
Past President
BC Women’s Hospital & Health Centre

Alycia Fridkin
Policy and Research Analyst, Indigenous Health
Provincial Health Services Authority


G3 What’s in Your ATTIC? Activities for Transforming Teams & Igniting Change

Friday, February 23rd | 13:30 - 14:30

Is your team looking to accelerate improvement in health care and beyond? Come join us for this hands-on session to explore the ATTIC toolkit – a collection of activities formerly known as MindShift that can be used to build teamwork, develop communication skills, enable creative thinking and help explore systems. We’ll explore and have a chance to try three of the 28 activities (and counting!) that are available. This hands-on practice will walk through the fundamentals and empower you to get the most out of these tools.

Colleen Kennedy
Director, Innovation & Engagement
BC Patient Safety & Quality Council

Andrew Siu
Engagement & Campaign Specialist
BC Patient Safety & Quality Council


G4 Thriving with Risk: How Venture Capital Succeeds by Failing 90% of the Time

Friday, February 23rd | 13:30 - 14:30

Safe care requires thorough management and minimizing risks. But this same philosophy can stifle progress if a healthy and positive attitude towards risk isn’t adopted. What is risk, and why do we so often equate it with failure? The venture capital industry is an excellent case study around the meaning of risk and the management of failure. Venture capital professionals allocate limited resources among groups of projects all aiming for success, while knowing that 90% of these initiatives will fail. This presentation will plumb 60 years of industry experience to determine how the reality of frequent failure can be turned into potentially massive success.

Bernd Petak
Investment Partner
Northmark Ventures


G5 At the Frontier of New Scopes of Practice: The Opioid Crisis as a Case Study

Friday, February 23rd | 13:30 - 14:30

On your way to the Forum this year, you may notice something new clipped to backpacks on the SkyTrain or stored on shelves of local pharmacies. In the midst of the opioid overdose crisis, Naloxone kits have become synonymous with basic first aid. As the three panelists will describe, shifts in mindsets and scopes of practice have led to rapid empowerment of both health care professionals and the public. What can we learn from this case study, and what are other areas of untapped potential where a scope of practice change may be beneficial? Let’s explore this together.

Erica Thompson
Person with Lived Experience & Peer Advocate

Roy Stanley
Advanced Care Paramedic & A/District Supervisor, Okanagan
BC Emergency Health Services

Sara Young
Manager, Hepatitis & Harm Reduction Programs
BC Centre for Disease Control


G6 Turning Towards Those in Grief

Friday, February 23rd | 13:30 - 14:30

A Learning Journey through Patient Journey Mapping

There is no greater agony than bearing an untold story inside you. – Maya Angelou

Patient journey mapping allows people to tell their story. It is a powerful tool that allows care providers to understand the care experience from the perspective of the people they serve.

In 2016 we conducted a patient journey mapping session with Sally, whose husband died after a stay in our facility. The session was an opportunity to improve care at multiple levels, including the local hospital and Home and Community Care Services.

We followed our normal protocol and scheduled meetings with Sally to discuss what she could expect during the mapping session. As Sally tried to understand the process, her questions and suggestions contributed to us adopting a different approach for the mapping session.

The mapping session occurred in September with a number of follow-up meetings with Sally to validate the map. Sally challenged our status quo and contributed significantly to the final product. From the draft Sally further developed the map, using her own creative approach, to fill in the rest of her story that was not captured in the mapping process. From this work we have developed a learning resource that is being shared throughout our organization to highlight the value and importance of including the patient voice in our improvement work.

Quality Improvement professionals have a structured approach for patient journey mapping sessions. In this presentation we share the experience of how we learned from Sally to improve our process and the system. When we authentically collaborate with patients and family members there is much the system can learn. And if we are open to co-leading with them there is a great reward both in the journey and the final product created.

Marlene Apolczer
Quality Improvement Lead
Northern Health

Sally Rosevear
Patient Partner
Patient Voices Network


Building a Community of Hope: The Story of Camp Kerry, A Family Bereavement Retreat

