The program is called the neonatal antimicrobial stewardship program and its aim is to ensure that antibiotics are used the right way at the right time.

The program started in April 2016 at an information session for staff and parents of the hospital’s frailest patients.

“The problem of antibiotic resistance is a global one, and we can do our part in health care to address it,” says Julie Choudhury, the clinical pharmacist who leads the program.

It has been standard practice for antibiotics to be used in preemies if they’re at all at risk of getting an infection (for instance, if they’re showing respiratory distress) because they can easily acquire one before, during or after birth. An infection in underdeveloped babies can easily become life-threatening.

Part of the reason for this approach is because such young babies “can’t tell us when they’re sick,” and their symptoms can be “non-specific,” Choudhury says.

The team behind the program includes physicians, nursing and pharmacy staff, as well as the parent of a past patient. During their daily rounds, team members share information on the antibiotic each baby is receiving and the overall plan for its use.

Oftentimes, says Choudhury, the antibiotics are discontinued after the team conducts a thorough discussion – focusing on what has been reported about the antibiotic each baby is receiving, the intended plan for the medication, and other possible ways to determine if the baby is under threat of infection.

An analysis completed in November found the use of antimicrobial medications in the NICU had declined by 19 per cent. In the long term, the team is aiming for a 55-per-cent reduction in antibiotic use.

Photography by Doug Nicholson

The post Decreasing antibiotic use for preemies in the NICU appeared first on Your Health Matters.

Our eyes, it has long been said, are windows to the soul. Now, new research is hoping they can also provide some insight into the link between the health of our brains and our bodies.

This is the aim of a groundbreaking study at Sunnybrook focusing on the eyes of Lauren and dozens of other youth, ages 13 to 20.

The hope is that images of the tiny blood vessels of the retina, at the back of the eye, may unlock part of the mystery about why people with bipolar disorder have a higher and earlier risk of heart disease and cognition problems.

Could it be that atypical blood flow also impacts mood and brain function? The multidisciplinary study is unique in several ways.

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“I’m hoping that for future generations – and possibly even any children I may have – this research will really benefit them“

– Lauren, study participant

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It involves using a special camera to photograph the inside of the eyes of Lauren and other participants with bipolar disorder, as well as a control group without major mental illness.

It also marks the first time retinal photography has been used to capture images of the blood vessels in the eyes of young people with bipolar disorder. The researchers are also looking at factors that may predict small-vessel problems, such as inflammation, exercise, diet and use of medications.

The objective is to examine the blood vessels of the retina, which are “a close relative of the blood vessels in the brain,” notes youth psychiatrist Dr. Benjamin Goldstein, who is the director of Sunnybrook’s Centre for Youth Bipolar Disorder, the driving force behind the ongoing research.

Retinal photography has long been used in studying conditions related to aging, such as Alzheimer’s disease, atherosclerosis (hardening of the arteries) and diabetes.

“The retina offers the only way of directly visualizing central nervous system blood vessels,” explains Dr. Goldstein, who is also director of research in Sunnybrook’s Department of Psychiatry.

“Blood-vessel problems may be one of the core causes of bipolar disorder, and [retinal photography] is a very inexpensive, non-invasive way of understanding this link.”

According to Dr. Peter Kertes – Sunnybrook’s chief of ophthalmology and a member of the youth bipolar retinal photography research team – the retina, which is “essentially an extension of the brain,” works like the film in a camera. It’s responsible for interpreting what is out there in the world and sending that back to the brain as vision.

The project illustrates a unique collaboration between different specialists within Sunnybrook’s Hurvitz Brain Sciences Program, one that includes Dr. Goldstein, Dr. Kertes, Dr. Sandra Black, a senior scientist and neurologist, and Dr. Victor Yang, a neurosurgeon and medical biophysics expert.

From left: Drs. Victor Yang, Benjamin Goldstein, Sandra Black and Peter Kertes are part of a cross-departmental team involved in work linking retinal-vascular systems and bipolar disorder (Photo by Kevin Van Paassen).

“This study has brought together researchers who otherwise don’t cross paths, which is highly atypical – and inspiring from my perspective,” Dr. Goldstein adds.

“It’s been the fastest-recruited study we’ve ever had in our research program, and I think that speaks to the appeal of taking a picture of the eye to understand mental illness. These are not typically two things you pair with each other.”

Study recruitment is ongoing; the goal is to include a total of 300 subjects.

In Lauren’s family, another member has been diagnosed with bipolar disorder, her 24-year-old brother, James. Their mother, Gen, has always encouraged them to participate in research and not to feel they have to hide their diagnoses.

