Quality

Northwest

All seven northwest acute care facilities (hospitals) are using new admission and planning forms so that the staff interprofessional team (such as doctors, nurses, pharmacists and other health providers) can work together with families to help give better care to patients while they are in the hospital and also for when they are ready to go back home. Acropolis Manor (residential care) in Prince Rupert has been recognized provincially for the work staff have done on their local CLeAR (Call for less Antipsychotics in Residential Care) project from the BC Patient Safety & Quality Council.

Haida Gwaii started testing a new service in March 2017 for patients with chronic disease. Patients are using two-way text messaging to talk with their interprofessional team. Staff on Haida Gwaii worked with Northern Health’s perinatal program (safe delivery of babies) to bring emergency obstetrics training to local nurses and rural doctors on the island.

The Kitimat rehabilitation department (physiotherapy) started a joint optimization clinic, using telehealth service (videoconferencing), to help support clients who need joint replacements both before and after orthopedic surgery, so that they don’t have to travel to get care as often. The Kitimat rehabilitation team have supported a range of community groups which are helping local residents lower their health risks and stay in good health

Kitimat lab staff are working on a continuing project to help give service to patients and lower wait times.

Northern Interior

Staff and doctors at GR Baker Hospital in Quesnel are working together to improve patient care in the hospital. Strategies are being trialed around team meetings and senior’s rehabilitative care. This work includes looking at having the patient and family involved in discharge planning (when a person is ready to leave the hospital).

Improvements in services are being made at the University Hospital of Northern British Columbia in Prince George:

• The number of people waiting more than 26 weeks for surgery has been lowered by 30 per cent.
• There were 21 per cent more cataract surgeries (eye operation) in the past year and wait times have been lowered to less than three months.
• The hospital did 411 more MRI exams this year (which scan a person’s body and show pictures of what is inside), helping more people get the care they need.
• The Breast Health Imaging Centre renovations are underway and the centre is expected to open in fall 2017 (with support through the Spirit of the North Healthcare Foundation).

Robson Valley staff are looking at ways to deliver better care by using virtual medicine (telehealth) to connect patients with their team of health care providers (as part of primary care).

Northeast

Two staff have been hired for the First Nations Mobile Support Team, which provides outreach services to mental health and/or substance use clients. Team visits have started in Blueberry, Doig River, Halfway River, West Moberly and Saulteau First Nations communities. Support for Kelly Lake Cree First Nation is also being organized again.

Northeast Leadership Days were held twice in the past year, with record attendance at the June 2016 event. Topics included the Northern Health strategic plan, and workplace health and safety (eg. managing staff illness and injury, recognizing the good work of staff, time management).

The same admission assessment procedures for admitting patients are now being used in all facilities across the Northeast.

Staff training

• Throughout the Northeast, acute care (hospital), residential care and interprofessional teams were being trained in violence prevention, as part of the Provincial Violence Strategy (working towards 100 per cent of staff and managers completing this training).
• In the past year, 14 staff in the region enrolled in various Quality Improvement training and Patient Safety Officer training, which helped in starting more improvement projects in the region. More than 100 staff have now taken this training to date.
• Training on Brief Action Planning was provided to more than 65 staff, which helps support patient self-management and behaviour change, especially for patients with chronic disease.
• Provision of Dementiability Training (training on better managing dementia patients in all health care settings) to 42 staff each year for the past two years, as well as Gentle Persuasive Care training to support staff in caring for seniors.   

Dawson Creek

• Dawson Creek and District Hospital upgraded to digital mammography (screening for breast cancer) service. The new service provides better image quality and a more comforting environment for patients.
• Renovations to the hospital’s reception desk, including registration, have helped to provide better service for patients.
• Congratulations to Dawson Creek and District Hospital for being voted the best for their storyboard at the Northern Health Quality Conference. Their storyboard was about Care in the Right Place improvements at the hospital to enhance patient flow from admission to discharge with a focus of also improving the patient experience

Fort Nelson

• Several renovation projects at Fort Nelson General Hospital are providing better service (and comfort) for patients. These include the tub room in the Multi Leve Unit (residential care); the main entrance sitting; the morgue; and the roof (replacement)
• A partnership between Fort Nelson General Hospital and Dawson Creek and District Hospital is now bringing regular ultrasound services to Fort Nelson (one week per month).
• Work is progressing on supporting two dedicated in-patient beds at Fort Nelson General Hospital for withdrawal management.  

