Webspread FLN Vol. 3 No. 38 - Hôtel-Dieu Grace Hospital

Volume 3, Number 38 September 22, 2008
CAN YOU IDENTIFY THESE STAFF MEMBERS? GO TO THE BOTTOM OF PAGE 4 FOR THE CORRECT ANSWERS.
CCOT Celebrates 1st Year Anniversary
Congratulations to the Critical Care Outreach Team who are celebrating their one year
anniversary on September 25th in the Learning Centre. The CCOT is taking this opportunity
to host an Open House from 10:00 a.m. – 2:00 p.m., 4:00 p.m. – 6:00 p.m. and 10:00
p.m. – 12:00 a.m. so that they can thank and update staff on the units who have used
their services over the past year.
This new critical care program was launched on September 2007 by Dr. Eli Malus,
Medical Director, ICU and Mary Cunningham, Acute Care Nurse Practitioner. As the
CCOT Co-Lead, Mary states that the CCOT mandate followed is two fold. “Our first
priority is to always provide quick access to critical care services to inpatients and our
second function is to follow all ICU patients for 48 hours after discharge from ICU, which
is approximately 200 patients each month.”
The CCOT is made up of seven physicians and 19 registered nurses who have received
advanced training so that they can provide rapid response to patients who are critically
ill throughout the hospital, outside the doors of the ICU. CCOT members Dr. E. Malus,
Dr. N. Malus, Dr. A. Wasserman, Dr. C. Rosen, Dr. A. Brisken, Dr. M. Haddad,
Dr. G. Cuccarolo, Dr. R. Tan, Mary Cunningham, Doris Motruk, Pam Groh, John
Keokuyt, Charlene LeBlanc, Andrea Brearly, Sherry Shipper, Bobbi Reimneitz,
Marc Conte, Emily Bohdal, Sharon Alejandria, Sue Smith, Karen MacKinnon,
Denise Deimling, Barb Hamilton, Sharra Hodgins, Sue Ravija, Jody Shepley, Trish
Jarvis and Colleen Berthiaume see approximately 50 consults each month.
Most of the calls the team receives are problems with breathing or circulation. “When
the team is called, we spend as much time as the patient needs, to either give fluids
or to transfer the patient to ICU,” said Mary. “In looking back over the past year, we
have admitted about 10 patients a month to ICU either for more intensive monitoring
or lifesaving interventions like mechanical ventilation. The CCOT has also helped our
nursing staff manage their patients on the units, in fact, about 80 percent are able to
stay on the unit with their primary team and avoid admission to the ICU.”
During the past year, the ICU has received numerous positive comments from staff on
the units who have requested the help of the CCOT. Comments include, “We all think it
is wonderful. It is the best thing that has happened to this hospital. What a great
resource for the nursing staff. We love the CCOT, don’t ever get rid of it.” Dr. Sharon
Doyle, said, “I love this program, and I hope the ministry keeps it going. I especially like
the follow ups.”
Another unique aspect of the CCOT is an awareness of end of life issues and care
planning states Mary. “As experts in resuscitation and critical care, we can help patients,
families and primary health providers assess to see if ICU can be of benefit.”
As Lead of the CCOT, Dr. Eli Malus states, “I am thrilled that the CCOT is able to
provide this calibre of care beyond the doors of the ICU and I think I can speak for the
team when I say that we all thoroughly enjoy reaching out to the rest of the hospital.”
According to Mary Cunningham, any healthcare practitioner caring for a patient at HDGH
can consult the team by paging 519-255-8888 for reasons outlined on the CCOT
badges provided to all nurses.
Sue Johnston and the ICU Safe
Transfer Team Champion a New Way
Sue Johnston began her nursing career in Windsor at Grace Hospital in the CCU in
1983 and moved over to ICU at HDGH following amalgamation of the two hospitals in
1994. For Sue, this move marked the beginning of an exciting career in ICU nursing that
she says has been one of the most positive experiences of her life. Today, she is thrilled
to introduce us to our new ICU Safe Transfer Team, who are championing the use of a
new physician order form and nursing checklist to ensure SAFE and thorough
transfers from the ICU to other inpatient units within the hospital.