“I eventually told my friends [about the diagnosis],” recalls Lauren, who was 16 when she was referred to Dr. Goldstein after experiencing symptoms of bipolar disorder.

“I’m comfortable expressing myself because it’s no different than telling people you have  diabetes or some other health issue.”

And she participated in several youth bipolar studies before turning 21 in the fall.

“I’m hoping that for future generations – and possibly even any children I may have – this research will really benefit them,” says Lauren, who has a graduate diploma in early childhood education and recently started her career.

The primary tool being used in the project to photograph retinas is a Topcon TRC-50DX Type IA camera in Sunnybrook’s Department of Ophthalmology.

To start, drops are administered in the eyes of each study subject, so the pupils are dilated widely enough for the camera to see into them properly.

Next, the ophthalmic photographer positions the subject to sit facing the camera lens, with their chin in a chin rest and their forehead against a bar that’s part of the apparatus.

“I’m comfortable expressing myself because it’s no different than telling people you have diabetes or some other health issue,” says Lauren of her bipolar disorder diagnosis. (Photo by Doug Nicholson)

The photographer then adjusts the exposure to the proper intensity to photograph the retinas. Lauren says the whole process took about half an hour (with the photography component taking less than a minute).

Dr. Black says one of the obstacles the researchers were working to overcome was to figure out how to actually measure the blood flow in the retina.

However, that’s where Dr. Yang’s expertise has proved important. He uses optical coherence tomography (OCT), a revolutionary medical imaging technique that captures high-resolution 3D images showing a cross-section of the retina and all of its layers.

“It allows us to see into the body without injecting any dyes,” says Dr. Yang. “Our lab has been developing OCT technology for the past two decades and is opening up a whole new understanding of the effects of blood flow in the brain and retina.”

Notes Dr. Black, Brill Chair of Neurology, “From this melting pot of different specialties working together, new ideas can spring forth.” For his part, Dr. Kertes says, “I have learned a great deal about dementia [from another study with Dr. Black] and bipolar disease in particular, and feel confident that this insight and knowledge have made me a more caring and better doctor.

“The work that [ophthalmologists] do in restoring and preserving vision has been fantastically gratifying, but the potential of contributing to the diagnosis and monitoring of neurological and psychiatric diseases is tremendously exciting.”

Early results of the study have uncovered some interesting findings about teens with bipolar disorder, specifically the following:

• Those with high blood pressure had poorer retinal blood-vessel health.

• Healthy blood vessels in the body are linked to healthier blood vessels in the eyes.

• Teens that did well in a series of specialized online games aimed at measuring their ability to problem-solve had healthier blood vessels in their eyes.

The researchers hope their work will lead to new approaches to diagnosing, monitoring and treating mental-health issues, with a focus on prevention.

For instance, they foresee a future in which blood-vessel health is considered in the diagnosis, monitoring and early treatment of bipolar disorder, and prevention and treatment approaches may include everything from prescribing exercise (to help improve blood flow in the brain and body), to using different counselling methods and medication that may not have been standard practice before.

Knowing that bipolar disorder isn’t just a mental illness can be “empowering,” notes Dr. Black, and can “motivate kids to do the right thing, which is to exercise [and] take it seriously, because you can change your outcome, and you can change your life by dealing with that biology.”

Other Sunnybrook-led studies get to the heart of youth bipolar disorder

Sunnybrook’s groundbreaking retinal photography project is just the latest of a wealth of research examining the link between youth bipolar disorder and blood-vessel and heart health.

Dr. Goldstein – director of research for the hospital’s Department of Psychiatry, as well as director of its Centre for Youth Bipolar Disorder – was also the lead author of a 2015 scientific statement published in Circulation, the American Heart Association’s Journal. The paper determined that depression and bipolar disorder increase the risk that young people will develop atherosclerosis (hardening of the arteries) and heart disease.

In late 2016, Dr. Goldstein led another study, the first to examine the link between cardiovascular health and mental flexibility in adolescents, ages 13 to 20, with bipolar disorder. The results of his research found that elevated blood levels of triglycerides (a type of fat that can be measured in the blood), which are known to increase the risk of heart disease, are also associated with decreased “executive function,” determined based on mental flexibility during a computerized task.

Earlier studies had already concluded that adults with bipolar disorder had greater cardiovascular risk factors, such as obesity, high blood pressure and high levels of blood sugar and triglycerides, compared to adults without bipolar disorder.

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“The goal is to prevent these kids from developing heart disease in the first place.”