Fort St. John 

• A successful grant application for a Quality Improvement (QI) Student mentorship from the BC Patient Safety Council allowed the Fort St. John Hospital team to make several improvements in medication safety. 
• The intensive case management team in Fort St. John is continuing work to help people with severe mental illness and/or substance use concerns, with clients getting more support in the emergency department. Also, doctors and other staff are learning and understanding more about what services are available for clients.
• Fort St. John acute care (hospital), residential care and interprofessional teams were trained in violence prevention.
• The Fort St. John Hospital Emergency Room Improvement Team was successful in improving patient signage, helping to decrease unnecessary visits to the emergency department for prescription refills, suture removals (patient self-removal kit implemented), procedure scheduling and patient follow-up. 
• The psychiatric liaison nurses in the Fort St. John emergency department are helping mental health and substance use clients get the local services they need, and some people do not have to stay in the hospital as often.    
• The Fort St. John Hospital is renovating and working towards the installation and start of the new Fort St. John MRI program, expected by early fall 2017. 

The Child and Youth Health Program guides care for children and youth from ages 0-17.

It is a new program that started in September 2015. In the first year, program leads spoke with doctors, staff, and families in the north to learn about the most serious issues that affect the health of children and youth. We learned that partnering with the First Nations Health Authority, Ministry of Children and Family Development, Ministry of Education, Provincial Office for the Early Years, and families will be very important. These partnerships will help us to address child and youth mental health concerns, strengthen families, and deliver the same care across the north for children and youth in hospitals.

In 2016, we focused on:

“Improving Care for Children and Youth with Mental Health and/or Substance Use Concerns” by

• Working with communities to find out how to better help children and youth in emergency departments who have mental health concerns.
• Finding the best way to give nurses the training they need to better help children and youth with mental health or substance use concerns.
• Working together with Northern Health’s Public Health department on a mental health promotion campaign project (to promote behaviours that contribute to mental wellness).

“Development of Regional Guidelines, Standards, and Education for the Care of Children and Youth within Primary and Acute Care Settings” by

• Having nurses in Northern Health hospitals use the Provincial Pediatric Vital Signs and Documentation Guideline (when they care for children).
   
• Using the Provincial Pediatric Early Warning System (PEWS) to help nurses identify and care for sick children.

The next important step is working with Public Health to support parenting, early childhood development, and mental wellness.

The Mental Health and Addictions program has two main goals:

• To have more people get follow-up care through a community worker and/or a doctor within 30 days of leaving the hospital, after being treated for a mental health or substance use disorder. (Goal: 90 per cent of patients)
• For people who went to the hospital for a mental health or substance use disorder, to find out how many went back (readmitted) to the hospital within 30 days of going home, and to learn how to lower these 30-day readmission rates.

To reach these goals, information on patient visits was looked at and different ways to help people were developed together with hospital staff, doctors, and community health care workers. In this past year, new steps were put in place at hospitals to support people in care for a mental health or addictions issue, assist with their treatment in the hospital, and arrange supports and services for their return home.

Mental Health and Addictions received funding from the Ministry of Health to provide services for people with severe addictions and mental illness. These services were put in place during the past year. The services included hiring psychiatric liaison nurses to work in emergency department across the north, and establishing an intensive case management team in each of our regions. In addition, a mental health and addictions nurse was hired to work in partnership with the police (Car 60 program) to respond to situations in the community.

Working together with the First Nations Health Authority, Mental Health and Addictions received funding to create mobile support teams to visit Indigenous people in their communities and provide mental health and addictions services. In this past year, mental health and addictions staff were hired in three centers to help support people in nearby Indigenous communities and connect them to primary care services. Next year, we will continue the partnership and bring services to more communities.

The Critical Care Program helps the community and hospital teams at Northern Health to improve health care for people in the north.