As a Clinical Resource Nurse (CRN) on the unit, Sue has been involved in a number of
projects over the years, including a review of the restraint policy and a review of organ
donations and education. She is also a member of the Safe Medication Practice
Committee. Her current project involving the ICU Safe Transfer Team is one she feels
very passionate about because the new physician order form and nursing checklist
partners both doctor and nurse responsibilities when transferring patients.
“We want to make things smooth and safe,” states Sue. “The new ICU preprinted
transfer orders and safety transfer checklist will be good for the patient, family, the ICU
and the units.” Prior to developing this new way of doing business, Sue and the CRN
team conducted a review of the current nursing transfer document and reviewed
transfer order forms from other hospitals. A smaller team then worked at developing
a form that would ensure safe transfers.
Sue and the other members of the ICU Safe Transfer Team (Sheri Testani, Ann Marie
Marsigliese, Jill Best, Marc Conte, Tracie Howson, Anita Mihalic, Sue Elliott, Frank
Foote, Ariel Rogozinski and Dr. Eli Malus) have been responsible for reviewing and
revising the new forms and educating the ICU multidisciplinary team on their use.
The new ICU Patient Transfer Orders & Safety Checklist will go live on September 22nd.
According to Sue, the new process that blends doctor’s orders on the left side of the
form with the nurse’s safety checklist on the right side of the form is an approach
towards achieving optimal patient safety.
The next step for the team will be to develop a pamphlet that prepares patients and
families for the transfer from ICU to the units. Sue says that the team will be working
together with their nursing colleagues on the units to develop this pamphlet later this Fall.
HÔTEL-DIEU GRACE HOSPITAL - 1030 OUELLETTE AVE. WINDSOR, ONTARIO

ACCREDITATION COUNTDOWN Frontline News Special Edition
Ask Accreditation Annie
Dear Annie,
I understand that patients and health care workers
can become infected with diseases while in hospital.
I’ve also heard that there are some diseases which
do not respond to antibiotics. How do these diseases
get in the hospital? What are we doing to reduce
infectious disease transmission? What role do
procedures such as hand-washing and infection
control guidelines play in combating infections in
our hospital?
– Perplexed in Purchasing
Dear Perplexed in Purchasing,
When a patient is in-hospital for a surgery or other medical procedure there is always
the risk that they may acquire an infection which could worsen their health situation.
The Original Handwashing Champion -
Ignaz Semmelweis (1815-1865)
The importance of protecting patients from infections
through hand-washing and sterilization was advocated
by a Hungarian physician named Ignaz Semmelweis
back in the year 1861. Semmelwies fought valiantly
to convince his colleagues that the cause of the high
death rate among women giving birth was the result
of infections being transmitted by medical students
who had not washed their hands after examining cadavers
and then assisted with childbirth. Once most
of the hospitals in Hungary implemented a strict
hand-washing and instrument washing policy, the
death-rate fell, and lives were saved.
Semmelwies helped us learn that bad
bugs can live on hands and cause
illnesses and death to spread
“Bad bugs” captured in action on an HDGH
employee hand prior to washing (2008)
Today, the challenge of getting healthcare staff, patients and family to wash their hands
to protect themselves and others from nasty infections that could lead to severe illness
and death, continues! Each year patients in hospitals across North America pick up
infections. Sometimes the infectious microbes are in a patient’s body prior to entering
the hospital or acquired in the hospital or another community health care setting. These
microbes can be transmitted to others within the hospital or to others at a patient’s
home. A high percentage of these infections are due to microbes that are hard to fight
effectively, these “super bugs”, often referred to by “nicknames” like MRSA, Cdiff. and
VRE, are fast learners who rapidly develop the ability to resist the antibiotics that were
Dear Accreditation Annie,
I would like to know exactly what HDGH is doing to help prevent patient infections.
Dear Caring in the Cafeteria,
Days / Hours / M
designed to kill them. We call them “super bugs” because they can be super hard to
defeat. Sometimes treating one “super bug” with an antibiotic can also make a patient
more susceptible to another type of “super bug”! The end result is that patients and
healthcare workers are susceptible to acquiring severe infections that could result in
sickness or death if proper infection control procedures are not used. While we cannot
stop every infection from occurring, it is our goal to monitor and control infections so
that they are not transmitted to others.
Simply washing your hands as often as possible is the single most effective thing you
can do to keep yourself, your patients and your loved ones safe from the “super bugs”
– also known as - infectious diseases. Alcohol-based hand rubs are the mortal
enemies of super bugs and dispense with them readily. Don’t miss every opportunity
you can to obliterate these enemies of good health by washing your hands at
hand-wash stations throughout all areas of the hospital.