Heather Mohan
Founder & Executive Director
Camp Kerry Society

Josh Dahling
Director of Operations and Youth Services
Camp Kerry Society


MyGrief.ca and KidsGrief.ca: Taking Bereavement Support Online

Research, experiences of health providers and families, and information Canadians requested on the Canadian Virtual Hospice (CVH)’s Ask a Professional tool informed the need to develop an online grief support tool. MyGrief.ca is the world’s first evidence-based, psycho-educational tool to provide online loss and grief supports. The tools respond to a critical gap in bereavement services. It complements existing services and provides an accessible option for people who cannot easily access in-person grief support. A literature review and International development team of researchers, clinicians, and bereft family members developed MyGrief.ca. The modules cover topics from anticipatory loss, the nature of relationships between survivors and the ill/deceased, and challenges to navigating everyday life. Given the scope of the subject matter it was a challenge identifying where to draw the line for module content. KidsGrief.ca expands off of MyGrief.ca, It helps adults to recognize children grief, and provides them with well-informed grief support. It’s also a tool for educators, and health providers who are in a position to support young grievers or provide guidance to parents. Topics include: teachable moments, such as the death of a pet; preparing kids to be at the bedside of someone who is dying; informing kids about a death; and explaining Medical Assistance in Dying, and suicide. Both tools include text-based content and videos from actual grievers representing diverse age, cultural, and gender. The University of Victoria and First Nations University evaluation indicated that MyGrief.ca exceeded user expectations. Users indicated that it’s easy to navigate; includes high-quality information, easily supports existing university and volunteer education programs, and provides a sense of shared experience. Hosting and updating of the tools have been built into the CVH operating budget. Users accessing MyGrief.ca from outside of Canada are levied $25 USD for use.

Marissa Ambalina
Communications Specialist
Canadian Virtual Hospice

Shelly Cory
Executive Director
Canadian Virtual Hospice


G7 Because Where We Care Matters

Friday, February 23rd | 13:30 - 14:30

Abbotsford Rapid Response – Meeting Urgent Health Needs of Frail Seniors at Home

This rapid-fire session will be streamed on Facebook Live!

A community engagement session, led by Abbotsford Home Health (HH), revealed that frail seniors often have difficulty visiting their primary care provider. As such, they resort to going to the Emergency Department (ED) for non-emergent issues.

HH, family physicians, Division of Family Practice, Home Support, Mental Health, Specialized Seniors clinic and Abbotsford community services developed a solution – Rapid Response Resource (RR), a service that is comprised of Registered Nurses (RN) with enhanced competencies in gerontology and urgent health issues. At present, seniors are referred to RR through other health care professionals.

Key features of this program include: (1) Rapid Response – senior (over the age of 70, has a Rockwood Frailty Score of 4-7 and has one or more chronic conditions) is contacted within 1.5 hours of the referral and a same day home visit. (2) Timely partnerships with physicians. (3) Paperless system.

Qualitative data is tracked manually by RNs and quantitative data is captured through the electronic record. Results show that 98% of the seniors seen by RR do not access ED for non-emergent issues, 72 hours post visit. The top 3 reasons for referral are: urinary tract infection, flare up of COPD and heart failure. The top 3 sources of referral are: Home Support, Community Care Professional and Assisted Living staff. Overall, data is showing a decline in ED and hospital utilization for 70+ seniors for non-emergent issues. A cohort evaluation is scheduled for end of October 2017.

Key learnings include: (1) Timely physician support is critical for successful RR intervention. (2) Continuous communication with physicians is required. (3) Known clients call RR directly. (4) Existing information and referral systems were a barrier to providing rapid response Next steps include: (1) Ability for any Abbotsford frail senior resident with an urgent medical need (within RN’s scope of practice) to access RR directly. (2) At home blood draws.

Sarah Siebert
Interim Clinical Nurse Specialist, Home Health
Fraser Health

 

Julie Fraser
Manager, Home Health Abbotsford
Fraser Health


Going Beyond the 9-1-1 Call: Cultivating Innovation to Support Low Acuity Patients

This rapid-fire session will be streamed on Facebook Live!

Have you ever wondered why some of the patients arriving by ambulance to the emergency department wait long hours to be seen? Have you ever wondered how we could better support these patients?

BC Emergency Health Services (BCEHS) has made this a top priority. Using a combined quality improvement and change management approach, BCEHS is actively working on freeing up ambulance resources by referring non-urgent 9-1-1 callers to alternative care pathways, like HealthLink BC’s Nursing Services (HLBC NS). Once connected with HLBC NS, patients get in-the-moment clinical advice without a lengthy and unnecessary ambulance trip to the emergency room. Since the completion of this project, on average, over 180 patients a month are now accessing more appropriate support and services and, at the same time, BCEHS ambulances are been reallocated to address patients’ with high-acuity needs who require timely urgent assistance. This project has helped to lessen the burden placed on the overall health system and has also resulted in quicker ambulance responses for patients who truly need it!