Quality Improvement Goals

Emergency Departments (Trauma Accreditation):

• Ensure trauma care (for when people are badly injured) is provided in a way that is guided by what health research says is the best way to care for people to help them get better again.
• Updated existing trauma Standards, Guidelines, Protocols and Policy to make sure they help staff to provide the best care possible, and also meet (or do better than) the Accreditation Canada guidelines.
• Making sure that Northern Health hospitals and health centres get feedback on what they did welt and/or what they can improve in providing trauma care (using the same review form for everyone).

Emergency Departments (Sepsis):

Improve on and keep using the Sepsis Protocol (a method to check patients for this health condition).

• Sepsis is an inflammation of the whole body that comes from an infection
• The Sepsis Protocol helps doctors and nurses to more quickly see when a patient staying in the hospital has sepsis. This is important because diagnosing sepsis early can reduce complications and deaths.

Emergency Departments (Adult Febrile Neutropenia):

Improve on and deliver the same care to adult patients all across the north who come to the emergency department with Adult Febrile Neutropenia.

• When people have a fever and a low number of white blood cells in their blood, they may have a condition called febrile neutropenia.
• Education and treatment plans have been developed for Northern Health emergency department staff to treat patients with fever and low white blood cell counts. This is important because diagnosing febrile neutropenia can reduce complications and deaths.

Intensive Care Unit (Pain, Agitation and Delirium):

• Improve on and deliver the same care across the north for patients experiencing pain, agitation and delirium.

Sustainability Goal:

Transfer of care documentation (for when a patient needs to be moved from one health site to another).

• This is an Accreditation Canada Required Organizational Practice that makes sure that doctors and nurses share all patient information that might be needed by other doctors, and health care staff to safely care for someone who has been moved to their hospital. Health research shows communication breakdown/mistakes can happen most often during the time a patient is moved from one care provider to another.

Northern Health Connections is celebrating its tenth year of offering health care transportation to the residents of the north. Even though the service has been operating for this long, residents of the north still do not know a lot about the service or think it can only be used when you are sick.

The NH Connections team, who work with our contracted partner Diversified Transportation, are helping people learn more about the program. One way they are doing this is by changing the signage on new buses each year. This includes putting images of local health professionals on the signage, including dentists, pharmacists, and eye doctors with their families and/or a range of people of different ages, from babies to seniors. Watch for the next bus coming through your community. It might have a familiar health care staff face from Northern Health on it!

The people that do use the bus service are our best champions of the program. Every survey card that we get offers positive comments about the drivers and the quality of the buses. Passengers also sometimes give us comments to help make our service better and we look at every suggestion carefully to see if we can put it in place. This year, through suggestions, we started using Facebook to help more people learn about our program.

People who have used the service, or their families, have had a lot of positive things to say about the program in the Facebook comment section, especially about the drivers. Our drivers spend countless hours to help patients from as far away as Prince Rupert get to health care appointments across the north and down to Vancouver. Every day, there are two to five buses moving through communities in the north. Our experienced and trusted drivers help make sure that passengers feel respected and arrive at their destination safely, and on time.

The Northern Health Connections program is about the people we serve and the dedication of the people serving them.

The goals for 2017 for the Surgical Services Program are:

• Working on presurgical screening processes (helping patients get ready for surgery) so that they are the same across the north in all health facilities
   
• Developing, and putting in place, a system that doctors and staff across Northern Health can use to book timely surgery for different emergency patient cases
   
• Using Cerner Electronic Scheduling in all Northern Health operating room booking offices
   
• Working on Venous Thromboembolism (blood clots) and surgical safety checklist projects

Patient safety is the most important priority for Northern Health and this includes making sure patients who undergo surgery have a safe experience.

The Surgical Services Program is working to improve the help and care that patients get through the presurgical screening (PSS) department. This includes making sure that processes are the same across Northern Health, such as using the same patient questionnaire. Also, a PSS brochure was developed because patients asked for presurgical information that would help them in getting ready for their surgery. A regional policy has been put in place to make sure that operating room resources are being used in the same way across Northern Health for patients who require emergency surgery.

A new system, Cerner Electronic Scheduling, for booking surgery is helping to provide better service for patients in the north through improved waitlist management. The Surgical Program continues to monitor, report and provide ongoing education for two projects: a venous thromboembolism checklist (for blood clots) and a surgical safety checklist.