In addition to hand washing, it is up to every employee to know and use the proper
Infection Prevention and Control procedures to avoid spreading the illness and death
that “super bugs” can cause for human beings everywhere. There are many resources
available to you here at the hospital. Every patient unit and most departments have an
Infection Control manual. There are approximately 50 manuals throughout the
hospital. Your manual contains everything you need to know when it comes to
transmission of infections. There are also laminated summary sheets for Standard
Precautions posted everywhere. The “short list” is a summary of the diseases that need
more than Standard Precautions (as per the Centers for Disease Control (CDC). This
laminated sheet is posted on all the patient units. It is also in the manual (yellow pages).
The “long list” contains every disease known to man, what precautions are needed
and is also done according to the CDC. It is part of the manual (green pages). Our
Intranet is also a great resource. Some of the things it lists are: the full manual, local
health unit alerts and areas currently affected by Avian influenza,
Practice Questions:
Do you know the correct infection control practices you should be using?
Where would you find infection control practices and policy?
- Caring in the Cafeteria
We are constantly on alert for the presence of “super bugs” in our hospital because
these “villains” have some super powers they use in order to ingeniously “hitchhike”
their way onto the bodies of other patients or staff. Some “super bugs” hide in bodily
fluids, or “catch a ride” in a droplet becoming airborne via a cough or sneeze, they can
lurk on surfaces just waiting to attach themselves to your hand or body where you
may ingest them with food (because you haven’t washed your hands) or touch your
face. Now, can you see just why hand washing is so important in this battle against
the “super bugs”?
We also have an aggressive targeted surveillance system which means we are always
tracking the movements of the biggest “super bugs”, including the notorious MRSA,
CDiff or VRE. We start looking for these “super bugs” when patients get admitted by

inutes Left to Accreditation Countdown... 27 days, 8 hours, 0 minutes and 0 seconds
screening high-risk populations, such as patients who are being transferred from health
centres in the community or another hospital and patient from the United States. If we
suspect that a person is carrying a “super bug”, we will then test the patient by using a
swab to gather a test culture. If the results of the culture indicate a “super bug” is present
we take strict measures to protect other patients. We ensure thepatient is put in a room
away from other patients, or in cubicle isolation, put signage up, and use standard safety
precautions which may involve wearing gowns, gloves and face masks to stop the spread
of the “super bug”, and special disinfection procedures on surfaces which the patient is
near. There are many aspects to Routine Standard Precautions and they all help to
control infections.
Dear Accreditation Annie,
How do we monitor and share the infection rates of “super bugs” in our hospitals with
managers and staff?
- Vigilant in Volunteer Services
Dear Vigilant in Volunteer Services,
Infection rates in our hospital are monitored “in real time” which means we are able to
assess where we are on a daily basis when it comes to infection rates and act on this
information to better protect patients from an outbreak.
Monthly, unit-specific rates are posted on the Performance indicator dashboard for
managers to access in the form of the chart below. All Unit Managers are expected to
copy and post a hard copy on the unit. This chart helps our key defenders – Unit Managers
and Frontline Staff- to work with Infection Control to defeat the “super bugs” by gaining
immediate assistance with efforts to step up all protective measures and prevent
an outbreak.
MONTH:August YEAR:2008
# of reportable diseases - ER and OP =
# of reportable diseases admitted =
UNIT BACT. BACT. MRSA MRSA VRE VRE CDIFF CDIFF
Primary Secondary on adm. noso on adm. noso On adm. Noso
8 East
8 West
7 East
7 West,
etc.
Monthly rates (facility- specific) are posted on the Executive dashboard. Key rates are
included in the Patient Safety Monitor report that is issued on a quarterly basis to the Board
and staff at public meetings and is also available on the Intranet.
Public reporting means that our rates will also be posted on the Ministry website as well
as on our hospital website. Ask your Unit Manager where the latest Infection Rates are
posted in your unit and look for the latest hospital-wide infection rates in next week’s
Accreditation Countdown.
Practice Questions:
Explain how your unit monitors the rate of infections
Do you have any stories to tell the surveyors about what has been done on your unit
to combat “superbugs” like VRE and C.Diff?