This rapid fire session will cover the ins and outs of the project including: the approach, the interventions implemented and the ongoing improvements underway, as well as insights on how to successfully establish collaborative relationships with other health providers to ensure best patient care.

Jessica Jaiven
Director, Quality, Patient Safety & Accreditation
BC Emergency Health Services

Corinne Begg
Continuous Improvement Manager, Dispatch Operations
BC Emergency Health Services


How One Nurse Changed a System

This rapid-fire session will be streamed on Facebook Live!

A nurse can make a difference. In fact, one nurse can change a system. At a time when the population is aging and home care needs are increasing beyond the ability of the health care system to manage them, we needed to make a change in how we work together between our GP providers and the HA specialized services.

The Fraser North West division of family practice began a revolution by hiring one nurse. Her name was Debbie. She in partnership with the family practitioners selected the most frail and at risk seniors to have proactive home visits to find out how they were functioning in the community and if there were any proactive supports needed. This extended the reach of the family physician to give a lens into the happenings and needs in the home and gave the patient one point of contact if there were concerns that they had. This nurse provided both case management and clinical supports to this group of over 500 patients

All of this was ongoing the health authority specialized team had just completed a review of the home health service to determine what was not working and the list was long. When they worked with the FNW division on how to improve the system they were oriented to the Nurse Debbie project and decided to look at those clients and determine if there was an effect on system utilization. The results were astounding. Over 500 ED visits averted and over 17000 patient days saved in the same cohort of clients within a 1 year period of introduction to this change in Nursing from a reactive to a proactive approach.

This started the redesign of the HH system for our region. We are now at a stage where positions have been changed to create an additional 16 Primary Care Nurses (Nurse Debbies) and 2 social workers. It is important to note that new dollars were not required for this change but a willingness to look at the system from a different perspective is. There will be many more steps along the way, but this will change our system.

Kristan Ash
Executive Director
Fraser Northwest Division of Family Practice

Jeff Dresselhuis
Family Physician
Fraser Northwest Division of Family Practice


G8 Much Ado About Data

Friday, February 23rd | 13:30 - 14:30

Real-Time Patient Experience Survey: Timely Feedback for Rapid Improvements

Meaningful patient feedback is often hard to obtain in a manner that is reflective of care, responsive and accessible. Patient feedback also is an accreditation requirement that many health authorities struggle to meet. Fraser Health has joined a partnership with Crede Technologies to build, pilot and implement a standardized patient experience survey that is brief, responsive and provides feedback and data that is immediately accessible at the unit, team and facility levels.

A shared work team reviewed several existing patient experience surveys as well as data gathered through our care quality office, and created a brief questionnaire that can be applied across all care areas. The surveys are electronic and can be completed autonomously on a patient’s personal device, or through facilitated completion in partnership with staff/volunteers.

There are currently 35 units who are live with this survey and early results and showing strong response rates and are providing leaders and staff with important quality and patient experience data to help drive change at the unit level. The survey is also equipped to gather positive feedback and “kudos” which have been valuable for leaders to support staff recognition.

Next steps are to implement broadly beyond the early adopter group, open up the ability for units to add to a unit specific question bank and to include patient experience data with other quality metrics to help enrich our understanding of the links between patient experience, quality, safety, staff well-being and psychological safety.

Joshua Myers
Director, Patient Experience
Fraser Health

Terry Brock
Regional Practice Leader, Social Work
Fraser Health


How a Resilient Perspective Shifted Our View of Performance Measurement

Measuring quality is key to improving patient care. There has been growth in the development and implementation of measures to track quality. Administrative hospital data are routinely coded and are used to identify examples of hospital harm. This work evolved out of our interest in understanding the application of the CIHI harm indicator (HI) criteria (to measure postoperative anemia/hemorrhage) in our facility. The HI process relies on the quality of information documented in the chart and captured in the administrative data. Coders use the CIHI HI criteria to identify instances of hospital harm. Using a clinical lens to identify harm we conducted a retrospective review of a 12% randomly selected sample of cases identified by coders as examples of harm. We identified a 49% discrepancy in rates of harm, consistent with our review of 2 other CIHI HI criteria applied to data. The review showed that the HI process over-reported harm, and that patient and procedural complexity must be considered in any measurement of harm. The review also identified features of a resilient system that anticipates and responds to complexity to mitigate harm and support good outcomes. This highlights the added value of looking beyond what goes wrong to looking for what goes right, and understanding how the system creates success, in spite of competing demands, complex patients and settings. This way we can learn from events that are “frequent” rather only from those that are “severe.” Resilience refers to how people cope with everyday work by adjusting their performance to the conditions. Anticipation and responding are two features of resilient systems. The work shows that the story behind data is powerful and central in driving quality improvement and resilience is a key feature of work that needs to be identified and showcased. Shifting the way we use data to guide quality improvement deserves attention. Next steps will focus on how we identify complexity and celebrate resilience.