– Dr. Benjamin Goldstein

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In Dr. Goldstein’s research findings, the adolescent subjects with bipolar disorder also had greater cardiovascular risk factors and didn’t do as well on a computerized test measuring mental flexibility and impulsive risk-taking, compared to the control group.

So what’s happening with the vascular systems of teens with bipolar disorder?

“There are multiple things going on,” Dr. Goldstein points out. “These teens are similar to adults with bipolar disorder – they’re more likely to smoke, less likely to exercise, and their nutrition is not as good [as individuals without bipolar disorder]. “But it’s also stressful to live with bipolar disorder, so [the strain] impacts their risk for heart disease.

And then there’s another piece – some of the medicines used [to treat and manage mental health conditions] increase weight. All these factors are part of the story.”

“We know that the reality for middle-aged adults with bipolar disorder includes excessive heart disease which can shorten their life by 10-15 years. That’s the status quo and we’re not happy with the status quo,” Dr. Goldstein continues. “The goal is to prevent these kids from developing heart disease in the first place.”

The post The eyes could reveal clues about bipolar disorder and its link to heart disease appeared first on Your Health Matters.

It was a stressful situation for a new nurse in Sunnybrook’s Neonatal Intensive Care Unit (NICU): A father, upset over a change in the care plan for his premature baby, was becoming increasingly emotional and the nurse – who had been on the job for about six months – was struggling over how to handle the situation.

Enter registered nurse Jo-Ann Alfred, a nurse educator whose advanced education and clinical training gave her the tools she needed to calm the nurse down and help her deal with a potentially confrontational situation.

“The father was emotional, and at the time the nurse wasn’t sure how to properly explain the change in the plan without getting the father more upset,” says Alfred, an 18-year veteran nurse who has been working in the NICU since 2014. “I told her the biggest thing to do in this situation is to use kindness and understanding, and listen, because [for the most part] they just want to be heard.”

The work of Alfred and other nursing mentors is part of Sunnybrook’s emphasis on continuing education, which is proving to be more important as health-care workers adapt to new challenges of increasingly complex hospital settings, an aging population, complex medical conditions and technological advances such as mobile devices and electronic medical records.

“This is about ensuring that we are providing the best care we can for patients and families in a constantly evolving world,” says Elizabeth McLaney, Sunnybrook’s director of Interprofessional Education. “And at the same time, ensuring we can continue to provide that care for future generations.”

In the nursing education department, improving the patient experience comes in many forms – but it all starts with making sure newly hired nurses are comfortable and confident in their roles. Critical to this is mentoring. Following an orientation period, each new nurse is teamed with an experienced colleague, says Beverly Waite, a nursing education leader at Sunnybrook.

As well as benefiting from mentoring initiatives, many of Sunnybrook’s registered nurses pursue a master’s degree and even a PhD, qualifying them for advanced-practice nursing positions (such as nurse practitioner and clinical nurse specialist) and other clinical roles, as well as research, teaching and leadership positions.

So who are these Sunnybrook nurses embracing the never-stop-learning culture? Below are just a few.

Lauren Cosolo

Part-time registered nurse (RN) in the trauma unit and clinical instructor for University of Toronto (U of T) nursing students.

Lauren Cosolo knows through her own experience the value of having a mentor.

“When starting out as a new nurse, you’re not confident in yourself or your skills, but having somebody there to help you through that is so valuable,” says Cosolo, 27. “In the trauma unit, we get people who’ve been seriously hurt from motor vehicle collisions to gunshots and have traumatic brain injuries – they’re complex traumas that involve lots of different systems.”

For the past couple of years, while working part time in the unit, Cosolo has pursued a master’s degree in nursing. By doing so she hopes to become a nurse educator, to teach other nurses in “evidence-based practice” – that is, caring for patients using the best knowledge possible, based on both scientific findings and what has been shown to work in practice.

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“I really enjoy nursing education and being that support system: helping new nurses and nursing students develop skills and confidence.”

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When patients arrive in the trauma unit, she says, “usually they’re from the Intensive Care Unit (ICU) and they’re acutely ill. A newly hired nurse in the ICU may struggle at first with addressing the concerns and fears of distraught families of these patients. But the mentor helps by giving valuable advice and recommending resources to help the new nurse deal with the needs of the patients’ loved ones.”

Under the early guidance of her mentor Melanie Santos at Sunnybrook, Cosolo learned to hone her nursing skills. “Melanie was very much the one who would give me confidence. She was always there for support when I needed her, but also pushed me to be independent, which is important,” Cosolo says.

After taking a nurse preceptor workshop (which educates nurses on how to guide and work with students), Cosolo mentored her first student last year and takes pride in seeing her now working in the trauma unit.