Do you know these bad “Super bugs”?
Clostridium difficile is the name of one of the bugs that may be present in small
numbers in the bowel (gut) of healthy people that usually cause no harm. Sometimes
as a result of taking antibiotics, some bacteria in the bowel are killed but
Clostridium difficile is left behind and can reproduce in large numbers. It then
irritates the gut lining, causing symptoms that can include diarrhea, abdominal
cramps, and loss of appetite, fever and nausea.
How it’s transmitted: When Clostridium difficile causes diarrhea it invisibly
contaminates the environment where it can survive for long periods and then be
picked up on other people’s hands and via hand to mouth contact, can be transferred
into the stomach and bowel.
What is done to prevent spread? For patients the most important method of
preventing spread is to wash hands carefully with soap and water after using toilet
facilities and also before eating. Everyone who has contact with a patient or the
immediate environment must clean their hands. Staff will wear gloves and aprons
when giving a patient personal care to prevent spread to other patients and from
patients to staff. A sign is placed on the patient room door to remind everyone
entering to take the precautions and follow infection control advice. Family and
friends can still visit and nursing staff will advise them on precautions they need to
take – all visitors should wash their hands on leaving the room or bed area.
MRSA stands for Meticillin Resistant Staphylococcus Aureus. It is a common germ
that can live quite harmlessly in the nose, throat and sometimes on the skin of
healthy people. This is referred to as ‘colonization’. Some people will remain
‘colonized’ with MRSA but live completely normal lives. Staph. aureus may cause
harm (infection) when it has the opportunity to enter the body.
How it’s transmitted: MRSA can be transmitted from a carrier patient to another
patient through the contaminated hands of health care workers or contact with
shared items or surfaces that have come into contact with someone else's infection
or it may get into the body via abrasions, cuts, wounds, surgical incisions or
indwelling catheters.
What is done to prevent spread? Hand hygiene is the most important way of
preventing spread of MRSA which is largely through direct contact. To protect other
vulnerable patients and themselves hospital staff will wear gloves and an apron for
procedures involving patient contact for tasks like washing or changing a
wound dressing.
Accreditation Learning Event Calendar
Want to have some fun while testing your Patient Safety Knowledge? All of your
study materials are available online and include: the Accreditation 2008 Handbook,
the Accreditation Annie Columns and the Patient Safety – It’s Up to Me video. Get
set to play live and online Jeopardy in October. Two Live Jeopardy games will take
place in the Goyeau Street Lobby at 2pm on October 14th and 15th.
What has your unit is done to prepare for the Accreditation? Please let us know so
we can share your ideas in the Accreditation Countdown. You can reach the writer
of Accreditation Countdown, Mary-Jo Rusu at ext. 3855 or Mary-Jo.Rusu@hdgh.org.
Accreditation Info
at your Fingertips
Internet Information Locator
Find our Infection Control Manual containing all of our policies and
procedures by using a keyword search on the website

Our hats
go off to…
The RIE Team would like to acknowledge all of the staff on 2North for their outstanding
efforts with the Flo Collaborative, especially their new charting system and red light,
green light initiative. Excellent work is being done regarding patient focused care. Their
group of champions are expected to spread the initiative throughout our organization.
Lots of hard work has gone into making this initiative successful and great results are
being seen. Thank you 2North staff. Our hats go off to you!
Toni Janik for the assistance that she provided to one of the Chaplains at Windsor
Regional Hospital while she was working on her Master’s thesis. A letter to our Interim
CEO John Coughlin stated, “It is my desire, at this time to express my appreciation to
Toni, and to applaud your institution on the wonderful and informative library services
you continue to maintain. Not only was Toni an informative resource and vast source
of support, but the information and education I received was invaluable. My gratitude
is extended both to her and to your hospital for the community service and educational
information you provide.”
HDGH Logo Cardigans Available
As a result of numerous requests from staff wanting to purchase white cardigans with
the hospital logo, the Communications Department has acquired a limited supply of the
cardigans and is selling them at a cost of $35 each. The cardigans come in sizes
medium and large. For more information, please call ext. 4433.
InterProfesional Practice Workshop
Leamington District Memorial Hospital and Assumption University, Windsor are
hosting an InterProfessional Workshop on Friday, September 26th in the auditorium at
Sun Parlor Home for Senior Citizens. This workshop is aimed at all clinical staff, allied
health professionals and support staff.