Karen Cardiff
Researcher
Vancouver Coastal Health

Allison Muniak
Interim Executive Director, Quality, Patient Safety & Infection Control
Vancouver Coastal Health


Collecting, Analyzing & Using Data: Reforming Information Management in Health Care

Health care organizations have more data than ever and are struggling to determine what to measure and how to use it for improvement. Data is a critical component of decision-making in health care, and ensuring that accurate data is used properly is necessary for any reform effort a system might undertake. Southcentral Foundation (SCF), an Alaska Native customer-owned health care system, has implemented a data management program that effectively handles the collection, analysis, and use of data.

For some time, SCF’s data analysis was fragmented, and many people in the organization had a misconception that data analysis was a function of IT. Or, as is the case with many health care organizations, SCF’s high-performing providers were working on IT issues caused by the EHR. With support and direction from senior leadership, SCF embarked upon a reform effort, developing a data services department and bringing data analysis out from under the IT umbrella. Today, SCF has built a data management system that efficiently tracks health outcomes for patients and provider performance over time. The data can be segmented to gain perspective on outcomes, cost, improvement trends over time, and effectiveness.

This presentation will present information on the specific tools and measures SCF uses, such as the Data Information Request Tool (DIRT), and the population-based action lists SCF generates for providers (tracking specific health measures flagged as important by SCF leadership). Also covered will be SCF’s Integrated Information Teams (IIT), which are multidisciplinary teams of subject matter experts who convert data to actionable information. The presentation will also cover SCF’s methods for tracking organizational performance, and the products SCF uses to create reports (SQL, databases, and reporting services). This presentation will be valuable for anyone looking for ideas on how to transform and improve their organization’s approach to data handling.

Doug Eby
Vice President of Medical Services
Southcentral Foundation


Debate:


Quips, Quandaries And Comebacks: A Quality Debate

Thursday, January 1st | -

Listen to the debate on your phone! Download the mp3 version here, or listen to it below. (Right-click the link and choose “Save Link As”)


Health Talks:


Ranj Singh

Thursday, January 1st | -

Listen to Ranj’s presentation on your phone! Download the mp3 version here, or listen to it below. (Right-click the link and choose “Save Link As”)


Bruce Campana

Thursday, January 1st | -

Listen to Bruce’s presentation on your phone! Download the mp3 version here, or listen to it below. (Right-click the link and choose “Save Link As”)


Candy Tran

Thursday, January 1st | -

Listen to Candy’s presentation on your phone! Download the mp3 version here, or listen to it below. (Right-click the link and choose “Save Link As”)


Cari Taylor

Thursday, January 1st | -

Listen to Cari’s presentation on your phone! Download the mp3 version here, or listen to it below. (Right-click the link and choose “Save Link As”)


Colin Ross

Thursday, January 1st | -

Listen to Colin’s presentation on your phone! Download the mp3 version here, or listen to it below. (Right-click the link and choose “Save Link As”)


Duane Jackson

Thursday, January 1st | -

Listen to Duane’s presentation on your phone! Download the mp3 version here, or listen to it below. (Right-click the link and choose “Save Link As”)


Jessica Hannon

Thursday, January 1st | -

Listen to Jessica’s presentation on your phone! Download the mp3 version here, or listen to it below. (Right-click the link and choose “Save Link As”)


Mustafa Ahmed

Thursday, January 1st | -

Listen to Mustafa’s presentation on your phone! Download the mp3 version here, or listen to it below. (Right-click the link and choose “Save Link As”)


Pre-Forum: Champions of Change – Breakout A:


Pre-Forum: Designing and Delivering Sustainable Improvement: Pre-Forum


Pre-Forum Designing and Delivering Sustainable Improvement

Thursday, January 1st | -

How many times have we made improvements, only to have things drift back to the way they were before? What can we do within our quality endeavours to avoid getting caught at the end with something that’s not going to stick around?

Creating sustainable change is one of the biggest challenges for improvers, and changes that don’t stick can actually do more harm than good. Sustainability is everyone’s issue, and the good news is wherever you are within an organization or a project team, you can do something to improve it. This full-day, hands-on workshop will explore the key drivers of sustainability as well as some tools to help design and direct interventions that not only do good, but also last. Grow your knowledge in the science of improvement while building the practical skills needed to apply it in a real-life setting to better sustain the progress we make.