“I really enjoy nursing education and being that support system: helping new nurses and nursing students develop skills and confidence, handle a full patient load and practise confidently, ethically and safely,” Cosolo adds.

Craig Dale

Advanced-practice nurse (APN) in the ICU and assistant professor at the Lawrence S. Bloomberg Faculty of Nursing at U of T

Craig Dale has seen his career as a nurse go through quite an evolution over his 22-year tenure at Sunnybrook; through it all, he’s constantly reminded of the importance of learning from the patient experience.

Dale, 51, has been an APN in the ICU for the past decade, with specialties in qualitative health research and critical-care nursing. He has been an assistant professor at the University of Toronto since January 2015, two years after earning his PhD in nursing.

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“A lot of people entering the profession don’t realize that you can have a rich career that advances patient care from more than one vantage.”

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“One thing I didn’t realize at the start of my career,” he says, “is, you can become a scientist at the same time as being a nurse clinician. A lot of people entering the profession don’t realize that you can have a rich career that advances patient care from more than one vantage. In my case, I’ve done this through my clinical role, my academic work, my research and as a mentor to other nurses at Sunnybrook.”

Dale’s research focuses on improving hygiene practices for intubated and mechanically ventilated adult patients. For his doctorate, he studied the practical challenges of providing oral care and how to improve it. It’s an essential life-saving skill; for instance, he discovered that pneumonia starts with bacteria in the mouth.

He believes nurses play a crucial role in the health-care system internationally, including in leadership positions, “because they understand what’s happening at the point of care: they know how things work and how they break down. They’ve also been trained to communicate with people in distress which is one of the most important skills clinicians can bring to the patient-family encounter.”

One young trauma patient, who suffered extensive orthopaedic and facial fractures in addition to a life-threatening pneumonia, was particularly memorable for Dale.

“He couldn’t speak while on the ventilator and his eyes wouldn’t open because of his facial swelling,” he says. “Assuming he was able to hear and understand me, I guided him during his care and offered encouraging details about his recovery. Many months later he walked into the ICU to thank me. He didn’t know what I looked like but said he could recognize my voice.

“Despite the high-tech focus of ICU life-support, I have learned how patient survival is undeniably conditioned by empathetic support and communication.”

Desiree and Drew Lewis

Staff RNs, Neonatal Intensive Care Unit (NICU)

Born several weeks early, it seemed fraternal twins Desiree and Drew Lewis’s destiny that they would end up working with other premature babies. They have been doing just that in Sunnybrook’s NICU since September 2015.

The sisters, who turned 26 in May, say their experiences in the NICU after getting nursing degrees have been “amazing,” in large part because they weren’t just thrown into the nursing pool to sink or swim.

Drew, the older twin by five minutes, always wanted to be a nurse. Desiree earned an accounting diploma before realizing she, too, would rather work in health care.

After graduating last year, they joined the NICU staff and entered an orientation program with in-class learning for two weeks, then received one-on-one training by nurse preceptors over a three-month period.

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“I am lucky that I can come to work every day and feel inspired by all those around me.”

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Their own background as premature twins helps fire their enthusiasm for their work in the NICU. “I am inspired by [preterm babies’] strength, resilience and fight, and by how strong and hopeful their families are,” says Desiree, who says these young patients motivate her every day to want to learn as much as possible about her profession.

“I am lucky that I can come to work every day and feel inspired by all those around me,” she says, adding she wants to further her education and inspire future nurses “the way I was inspired by many throughout my journey.”

Desiree says she and her sister continually experience what it means to be part of a teaching hospital. They’re grateful they can collaborate with other nurses, doctors, pharmacists, dietitians, social workers and other professionals who are passionate about their jobs and enthused to teach and “clarify their piece of the patient puzzle,” while trying to return that to their colleagues at Sunnybrook.

Although she’s not certain what her career future holds, Drew says she, too, will one day pursue additional education, and her experience at Sunnybrook will prepare her.

“I will be ready for the journey.”

All photography by Doug Nicholson

The post The importance of a never-stop-learning nursing culture appeared first on Your Health Matters.

At Sunnybrook, the Medical Devices Reprocessing Centre (MDRC) is at the heart of preparing and organizing all reusable medical tools, devices and accessories.

“Reprocessing involves cleaning, decontamination, packaging, assembling and then you sterilize,” says Abdool Karim, who has been the MDRC’s manager for 10 years. “What [MDRC staff are] doing is providing devices that are functional and sterile and free of any infectious agents – 100 per cent of the time.”

