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ENVIRONMENTAL SCAN – JUNE-JULY 2009 ANALYSE DU MILIEU – AÔUT-OCTOBRE 2009 Issue/Catégorie AB The Health Quality Council of Alberta released its report on the reuse of syringes to administer drugs to different patients. The issue came up last October when it was found that in three facilities patients were potentially exposed to blood-borne pathogens because syringes had been reused. A review of patient files has already established that the risk to public health was very low, but the Council recommended an audit be conducted of the clinical practice use of all critical, single-use devices to ensure compliance to Alberta Health and Wellness standards. It also wants a comprehensive orientation and ongoing education for all health professionals involved in endoscopy services. For a copy of the report, go to Strategic Directions/ Orientations stratégiques This issue of “reuse” is addressed in the sterilization standards. http://www.hqca.ca/assets/pdf/High%20Prairie%20Review/HP_Report_to_Ministry_J uly_22_2009_FINAL.pdf BC Health Quality Council of Alberta 2009.07.24 British Columbia’s health minister wants all health regions to implement recommendations of two reports into a persistent C. difficile outbreak at Nanaimo General Regional Hospital. A report by the Chief Medical Health Officer at Vancouver Island Health Authority (VIHA) said there should be “an even greater emphasis on infection control” in hospitals and long-term care facilities as well as standard protocols for regular housekeeping and cleaning during outbreaks. The ROP on infection control includes tracking infection rates, indentifying clusters, outbreaks, and trends; sharing and reporting the information. 2 Issue/Catégorie Strategic Directions/ Orientations stratégiques A total of 18 recommendations were made in his report. It was followed by the release of another report by the B.C. Centre for Disease Control that chronicled a number of missteps in the Nanaimo hospital’s attempts to deal with the problem, including use of too weak a formulation of bleach to clean the facility, rendering the process ineffective. VIHA has already implemented, or will be implementing, all the recommendations in the two reports. Reports can be found at www.viha.ca/about_viha/news/news_releases/nr_nrgh_cdiff_reports_jun09.htm) Victoria Times-Colonist, 2009.06.20 BC British Columbia's provincial health officer released his report on the health and well-being of Aboriginal people in British Columbia. Improvements have been seen in overall mortality, external causes of death such as motor vehicle accidents, accidental poisoning, and drug-induced and alcohol-related deaths. But data indicates the gap still needs to be closed between the Aboriginal population and other residents, especially in the areas of chronic disease, HIV/AIDS, and hospitalization rates for external causes and mental and behavioural disorders due to psychoactive substance use. B.C. Ministry of Health 2009.06.25 CDA The majority of Canadians who suffer from chronic illnesses are getting primary health care, but there are gaps in the quality of care they are receiving for their Qmentum includes standards specifically designed for First Nation communities. Accreditation Canada is developing new versions of the standards for First Nations and Inuit Community Health Services and First Nations and Inuit Addiction Services for Qmentum. They will be used by clients being surveyed in 2010. Qmentum includes standards for populations with chronic 3 Issue/Catégorie CDA Strategic Directions/ Orientations stratégiques conditions, a survey by the Canadian Institute for Health Information suggests. The survey used 2008 Statistics Canada data and measured the experiences of 11,582 Canadians with primary health care such as family doctors, walk-in clinics and emergency rooms. Although the majority of people with at least one chronic illnesses (arthritis, cancer, emphysema, diabetes, heart disease, high blood pressure and mood disorders) reported they had access to a regular place of care, such as a family doctor or a walk-in clinic, 40 per cent said they had not made a treatment plan with their provider within the last 12 months. "This is important because people who have chronic conditions need to take measures between visits, which is the majority of the time," said Greg Webster, the institute's director of primary health-care information. The study, Experiences with Primary Health Care in Canada, can be found at www.cihi.ca. Health Edition 2009.07.24 conditions. Standards for primary care are being pilot tested in the fall. An Ottawa home telehealth monitoring program has cut hospital readmissions of heart failure patients by 54 per cent. The program, developed by the University of Ottawa Heart Institute, has followed more than 500 patients since 2005. Each day, patients measure and transmit their vital signs to the Institute which also uses an automated calling system for patient follow-up. In 2007-08 researchers tracked 121 heart failure patients. Of these, over 69 per cent were readmitted at least once in a six-month period before being signed up for the telehealth monitoring program at which point readmissions The telehealth supplement is being integrated into the Qmentum program in 2009. 