Storyboards: Storyboards


Storyboards Main Two Days

Thursday, January 1st | -

Improvement Capability (2nd Floor)

1 BC Women’s Hospital Interdisciplinary Simulation Training Evaluation Results
Jessalyn Almond
BC Women’s Hospital & Health Centre

2 Influencing Change for Quality Serious Illness Conversations
Doris Barwich
BC Centre for Palliative Care

3 Design Thinking a Better Discharge Medication List
Ian Bekker
Island Health

4 Moving Evidence into Practice: Early Results from a Regional Knowledge Translation Project
Agnes Black
Providence Health Care

5 A Standardized Process for Managing NPO Orders
Theresa Cividin
Vancouver Coastal Health

6 Fraser Health Assisted Living Tenant Satisfaction & Quality of Life
Donna Clark
Fraser Health

7 Shared Approach to Integrated (Enterprise) Risk Management
Annette Down
Healthcare Insurance Reciprocal of Canada

8 Implementing a Surgical Site Infection Reduction Bundle of Care to Reduce Occurences
Laura-Lynne Funnelle
Fraser Health

9 Introduction of a Multiplex Panel to Identify the Causative Agents of Gastroenteritis
John Galbraith
Island Health

10 Intra-Professional…the Other Collaboration in Health Care
Barbara Gobis
University of British Columbia

11 Building Powerful Health Care Teams: Lessons from the Business World
Barbara Gobis
University of British Columbia

12 Applying the Principles of Enhanced Recovery to Hip Fractures
Lila Gottenbos
Fraser Health

13 Evaluating Change: Fraser Health’s Success with Implementing E-Documentation
*Storyboard Winner*
Michelle Gramozis
Fraser Health

14 A Facilitated Multi-Source Feedback Process to Assure Quality of Practice
Laurie Kilburn
Vancouver Coastal Health

15 Patients’ Pre-Operative Health Status & Hospital Length of Stay
Ernest Lai
Vancouver Coastal Health

16 Equip Physicians to Lead Quality Improvement Projects: A Customized Physician Quality Improvement Training Program
Philippe Lang
Vancouver Coastal Health

17 Improving Patient Identification by the Laboratory
Angela Lee
Fraser Health

18 Using eSafety to Enable Quality Care
Yanyan Li
Fraser Health

19 A Provincial Network Approach to Improving Emergency Medicine Care
Ronald Lindstrom
BC Emergency Medicine Network

20 Embedding Accreditation Across Fraser Health Using Mock Tracers
Joanne Longson
Fraser Health

21 What Always Matters to You?
Leslie Louie
Provincial Health Services Authority

22 The Quality Improvement Challenge: Providence Health Care’s New Practical Training Program
Meghan MacLeod
Providence Health Care

23 The Surgical Quality Outcomes Reports (SQOR) Study to Spread Lower-Cost Monitoring
Malcolm Maclure
University of British Columbia

24 Better Together: Partnering with Patients & Families to Spread Family Presence
Christine Maika
Canadian Foundation for Healthcare Improvement

25 Radiation/Oncology Supply Standardization: Minimizing Inventory Costs & Waste
Deirdre McCaughey
University of Calgary

26 The Red Dot Project: Analysis of Post-Operative Visits to the Emergency Room
Susan McDonald
Fraser Health

27 Not Just Food: Striving to Make Your Dining Experience Beyond Good
Michelle McQuoid
ValleyCare

28 When Good Technology Has Limitations, How Safe Are We Making the System?
Tonya Ng
BC Cancer Agency

29 No Association Between Wait Times for Cholecystectomy & Patient Reported Outcomes
Alexander Peterson
University of British Columbia

30 Spreading a Process for Ethical Oversight of Quality Improvement & Evaluation Projects
Jody Pistak
Interior Health

31 Not For Comfort Anymore: A Peri-Operative Oral Care Trial to Reduce Hospital-Acquired Pneumonia
Trudy Robertson
Fraser Health

32 Using VMN (Virtual Mobile Number) to Expedite Communications: Nanaimo E-mentor Project
Rebecca Robson
Nanaimo Division of Family Practice

33 Triple S: Spreading, Sustaining & Scaling Health Care Innovation
Meghan Rossiter
Canadian Foundation for Healthcare Improvement