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In Sunnybrook’s operating rooms – there are 21 at the Bayview site – the equipment ranges from small instruments such as those used for ear procedures to larger scalpels, forceps and retractors (which prop open everything from the mouth to the abdomen while the surgeon works), and metal bowls, spoons and trays.

Not all equipment is reusable; for example, saw blades for orthopaedic surgery are used once and discarded, while retractors can withstand hundreds of uses.

Here’s an in-depth look at the MDRC, which handles about 2,000 pieces of medical equipment daily:

All photography by Doug Nicholson

The post How medical tools and devices are cleaned appeared first on Your Health Matters.

Who better to look into ways of improving patient health than the medical professionals with daily hands-on experience?

Scientists and physicians aren’t the only ones conducting important, life-changing research at Sunnybrook. Health-care professionals in myriad roles are involved in Sunnybrook’s program of practice-based research and innovation (PBRI) – drawing from their daily experiences on the job to conduct research into improving the patient experience.

Sunnybrook’s strategy for PBRI is driven by the belief that health professionals at the point-of-care have crucial knowledge and abilities that can play a critical role in quality patient care. Here are some examples of this philosophy in action.

Louise Rose, nurse researcher

Furthering critical-care work

Louise Rose loves giving a voice to seriously ill patients – literally.

Rose’s working mission − to influence decision-making in health-care policy and funding − includes researching the care and management of patients requiring mechanical ventilation.

One of the several collaborative studies she is leading involves the use of a communication device, known as an electrolarynx. “To be able to communicate is a fundamental need we all have,” says Rose. “Being unable to communicate is one of the most frustrating things about being a patient in the intensive-care unit.”

She’s referring to how the speaking ability of critically-ill patients can be hindered when using breathing devices that aim to save their lives. Some may need breathing machines (ventilators) temporarily, while others may need breathing tubes (tracheostomy) permanently. Breathing tubes use a balloon (called a cuff) that, when inflated, helps to prevent saliva and other secretions from entering the lungs, which could lead to infection.

When this medical equipment makes speaking impossible, health-care providers may need to read patient’s lips or facial expressions, “but that’s still extremely difficult and often leads to frustration for our patients,” says Rose.

Giving patients their voice back is the motivation behind the project Rose is leading to test whether they can be trained to use the electrolarynx.

The device, sometimes known as a throat back, is more commonly used by cancer patients who have had their voice boxes removed. About the size and shape of a small electric shaver, it is placed under the jawbone and produces vibrations to allow speech.

Terry Chaikalis, for instance, has multiple sclerosis and requires a tracheostomy with the cuff inflated. He says that since using the electrolarynx, “I’m enjoying talking again.” He hopes to get his own device for his move to long-term care.

Many patients and their loved ones are happy about the electrolarynx – one seriously injured patient was a “changed man” after learning to use it, says Rose, because he could once again communicate with his wife.

Still, it takes some getting used to, because it makes a buzzing noise, says Rose, who would like to collaborate with engineers to design a quieter and easier-to-use device.

Rose thrives on collaboration with professionals who have diverse skills. “Most of health care is a team − it’s not a single individual − so you have to include the perspectives of all those key members, both in applying things at the bedside and in doing research,” she says.

The U.K.-born Rose, who studied at Massey University in New Zealand and then earned her PhD at University of Melbourne in Australia, was lauded for her “wealth of experience” when she was named to the TD Nursing Professorship in Critical Care Research in 2014.

Now established in the role, Rose says: “I enjoy being here at Sunnybrook where I am close to the clinical environment. I can go up to the ICU (intensive-care unit) and be involved in data collection and screening, and talking to my research staff rather than just being in an office.”

Sabrina Rafaeli is on a mission to make the OR a quieter place for patients. (Photograph by Doug Nicholson)

Sabrina Rafaeli, registered nurse

‘Silent induction’ and other ways to reduce patients’ anxiety

As a dedicated operating room (OR) nurse for more than a decade, Sabrina Rafaeli has come to realize that patients preparing for surgery respond best to the sound of silence.

The 32-year-old is a team leader on night shifts in the OR, which can be extremely busy with trauma patients. On her day shifts, much of her OR work involves patients undergoing ophthalmological and gynecological elective procedures. She does everything from verifying surgical counts to working to ensure patient safety, all while collaborating with anesthetists, surgeons and others.

Rafaeli says patients can become unsettled if exposed to noises in the OR right before their surgeries. These disquieting noises can be as simple as the clanging of surgical instruments or the idle chatter of the surgical team.

Rafaeli, who joined Sunnybrook in 2011 after moving to Toronto from Israel, says one particular event gave her the idea for her research work.