Part One of this interactive and informative workshop Learning to Navigate the
Swamps of Infection Control (facts, myths, mythbusters & games including
Infection Control Jeopardy) will take place from 9:30 a.m. to 11:30 a.m.
Part Two If Research is the Answer, What is the Question.... Evidence That Matters
will take place from 1:00 p.m. – 3:00 p.m.
All those who attend will earn credits toward a certificate in InterProfessional Practice
from Assumption University.
The cost of the workshop is $75. To register, contact Barbara Whittle at 519.326.2373,
ext. 4234 or email her at bwhittle@ldmh.org.
Do You Know Your CCOT Quiz
How well do you know your CCOT? Answer the following questions and
submit your responses at the Open House for a chance to win a great prize.
1. Name one of the calling criteria under the C category.
2. What is the CCOT pager number?
3. How many days does the CCOT follow patients post ICU?
4. When is CCOT available?
5. Can I call CCOT if I’m worried?
6. Can you name three CCOT nurses?
7. What does CCOT mean?
8. Which calling criteria have been linked to adverse outcome?
9. Give an example of the B in SBAR.
10. Who gets called right after CCOT gets called?
Report Presented on Rapid
Improvement Events for September
Last Friday, three Rapid Improvement Event (RIE) Teams presented their “Report Out”
to all staff on the work they had done during the past week involving the Spread of
Hallway Clutter and Equipment 6S, Visual Discharge Process Improvements and the
Spread Plan for Flo Collaborative Improvements. A 30 day report out for the
Communication and Infection Control RIE and a 60 day report out for Hallway Clutter
6S and Equipment 6S on 8th floor were also presented.
RIE Team #5 tackled the spread of 6S to 4Medical, 7East and 7West. Team members
Carolyn Hadden, Jan Beddard, Libby French, Bev Bertling, Mary Yakopich, Carol
Mailloux, Joe Obeid and Marylynn Holzel dressed like pirates and gave a very
entertaining and informative presentation on how they reduced hallway clutter by as
much as 50 percent and improved staff survey scores by more than 60 percent when
asked if your work area is quiet and orderly based on the improvements made to the unit.
RIE Team #6 tackled the Red Light/Green Light Discharge Process and the Spread Plan
for the FLO Collaborative Improvements on 2North. Team members Joyce Lembke,
Amanda Coyle, Beth Clarke, Laurie Schengsbier, Raettie White, and Virginia Walsh
(covering for Eleanor Groh) presented the work they did on 2North to improve
discharge times for patients (team members Mike Dame and Dr. Yap were absent).
The team reported that they made some adjustments to the Red Light/Green Light
Discharge Process by asking the nurses to assign a discharge status and standardized
white boards and work posted. They set a target for patients to be discharged by 11:00
a.m. at 75 percent, a marked improvement over the current 16 percent and discharges
after 2:00 p.m. reduced from 39 percent to 10 percent. The team also provided a
schedule for spreading this initiative to other units between November 3, 2008 and
February 9, 2009.
A 30 day report out for the Communication RIE and Infection Control RIE on 6East &
6West was presented by Joe Karb and Dale Bernardes. Both presented very positive
reports on the status of their units, including the fact that a recent handwashing audit
on the unit showed an increase from 30-35 percent compliance to 100 percent
compliance. On the Communications side, Joe reported that initial survey results
showed staff only knew where to find information they needed five percent of the time,
is now up to 40 percent of the time, and that 90 percent of the time information is
now being found where it should be. He also reported that the unit continues to
operate with only six bulletin boards down from the original 24 and that no paper is
being posted to walls.
A 60 day report out for Hallway Clutter 6S and Equipment 6S was made by Sandi
McCracken and Kathy Quinlan from 8West and 8East who indicated that a culture of
order is being maintained on the units. Sandi reported that neither unit has reached
their target state of Level Five yet, but are on their way and that staff on the unit are
eager to implement other RIE changes that are happening in the building, based on the
success they have achieved so far.
The next Rapid Improvement Event will take place during the third week of October.
8 Photos – Sue Johnston, Ariel Rogozinski, Sharon Holland, Dr. Eli Malus, Jill Best, Sue Elliott, Marc Conte, Anita Mihalic, all members of
the ICU Safe Transfer Team