34 Novel Neonatal Complex Care & Transition (NCT) Primary Provider Team Model for Improvement
Sandesh Shivananda
Provincial Health Services Authority

35 Standardization of Hybrid Practice Through Order Set Reconciliation
Alison Steinbart
Island Health

36 Communication Skills to Optimize Patient Care: A Novel Continuing Professional Development Innovation
Sarah Tajani
University of British Columbia Continuing Professional Development

37 Incident Reporting: One Physician at a Time
Dave Williams
Fraser Health

38 Enhancing Critical Care Competencies for PACU Nurses at Island Health
Rachel Wilson
Island Health

39 Designing & Piloting an Opioid Stewardship Pharmacy Clinical Service
Brendan Woods
Lower Mainland Pharmacy Services

40 Hands-On Ultrasound Education Program: Improving Patient Care in Rural Communities
*Storyboard Winner*
Kathryn Young
University of British Columbia Continuing Professional Development

41 Better Together: Collaborative Quality Improvement in Residential Care
Kathleen Yue
BC Centre for Palliative Care

Experience of Care (3rd Floor)

42 Understanding Discharge Needs from the Client’s Perspective: A Quality Improvement Project
Nicole Beauregard
Providence Health Care

43 Understanding the Patient Experience of Emergency Department Case Management
Graham Blackburn
Island Health

44 Building a Provider Education Model to Optimize Care through Electronic Health Record
Jill Breker
Island Health

45 Improving Family Experience Discussing Risk in Inpatient Child-Adolescent Psychiatry
*Storyboard Winner*
Leah Burgess
BC Children’s Hospital

46 Clinician & Family-Centred Redesign of Outpatient Psychiatry Collaborative Care Planning
Taneille Johnson
Provincial Health Services Authority

47 Decreasing Length of Stay in Short Stay Program: A Cross Portfolio Project
Jennifer Campbell
Interior Health

48 Evaluating a Low Literacy mHealth Platform – TickiT® – to Collect Patient Experience Data
Mitchell Chow
Tickit Health

49 Promoting Interprofessional Collaborative Practice in Maternity Care across British Columbia
Nancy Falconer
Doctors of BC

50 Engagement & Empowerment: Success With Youth Who Have Mental Health Challenges
Joan Fujiwara
Surrey-North Delta Division of Family Practice

51 A Three-Pronged Approach to Surgical Quality Improvement at a Tertiary Care Hospital
Alana Gavsie
Fraser Health

52 Violence. Not Part of the Job.
Adriane Gear
BC Nurses’ Union

53 Infectious Disease Telemedicine Services in Northern British Columbia
Abu Obeida Hamour
Northern Health

54 Building Blocks for Sustainable Rural Maternity Care
Jude Kornelsen
Centre for Rural Health Research

55 Walking a Mile in Their Shoes: Using Design Thinking to Prepare Children for Surgery
Liz Lamb
BC Children’s Hospital

56 Improving Linkages of Services for Palliative Patients
Ben Lee
BC Cancer Agency

57 Looking into the Patient’s View of Safety: A Student Perspective
Tracy Lust
Provincial Health Services Authority

58 Bedside Shift Report: One Year Later
Kate McNamee
Providence Health Care

59 Implementation of Patient’s View at BC Mental Health & Substance Use Services
Robert Tang
BC Mental Health & Substance Use Services

60 Hello My Name Is: Creating a Human Connection in Care
Robert Tang
BC Mental Health & Substance Use Services

61 Releasing Time to Care: A Year in Review
Susan Waldron
Fraser Health

62 Patient & Family Partnership in Action: Creating an Intensive Care Unit Handbook
Vininder Bains
Providence Health Care

Clinical Practice (3rd Floor)

63 Critical Care Exchange: Enhancing Clinical Skills, Teamwork & Staffing Versatility
Vininder Bains
Providence Health Care

64 Improving Documentation of Pain, Agitation & Delirium (PAD) in the Intensive Care Unit
Jennifer Atchison
Fraser Health

65 Using Collaborative Quality Improvement to Improve Care for People Living with Opioid Use Disorder
*Storyboard Winner*
Laura Beamish
BC Centre for Excellence in HIV/AIDS

66 Perioperative Glucose Control: Is this the Missing Piece to Success in Reducing Surgical Site Infections?
Cammy Benson
Fraser Health

67 Does Vincristine Chemotherapy Effect Lower Extremity Movement & Function in Adults Living with Acute Lymphoblastic Leukemia?
Jennifer Bermingham
Vancouver Coastal Health