4 Issue/Catégorie Strategic Directions/ Orientations stratégiques plummeted to less than 15 per cent. More information can be found at www.ottawaheart.ca Health Edition 2009.07.10 CDA A new trend to harvest transplant organs from people whose hearts have just stopped, but may not be yet brain dead, has underlined the "pressing need" for federal legislation to define exactly when someone has perished, a leading medical ethicist argues. Canada has an assortment of case law and legislation defining end of life, but the growing use of organs from cardiac-death patients may violate the law, argues Jocelyn Downie of Dalhousie University in a recent journal paper. Health-care workers motivated simply by the desire to help seriously ill patients are at risk of civil or even criminal court action because of the lack of a clear definition, she says in the Canadian Journal of Anesthesia. The cardiac-death protocol, meanwhile, should probably be halted until more is known about when someone whose heart has stopped is beyond recovery, Prof. Downie said. Clarity is critically important for a host of reasons. "It's only after the declaration of death that certain things can happen: We can take your organs, we can bury you, we can do an autopsy ... we can trigger all sorts of things around your property," said Prof. Downie. Her comments are part of a debate in the medical community about the ethics and legality of the new organ donation approach. Some experts have even argued that current practices in organ harvesting can amount to "physicianassisted death," though are not necessarily unjustified. Standards for organ and tissue donation and transplant, being released in 2010, incorporate the donation-after-cardiacdeath (DCD) protocol. 5 Issue/Catégorie Strategic Directions/ Orientations stratégiques The law in Canada is muddy, her paper indicates. Most provinces' legislation suggests that death is to be determined by physicians according to "current medical practice." PEI's law is a little more specific, saying death can "include brain death," while Quebec has no legal definition at all, leaving the matter completely to doctors. But the head of Ontario's Trillium Gift of Life Network, the country's largest transplant organization, said his agency endorsed the new donation-aftercardiac-death (DCD) protocol only after extensive research and consultation that ensured it is a moral and medically appropriate practice. National Post 2009.07.16 CDA The Registered Nurses’ Association of Ontario (RNAO), in collaboration with the Nurse Practitioners’ Association of Ontario (NPAO), will launch a public awareness campaign to educate people about the role of a Nurse Practitioner (NP). NPs are registered nurses with advanced education and legislative authority, who help keep patients healthy, diagnose and treat common illnesses and injuries, prescribe medications, and order lab tests, x-rays and other diagnostic tests. In the 11 years the role has been legally recognized in Ontario, nurse practitioners have expanded their reach and work in almost every sector of the health care system from hospitals and community clinics to long-term care facilities and family health teams. OHA Reports 2009.05.13 According to the Canadian Medical Association (CMA), British Columbia For information. 6 Issue/Catégorie Strategic Directions/ Orientations stratégiques has 5,250 family physicians for a population of more than four million people. This number of family physicians cannot be expected to care for a population that large. NPs can alleviate physician workload and increase public access to health care services The Canadian Nurses Association (CNA) plays a significant role in promoting the integration of NPs into our health care system. It believes that NPs can improve access, delivery and coordination of services to the public. The CNA is not suggesting that NPs take over physicians' duties but that they act as a complement to the healthcare system by working with other health care providers. The Vancouver Sun 2009.06.25 NS A state-of-the-art Emergency and Trauma Centre has opened at the QEII Health Sciences Centre in Halifax. The $20.4 million facility boasts several new features including better infectious disease control and a mental health suite. There is also an enhanced role for paramedics. A paramedic will do the initial triage of patients and determine whether they need immediate attention. Paramedics will also suture cuts and administer drugs under physician supervision. No additional physicians or nurses are being used to staff the 2,900 square metre facility. Halifax Chronicle-Herald 2009.06.24 For information. ON Ontario has taken another step toward creating a 10-year strategy to transform mental health and addiction services. Long-Term Care Minister David Caplan released a discussion paper created Qmentum includes standards for mental health, as well as for substance abuse and 7 Issue/Catégorie by an advisory group comprised of people with direct experience with mental illnesses and addictions, family members, service providers and researchers. The proposed strategy aims to integrate people with mental illnesses and/or addictions into their communities and to integrate mental health and addiction services with the rest of the health system. The government made improved community-based mental health and addiction treatment part and parcel of its strategy to reduce emergency department wait times in early 2008. Research has shown that patients with mental health issues are among the most frequent users of ER services — a sign that their needs are not being met in the community. Mental health, problematic substance use and problem gambling services will be integrated into the same strategy instead of in separate silos in different government departments. As well, the strategy will include services for people with mild to moderate symptoms not just those with serious conditions. Consultations on the discussion paper are being held in Ontario this fall, and the advisory group is to report back to the minister in the winter. The paper, Every Door is the Right Door, can be found at Strategic Directions/ Orientations stratégiques problem gambling. The mental health standards are being revised to better reflect community-based programs in mental health. Mental health content is also being considered for Seniors Population and Child and Youth Population standards. www.health.gov.on.ca/english/public/program/mentalhealth/minister_advisgroup/p df/discussion_paper.pdf. Health Edition 2009.07.17 ON Ontario has started Canada’s first e-prescribing program, a new tool being developed by eHealth Ontario. Electronic prescribing is a key component of the Medication Management For information. 