“A few months ago, I was circulating in the operating room when it struck me how noisy it can get. Everything from staff talking, the radio playing, monitors beeping, metallic instruments clanging and people coming and going,” says Rafaeli.

“As an operating room nurse, I notice extreme anxiety in patients. Sometimes patients don’t verbalize it, but you see their heart rate and blood pressure go up. They may ask to go to the washroom. They don’t have to tell you they’re scared, but we know those patients are anxious, and we are there to help them and make them feel better,” she adds.

As part of her research, Rafaeli created surveys for patients to evaluate their anxiety levels before and after each surgery, and to help her determine how certain interventions could decrease those feelings.

“If we have patients who are anxious before surgery, they will wake up anxious and post-operative anxiety affects post-operative pain, which means the patient may require more pain medication for recovery,” she says. “And if they need more narcotics in recovery, that recovery may take longer.”

To that end, Rafaeli has devised some novel approaches to managing noise levels, including a “silent induction” plan: During the administering of the anesthetics, there should be no counting of instruments or discussions among staff, who would also be asked to avoid entering the room unnecessarily and to turn off their pagers. She also aims to increase surgical teams’ awareness of the impact of noise on patients by holding educational sessions, hanging posters around the OR and engaging “noise champions” to oversee silent inductions in their practice.

Jenn Bowler, social worker

Improving the discharge experience for trauma patients and families

Jenn Bowler’s years of social work experience at Sunnybrook’s Tory Regional Trauma Centre have taught her that patients and their families need help from the moment a life-altering injury happens, through to when they are discharged and long after.

“Traumatic injury and hospitalization are always overwhelming and intimidating events,” she says. “Besides physical injuries, there are typically significant psychological and social impacts and stressors on the patient and family.”

Bowler has a master’s in social work from Wilfrid Laurier University and joined Sunnybrook in 2007. Working in what is Canada’s largest regional trauma centre, she is among three social workers who get involved within the first day or two of a patient’s admission. She says: “We have a continuity-of-care model where we follow patients from admission to point of discharge from hospital.”

Her work, she says, provides her the opportunity to work with trauma patients who have sustained injuries that involve many systems in the body, including the brain and spinal cord, from serious accidents or sometimes violence. She offers in-depth support and counselling to patients and their families to help them adjust during times of crisis or while they are dealing with grief. This can involve aiding their transition out of the acutecare environment into their homes or into the community, including during rehabilitation.

It is Bowler’s hope that her work – focusing on improving the educational materials given to patients and families after discharge – will help patients better deal with that transition from hospital to home, and be more prepared to cope with their injuries.

Bowler’s discharge packages educate trauma patients about problems to watch for, precautions to take and provides helpful tips and resources. That may mean, for instance, providing information to help a patient with a concussion and a broken leg learn how to shower with a cast, apply for Employment Insurance while off work and deal with headaches and fatigue. As trauma patients and their families have complex injuries and needs, it is essential that they are empowered and educated to improve their confidence and better deal with their physical and emotional recovery at home.

Bowler is driven by the people she helps. “Patients and families amaze me with their strength and resilience,” she says.

Jonathan Russell, ICU nurse

Working to improve staff handovers in critical care

Communication is key in most jobs, but for a medical professional, knowing everything that happened during a previous shift is vital.

To that end, Jonathan Russell’s research involves introducing and evaluating a tool to help organize and detail the information that is transferred between nurses as shifts change in Sunnybrook’s Critical Care Unit – known as the “handover” process.

At its core, a better handover means better quality care. “The idea is to change the way we think about handover by providing a framework around which to organize it. Structured tools make handovers more accurate by being specific about what information needs to be shared. For our patients, it means they can be confident that the person coming on shift has all the information needed to take care of them,” says Russell.

He earned his masters of science in nursing in 2009 from McGill University and relocated to Toronto in 2010 to work in critical care at Sunnybrook. Russell, 33, is also currently a student in the nurse practitioner program at the University of Toronto.

As a charge nurse, he says that effective handovers are necessary to improve the quality of care provided to patients and their families, particularly in intensive-care units (ICU). While handovers occur throughout the hospital − for reasons such as new admissions, change of shift or unit transfers – those that take place in the ICU differ in that the information tends to be of high volume and complexity. “The trick is finding a way to provide a comprehensive handover while avoiding information overload,” he says.

Russell figures that improving the transfer of information process will mean safer transitions in care between providers, and better patient care.

Amy Wainwright was on the team that created Sunnybrook’s myHip&Knee app. (Photograph by Doug Nicholson)

Amy Wainwright, physical therapist

New approach to improving patient experience of post-op pain

Amy Wainwright traces her passion for helping others overcome knee and hip problems back to her childhood.