To help give Northern Health patients the information that they need, a Surgical Services webpage is regularly updated. This site discusses the surgical journey with information both for the patient and their family.

The Perinatal Program is working on improving care before, during and after birth for mothers and babies in the Northern Health region.

Mothers do better if they can give birth naturally as close to home as safely possible. A workshop for rural nurses was put together by a midwife on Haida Gwaii. This workshop is helping new and experienced nurses in small communities to learn how to better support women during birth.

The vaginal birth rate is 72 per cent in the north, which is better than the overall rate in B.C. At the University Hospital of Northern BC in Prince George, staff are reviewing C-section rates to ensure mothers are receiving the best possible care.

Babies do better with their breathing, heart rate, sugar control, and staying warm if they are put on their mother’s skin right after they are born. Work has started to make sure that babies born at term (not premature) have skin-to-skin time with their mother or other family members after birth.

Prenatal classes, which help moms get ready for birth, are not available in all rural and remote areas in the north. To help, Northern Health helped to develop SmartMom, a free prenatal texting service that gives prenatal facts to women. NH staff are helping mothers-to-be sign up for SmartMom if they choose.

Nurses at Northern Health are starting to use the World Health Organization 10 Baby Friendly steps, which outline how to give the best care to newborn babies. Women who are pregnant or giving birth fall more often because of body changes and medicine use. Nurses at Northern Health have new supports to check mothers and babies to protect them from falling while in the hospital.

Northern Health’s goal is to provide high-quality services for seniors. To achieve our goal, we partner with doctors and communities throughout the north.

The focus for 2016-17 was:

• Supporting our hospitals to become more 'senior friendly' so that seniors can get the rehabilitation services that they need.
• Making sure seniors can better help themselves to get well after they have been sick.
• Having new staff teams help doctors give care to seniors who are in danger of falling or getting sick.
• Making sure that seniors get the best possible care based on their needs.
• Supporting education and learning opportunities for staff so they can better help patients with dementia (an illness affecting the brain and mental ability) in our long-term care facilities.

Goals for 2017-18:

• Identifying seniors who need help sooner so they can get the supports they need to stay at home longer
• Helping patients get home support services right when they need them
• Helping seniors living at home get the best care possible with more supports
• Putting a new, easier-to-use medical records system (holding patient information) into place for health care workers and doctors
• Continue to provide dementia training and education for all long-term care staff so they can give even better care to patients.

Northern Health laboratories are using more molecular technology to help quickly find pathogens (which cause disease), including MRSA. Planning is underway to do even more molecular testing to help provide quick and accurate results for more pathogens.

Health centres across the north are now using digital mammography (which helps find breast cancer in women), instead of film-based service. This includes Prince Rupert, Terrace, Quesnel, and Dawson Creek; Prince George will get digital service by July 2017. The benefits of digital technology include lower radiation, getting the images quicker, better patient experience, and electronic access to specialist doctors.

Quesnel and Hazelton received new automated chemistry analyzers, which will help deliver quick and accurate testing. And Terrace now has an automated hematology analyzer (used in testing blood samples).

Northern Health (NH) bought three new Magnetic Resonance Imaging (MRI ) units (which scan a person’s body and show pictures of what is inside) These new units cost $8.3 million, which is the largest equipment purchase that NH has ever made.. These machines will bring new MRI services to Terrace and Fort St John, while Prince George will get a replacement MRI. The new machines will help more people across the North to more easily get MRI service

Two general ultrasound technologists were trained through Northern Health’s Sonography Training At Rural Sites (STARS) program. These technologists are now working in jobs that had been not been filled for a long time – one in Prince Rupert and the other in Dawson Creek. Fort Nelson now has ultrasound service, thanks to a visiting service coming from Dawson Creek.

• Developed a plan to improve the quality and safety of the medication system for patients.
• Cleaned up out-of-date medication order sets; doctors, nurses and pharmacists can now easily find the order sets on Northern Health’s intranet.
• All long-term care homes have new contracts for retail pharmacy services.
• Work was completed on deciding how to best use medication inventory systems such as automated cabinets (for storing drugs). The changes that were made have saved almost $100,000.
• Increased support for clinical pharmacists to get mentoring and education so they can better help patients in choosing the best medication for their health needs.