8 Issue/Catégorie Strategic Directions/ Orientations stratégiques part of the province’s e-health strategy, and is expected to dramatically improve patient safety and quality of care by reducing prescription errors from illegible handwriting. Two sites are involved in a three-month demonstration project which started last month: the Group Health Centre in Sault Ste. Marie and Georgian Bay Family Health Team in Collingwood. Both are well advanced in the use of electronic medical records. eHealth Ontario 2009.05.15 ON All 148 Ontario hospitals are filmless with facilities now using picture archiving and communications technology to produce digital images. “Doctors will be able to review, diagnose and report on diagnostic imaging tests from anywhere within the diagnostic imaging repository system,” said Ron Sapsford, acting CEO of eHealth Ontario. Health Edition 2009.07.10 Qmentum includes standards for diagnostic imaging; as well, Accreditation Canada has surveyors who specialize in this area. ON Ontario has introduced legislation expanding the scope of practice of a number of health professions to improve access to care. Examples: nurse practitioners will be allowed to conduct ultrasounds and set a fracture; physiotherapists will be allowed to treat a wound; midwives will be able to place tubes in the nose or mouth of a newborn; medical radiation technologists will be able to give needles; and, dietitians will be able to prick the skin to check a patient’s blood readings. Health Edition 2009.05.15 For information PEI A Model of Care Design Team is at work in Prince Edward Island to clarify the roles of Island health care providers and support staff, and ensure everyone is As our clients restructure their services, Accreditation Canada 9 Issue/Catégorie working to their full potential. It is part of the government’s efforts to create an integrated health system for the Island. Health human shortages are an issue on the Island, and optimizing the resources the province does have is a key activity. A PEI health system review by consulting firm Corpus Sanchez last November counseled a shift in focus from hospital care to integrated, well coordinated primary care. The firm made similar recommendations in a review it did of Nova Scotia’s health system in January 2008. Considerable work has since been done on the Model of Care Initiative in Nova Scotia (MOCINS) which is also predicated on team members working collaboratively to their full scope of practice. Mr. Currie said his department is leading a detailed examination of all recommendations in the Corpus Sanchez report to determine which ones work best for the province. In April, a Health Governance Advisory Council began consultations on a province-wide governance model to oversee the delivery of health care on PEI. The lack of such an entity was a criticism in the Corpus Sanchez report. Strategic Directions/ Orientations stratégiques will ensure the program continues to meet their needs. Accreditation Canada has a positive and transparent relationship with PEI. Health Edition 2009.06.19 QC McGill University Health Centre is partnering with Quebec-based Medical.MD to launch a personal electronic health record called MedForYou. It will allow people to post and track their medical information online. Medical.MD is also in discussions to include its new offering in Telus Health Space, powered by Microsoft HealthVault. Medical.MD is looking for 300 subscribers to test its system which it hopes to The importance of good communication between clients and health providers is emphasized in the standards. 10 Issue/Catégorie Strategic Directions/ Orientations stratégiques make available to the Quebec market in October, and eventually to the rest of Canada. More information is available at www.medforyou.com Health Edition 2009.07.10 QC Le Centre universitaire de santé McGill travaille en partenariat avec Medical.MD qui est situé au Québec, pour lancer un dossier médical électronique appelé MedForYou. Ce dossier permettra aux patients d’afficher en ligne leur information médicale et d’effectuer un suivi de celle-ci. Medical.MD est en pourparlers et compte offrir son nouveau produit au moyen de la plateforme Telus Espace Santé, qui est optimisée par HealthVault de Microsoft. Medical.MD est à la recherche de 300 abonnés qui mettront à l’essai son produit; il espère ainsi pouvoir l’offrir en octobre au marché du Québec et par la suite, au reste du Canada. Pour de plus amples renseignements, rendezvous au www.medforyou.com Health Edition 10/07/2009 Les normes mettent l’accent sur l’importance d’une bonne communication entre les clients et les prestateurs de soins. SK The Saskatoon Health Region is formalizing its plan for "hallway nursing." A document is circulating to staff at Saskatoon's three hospitals detailing procedures for treating patients in hallways. Patients are to be placed in a bed when possible, the document says, but once beds are full, "the next patient is cared for in a hallway" somewhere in the hospital until other arrangements can be made. Saskatoon Health Region 2009.07.03 For information. Items have been compiled from Health Edition, Canada’s Health Newsweekly; Health Quality Council of Alberta; Victoria Times-Colonist; B.C. Ministry of Health; National Post; The Vancouver Sun; Halifax Chronicle-Herald; eHealth Ontario; and the Saskatoon Health Region.