“I had a lot of pain as a child; I had trouble with my knees and would go to physiotherapy every other Friday” at a children’s hospital, she recalls.

Wainwright, 34, has an undergraduate degree in kinesiology from McMaster University and a masters in physical therapy from the University of Toronto. She has been a physiotherapist at Sunnybrook’s Holland Orthopaedic & Arthritic Centre for eight years.

Patients with hip and knee replacements often experience challenges with pain management and rehabilitation, she explains. But there are unique concerns for patients who undergo knee replacement. They often experience more pain, and they have the added pressure of having to work to regain their knee movement quickly, beginning the day after surgery.

Wainwright has been involved in several patient-centred initiatives, including working on the development of a mobile app for patient use. Sunnybrook’s myHip&Knee app helps patients prepare for hip or knee replacement surgery by sending them reminders about what they should be doing before an operation, for instance.

After surgery, the app can help them keep on track during recovery by sending them daily questions to answer about their health. It also has a range-of-motion tracker that allows a patient who has had knee replacement to gauge how well the knee is bending and straightening.

Wainwright also plays an important role in the innovative, post-op knee replacement classes for patients, which offer peer support and focus on mobility, strengthening and functional training.

Wainwright says patients in the classes have reported that the classes are motivating and have helped them build confidence and make “functional gains.”

She is also part of an interprofessional committee that uses patients’ feedback to find ways to help them with pain management. As patients identify a need for more information on how to better manage their pain after discharge, one aspect of Wainwright’s fellowship program research is focused on creating new educational resources.

“Our patients have played such an important role on the team by identifying the issue and then helping us by providing important insights into how to make the resources the most meaningful to them,” she says.

Two important programs are aiding Sunnybrook’s research efforts

• TD Nursing Professorship in Critical Care Research: Established by TD Bank Group to support a nurse researcher focusing on work that will improve clinical outcomes for criticalcare patients, it’s the first role of its kind in nursing at Sunnybrook. In June 2014, Louise Rose, who specializes in critical care with a focus on mechanically ventilated patients, became the inaugural holder of the professorship.
• The 2015-2016 Health Professions Innovation Fellowship Program: Provides Sunnybrook’s point-of-care staff with the opportunity to improve patient care while developing leadership skills, including by interacting with professionals in other health-care disciplines.

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[dropcap]J[/dropcap]ason Myers is enthusiastic, energetic and ambitious – like any twentysomething with career and personal goals – but the Toronto university student also shares something deeply personal with many other young people.

For several years, Jason struggled with mental health, as well as substance use, issues. It was only after an exhaustive search that his parents finally found the right support and programs that would kick-start their son’s recovery.

After spending a total of nearly a year at two Utah treatment centres, Jason, now 21, is blossoming as a third-year student in the psychology program at Toronto’s Ryerson University, where he’s also passionately involved in an entrepreneurship program. As well, his mother, Rhonda Myers, turned her son’s negative experiences into a positive: She’s among the parents who were instrumental in the formation of the Family Navigation Project (FNP) – a Sunnybrook initiative that connects young people aged 13 to 26 struggling with mental health and/or substance abuse problems, as well as their families, with appropriate and timely help.

While the FNP has been in development for some time, it will officially launch in June 2014, boosted by $1.2-million raised through the inaugural RBC Run for the Kids. As well as a parents’ council of dedicated volunteers like Rhonda, there are staff health system “navigators,” other volunteers and a medical director, Sunnybrook’s Dr. Anthony Levitt.

In many ways, Jason wishes the FNP was around when he began struggling in middle school.

“Before I went away [to the American treatment centres], I went to a number of different therapists, tried a number of different programs – nothing really worked for me,” says Jason. “But it’s very different when you find the right groups and therapists.”

Dr. Levitt, Sunnybrook’s director of research in psychiatry, says an estimated two million youth in Canada have mental health and/or addiction problems, and only one in five gets specialized treatment.

[pullquote align=”right”]”Mental illness and addictions know no social barriers… The truth is, it can affect anybody, and it does.”[/pullquote] “Mental illness and addictions know no social barriers – they occur across socioeconomic class, and employment and housing status,” says Dr. Levitt, also a professor in the University of Toronto’s psychiatry department. “The truth is, it can affect anybody, and it does.

“What we have discovered is even those 20 per cent of kids who get the specialized treatment, a lot don’t complete it – then they have to go back and get treatment again, and even then that doesn’t necessarily work. Families are going through the system and can’t find the right door.”