68 Providing Patient-Centred Podiatry Care through the Abbotsford Regional Hospital Hemodialysis Foot Care Clinic
Micheli Bevilacqua
Fraser Health

69 B-Safe Project: A Safety Plan Co-Produced with Young People
Francess Doherty
National Health Service Child & Adolescent Mental Health Services (NHS CAMHS)

70 A Common Challenge: Designing an Appropriateness Quality Improvement Initiative in Paper-Based Systems
Flora Dong
Vancouver Coastal Health

71 Fragmentation to Integration: Triage Consulting Team
Rumneek Dosanjh
White Rock South Surrey Division of Family Practice

72 Using Machine Learning to Improve End-of-Life Conversations after Spinal Cord Injury
Nader Fallah
Rick Hansen Institute

73 Promoting Safer Practice in Medication Administration
Babita Heer
BC Mental Health & Substance Use Services

74 Why Fraser Health Needs an Interprofessional Complex Wound Center
John Hwang
Fraser Health

75 Improving Quality of Care for Burn Patients by Focusing on Nursing Education
Simmie Kalan
Vancouver Coastal Health

76 Family Physicians & Chiropractors Partnering in Low Back Pain Initiative
Liza Kallstrom
BC Chiropractic Association

77 Overcoming the Obstacles to Best Practice Education, the Foundation of Quality Care
John Kristiansen
BC Hip Fracture Redesign Initiative

78 Improving Glycemic Control within an Enhanced Recovery after Surgery Program
Kelly Mayson
Vancouver Coastal Health

79 Optimal Timing for Umbilical Cord Clamping: Towards Universal Guidelines for Newborns
Gustavo Pelligra
Island Health

80 Applying BC Health Quality Matrix to Ensure Quality Care: BC Insitute of Technology Nursing Program
Theresa Shaughnessy
British Columbia Institute of Technology

81 Surgical Site Infection Reduction of Almost 70% in Colorectal Patients with Global SSI Bundle
Pawan Sindhar
Fraser Health

82 Same-Day-Discharge Total Knee Replacement: Compatible with Canadian Standard of Care?
Bernardus Smit
Fraser Health

83 The Value of Bringing Quality Improvement to the Workplace: A Clinical Coaching Example
Claire Thomson
University of British Columbia Continuing Professional Development

84 Rising Up After a Fall: Quality Improvement for Patients at Risk of Impaired Mobility
Amy Williams
Island Health

85 Collaboration Between a Neurologist & Pharmacy Team Helps Headache Sufferers
Jamie Yuen
University of British Columbia

86 Exploring Nurses’ Perceptions of a Managed Alcohol Protocol at St. Paul’s Hospital
Beena Parappilly
Providence Health Care

Population Health (3rd Floor)

87 Exploring Perceptions & Attitudes of Stroke Survivors about Secondary Prevention
Beena Parappilly
Providence Health Care

88 A Case of Prevention: Registered Dietitians Impacting Upstream Primary Care in Abbotsford
Danielle Edwards
Abbotsford Division of Family Practice

89 A Family Physician Designed Community e-Map: Pacific Northwest FETCH
Colleen Enns
Pacific Northwest Division of Family Practice

90 Hepatitis C: The Basics – Education for Engagement
Liza McGuinness
BC Centre for Disease Control

91 Impact of Socio-Economic Deprivation on Chronic Disease in Kootenay-Boundary
Drona Rasali
BC Centre for Disease Control

92 Transforming Services for Young People: Foundry’s Stepped Care Model
*Storyboard Winner*
Karen Tee
Foundry

Students (3rd Floor)

93 Physical Activity Habits of Medical Students, Burnout & Patient Counselling Practices
*Storyboard Winner*
Magar Ghazarian
Royal College of Surgeons in Ireland

94 Gamification in Dementia Training
Lillian Hung
Vancouver Coastal Health

95 Using Video Reflexive Groups to Innovate Practice in Dementia Care
Lillian Hung
Vancouver Coastal Health

96 Introducing Patient Reported Outcomes in the National Surgical Quality Improvement Program at Royal Inland Hospital
Braedon Paul
Interior Health

97 Perceptions of Pharmacy Students Involved in Preventative Health & Wellness Events
Jillian Reardon
University of British Columbia

98 Choosing Wisely Canada STARS: Training the Next Generation of Medical Professionals
Melissa Wan & Dhruv Pandey
University of British Columbia

99 Pediatric Post-Appendectomy Surgical Site Infections: A Retrospective Single-Centre Study
Julie Wong
BC Children’s Hospital