Jason and his family had the door slammed shut on them many times while seeking help.

“I started struggling with anxiety and depression, and it got progressively worse to the point that, in Grade 11, I was unable to sleep, really had no motivation to get out of bed and go to school or do anything,” recalls Jason, the youngest of three children. “My mindset was, ‘Why bother going to school when I was going to be dead anyway,’ which was pretty grim, but that was my overriding thought.”

That dark period finally saw some light, however, in the summer of Grade 11 after he entered a 10-week program called Second Nature: Wilderness Therapy for Troubled Teens and Families located in a mountainous area of Utah. Jason says, in his first few days in the program, he wrote his life story while in isolation – an important eye-opener.

“Reading my life story was what really made it click that, ‘Wow, I’m wrong – nowhere did I mention friends and family – it was more about myself, and drugs and being cool. Before that, I was convinced I didn’t need help because no one understands me and it wasn’t my fault – it was everyone else’s.” Today, the sports-loving student is working part-time at a venture capital firm with the goal of a career in marketing and business development and shares a downtown apartment with two buddies.

Searching for answers

Rhonda says the FNP “was born out of trauma, but it was a brilliant development.” When she and her husband first started trying to navigate the mental health system, “nobody we called had any answers… . We were lost, absolutely lost, terrified.”

While attending a lecture by another Sunnybrook psychiatrist, Rhonda met Dr. Levitt and they discussed the harrowing road that parents like her often have to take to get help. From there, Dr. Levitt met with Rhonda and other parents to conceive the FNP “around the kitchen table.”

Jeanne Foot, chair of the FNP parents’ council, who has two children who overcame problems, says meeting other parents with troubled kids showed her she wasn’t alone.

“For all of us [on the council], we had exhausted every situation, but for these families who are now being helped by the FNP, they will get a lifeline right away,” says Foot.

That lifeline can come in various forms, say Kailey Patterson and Naomi Algate, who are the FNP’s first staff navigators. Working in a large office in Sunnybrook’s psychiatry department building, both have extensive education and experience in the field of youth mental health and addiction and in supporting parents and families of these youth.

In just the first couple of months of getting underway in November, the FNP had helped some 60 families, mostly from the Toronto area, but also from other parts of Ontario and as far away as British Columbia and Newfoundland.

“I’ve seen a lot of families dealing with anxiety and depression, and we’ve seen some with kids with bipolar or borderline personality disorder, accompanied by substance use,” says Patterson. “Many of the parents have taken on the full-time job of calling around to see if a certain program fits with their child’s needs and doing that runaround game. So we make the calls and do that for them sometimes.”

Algate says one of the biggest concerns of parents is the long wait lists for publicly funded help, the reason the FNP also serves as an advocacy group. But the navigators guide families through their options.

Dr. Levitt adds: “The majority of resources we find are publicly funded, while a significant minority are privately funded because those resources simply don’t exist in the public system or the waits are terribly long … . But even for those resources that are privately funded, there may be circumstances where government agencies may help cover them.”

Jason found salvation in private treatment – at Second Nature, as well as at Gateway Academy, a Salt Lake City residential treatment centre for adolescent boys, where he spent about nine months from 2008-09. But Jason stresses: “There are good programs in Canada that can help kids quite a bit – not every kid needs to go to Utah – but what is needed is a resource where you can find the connections you need.”

Banking on partnership

Since 2008, the RBC Children’s Mental Health Project has provided more than $20-million to support over 350 organizations dedicated to providing early intervention, increasing public awareness and reducing stigma of mental illness. Recognizing the need for a program to help youth more readily access mental health care, in 2013, the RBC partnered with Sunnybrook to establish the RBC Run for the Kids as a method to raise funds and awareness for the Family Navigation Project. Held in the Sunnybrook neighbourhood, the event attracted about 4,400 participants – nearly doubling expectations, says Jessica Diniz, Sunnybrook Foundation’s director of marketing and communications, who also oversees the RBC run event. “RBC was looking for a way to further their commitment to youth mental health and to engage employees in a cause that touches all families.”

Diniz says the second RBC Run for the Kids has been set for September 20, 2014, and will start at North York’s Mel Lastman Square, given that it’s expected to attract upward of 5,000 participants to the 5-kilometre, 15-kilometre and 25-kilometre events.

“We are very proud of our partnership with RBC. They are a true partner in every sense of the word, working hand in hand with us on this project.” says Diniz. “The money [from the inaugural run] is being put to use immediately and already it’s had an impact.”

To contact the FNP: Email: intake@navigatingfamilies.com or call 416-480-4444

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