100 Improving Patient & Visitor Hand Hygiene in a Pediatric Acute Care Hospital
Matthew Wong
BC Children’s & Women’s Hospitals


Workshops: W1W3W5W2W4W6


W1 The Fundamentals of Engaging People in Improving Quality

Thursday, February 22nd | 10:00 - 12:30

In this interactive workshop, we’ll explore the fundamentals of quality improvement principles and methods, and will apply a framework to guide and accelerate these efforts. Build your improvement muscle through understanding how rapid cycle testing of changes create the conditions for improvement and, using the Engaging People in Improving Quality (EPIQ) modules, walk through the fundamentals of change, the process of improvement, measuring and using data, and moving from ideas to implementation.

Leanne Couves
Principal
Improvement Associates Ltd


W3 Tools for Implementing Indigenous Cultural Safety in Your Work

Thursday, February 22nd | 14:30 - 15:30

Health leaders in BC have committed to building a culturally safe health system and empowering health organizations and individuals to innovate, develop cultural humility and foster an environment of cultural safety. System-wide change begins with every individual that works in health. This interactive session will provide practical tools for individuals to use in their workplace to advance cultural safety and humility. Learn key enablers and concrete actions you can undertake in your workplace or practice.

Harmony Johnson
A/Vice-President, Policy, Planning & Quality
First Nations Health Authority

Becky Palmer
Chief Nursing Officer
First Nations Health Authority

Cheryl Ward
Interim Director, Indigenous Health
Provincial Health Services Authority


W5 Activating Patients to Improve Care

Friday, February 23rd | 09:45 - 12:15

The concept of patient activation has gained a lot of momentum internationally through its connections to healthier behaviours, better clinical outcomes and lower rates of hospitalization. Perhaps you’ve heard it, but aren’t quite sure what it means? How does it differ from other concepts such as patient empowerment? And how do you support your patients in becoming more “activated?” In this interactive workshop, we’ll explore these questions and work collaboratively to learn how to increase patients’ level of activation. Attendees will leave the session with practical tips and ideas to take back to their care site!

Cathy Almost
Engagement Leader
BC Patient Safety & Quality Council

Anthony Gagne
Engagement Leader
BC Patient Safety & Quality Council

Ben Ridout
Director, Patient & Public Engagement
BC Patient Safety & Quality Council


W2 Finding and Building Digital Stories to Engage, Inspire & Drive Action

Thursday, February 22nd | 10:00 - 11:00

Stories move people. Since day one, humans have used them to connect, to relate, to persuade, to convince, to educate. You, too, can harness the power of story – and digital tools make it easier than ever to tell and distribute your messages. But what stories are most effective and how do you find those stories? Once you’ve found them, how do you shape them to best engage your audience, and how do you know which digital tool is best for the job? This interactive session will answer those questions by examining best practices and compelling narratives in health care and beyond.

Amanda Lee Smith
Partner, Engagement
Monday Creative Inc.


W4 Confronting Our Inner Homer Simpson: How Behavioural Economics Can Make Quality Improvement More Effective

Thursday, February 22nd | 14:30 - 15:30

Quality improvement is based on evidence, yet the ratio of “high quality evidence applied” to “high quality evidence available” is distressingly low. Why? Because while scientific evidence is linear and rational, people often aren’t. We are, to varying degrees, hybrids of Mr. Spock and Homer Simpson. And most of us aspire to be more Spock-like in our decision-making even when we understand why we aren’t.

Enter behavioural economics, which describes how our Homer-esque psychological wiring often thwarts our rationalist aspirations. This workshop will describe the evolution from classic to behavioural economics, and show how its insights can be applied to health care improvement so that we can narrow the gap between what we know we ought to do and what we actually do.

Steven Lewis
President
Access Consulting Ltd.

Shari McKeown
Director, Clinical Improvement
BC Patient Safety & Quality Council


W6 Addressing Adverse Childhood Experiences: A Hidden Key to Health

Friday, February 23rd | 09:45 - 12:15

Adverse Childhood Experiences (ACEs) have a very real and powerful impact on a person’s health. The relationship between ACEs and life time use of the health system, mental health and substance use, as well as the social and emotional wellbeing of children and families is well established. Through the stories of three communities, we will learn and discuss how we can all play a part in building the resilience needed to overcome this powerful determinant of public health.

Kirsten Hargreaves
Manager of Social Development
District of Mission

Nicole Martin
Project Manager
District of Mission

Marika Sandrelli
Knowledge Exchange Leader
Fraser Health