hdhEnews: January 27, 2015

Inside this issue:

Talking at the heart of 2015 Eating Disorders Awareness Week
New clinic takes singleminded approach to complex care
Diabetes program keeping on its toes with new best practices
Saying farewell to the caregiver of caregivers

Talking at the heart of 2015 Eating Disorders Awareness Week

Adult Eating Disorder Team in the new kitchenOne clear message will prevail when mental health experts at Hotel Dieu Hospital mark Eating Disorders Awareness Week (EDAW) Feb. 1-7:  talking saves lives.

“The sooner help is found, the better the outcome,” says Dr. Brad Mac Neil, a clinical psychologist in the Adult Eating Disorders Clinic at Hotel Dieu.  “People need to understand that an eating disorder isn’t just a phase or that trying to achieve that perfect weight can actually be making you very sick. 

“We want to talk about the support available to get people past the stigma and silence that affect those living with a diagnosed eating disorder or struggling on their own.”

Starting at 12:30 pm on Tuesday, Feb. 3, Mac Neil and his colleagues will host an Open House in Hotel Dieu’s Adult Eating Disorders Clinic.  Community members can tour the clinic, hear about its treatment program and join discussions on topics that include healthy body image and men and eating disorders.

“Men also struggle with eating disorders but only a small fraction seek help because they assume that treatment services exist only for women,” he says.  “They end up undiagnosed or under-diagnosed, so we need to raise awareness about their options.”

Men comprise only two per cent of the clients served in the Adult Eating Disorders Clinic, which sees 100 to 150 clients annually.  About 30 per cent are college or university students, says Mac Neil.

On Thursday, Feb. 5, other events include a Friends & Family session at 3 pm (for family and friends only of patients currently in the eating disorders program) and, throughout the day, Northern Smash!—a chance to drop off those tyrannical bathroom scales in the main lobby or the Eating Disorders Clinic on Centenary 5.

“People can write a message of encouragement or recovery on the scales before we give them a good smash,” says Mac Neil.  “It’s another way to raise awareness around weight-based stigma and body image.”

Photo:  Getting set for Eating Disorders Awareness Week in their clinic's new kitchen are (l-r) Sandra Leduc, Dietician; Dr. Brad Mac Neil, Psychologist; Cathy O'Brien, Social Worker; Dr. Pallavi Nadkarni, Physician; Tricia Barrett, Clinic Secretary; and Sara Maylin, Nurse Practitioner.

New clinic takes singleminded approach to complex care

Jennifer Olajos-ClowHaving complex health care needs usually means living with multiple chronic conditions, with more specialists, medications and trips to the Emergency Department being added to the mix when your health takes a downturn.  The result can be gaps in care, but a new clinic at Hotel Dieu Hospital aims to close those gaps by giving patients a single plan of care that keeps everyone in the loop.

Leading the way in the new Complex Chronic Disease Optimization Clinic is Nurse Practitioner Jennifer Olajos-Clow, whose job is to focus on the individual with multiple chronic diseases and to put a care plan in place for that will remove confusion and frustration for patient and caregiver alike.

“Patients referred to this clinic have a history of four or more chronic diseases such as chronic obstructive pulmonary disease, congestive heart failure, diabetes, hypertension and mental health conditions,” she says. 

“You can imagine the fatigue that sets in when someone has to repeat information to various health care providers, and how much better he or she would be served if everyone had access to one plan that clearly sets out the patient’s health conditions, medications and risks, plus health goals and strategies for self-management.”

The task of creating coordinated care plans for people with complex health needs is integral to Health Links, a Ministry of Health and Long-Term Care initiative that started in 2012. 

A Health Link is a defined region in the province that brings together health care providers to ensure people are at the centre of their care and that family doctors and Nurse Practitioners (NPs) can connect patients with the care they need.  The Kingston Health Link represents more than 130 family doctors in our region working with hospitals and community services to improve the health care experience for patients with multiple complex chronic diseases. 

As an NP associated with Health Links, Jennifer is currently supporting patients who do not have family doctor, seeing about 10 patients with multiple chronic conditions in her bi-weekly clinic and developing a coordinated care plan for each. 

As an NP, she can order diagnostics such as blood work and x-rays, prescribe medication and make referrals to allied health professionals such as Social Workers and to health care partners such the Community Care Access Centre.  Her clinic is supported by a medical director as well as excellent access to well-established Hotel Dieu services that specialize in managing chronic disease such as the NP-led Heart Failure clinic and the Diabetes Education & Management Centre.

“I sit down with patients and together we look at everything related to their health from the doctors they see regularly to medications to social supports to advance care planning,” says Jennifer.  “We discuss their health goals, how to recognize signs and symptoms of disease flare-up and what to do when they know they’ll need help. 

“All of that information is consolidated into a coordinated care plan document that’s given to the patient once completed.  It also goes on the person’s hospital chart and to the family doctor or NP if the patient has one, and it gets adjusted as needed over time. 

“The bottom line is making sure the patient and caregivers always have a whole health picture at their fingertips.  That makes it much easier to provide care than trying to figure out pieces of a puzzle.” 

It’s a level of planning and education that puts patients and families squarely at the centre of care, with benefits that include easy telephone access to Jennifer in her role as a health care coordinator.

“Patients can call me with their concerns, which can involve anything from adjusting medications to booking a test to just reassuring them,” she says.  “The idea is to keep people at home and out of the hospital as much as possible. 

And not only does that strategy translate into improved patient care, it also means a more sustainable health care system.

“We know that about 5 per cent of patients consume about two-thirds of health care dollars,” says Mike McDonald, Chief of Patient Care and Chief Nursing Executive at Hotel Dieu.  “As our population ages and the prevalence of chronic diseases increases, the challenge is to support patients with multiple chronic conditions without crippling the health care system. 

“The kind of coordinated care planning happening in the Complex Chronic Disease Optimization Clinic is one solution.  It’s bringing care providers together in a different way so that those living with chronic care needs get the most efficient and effective care possible.”

Photo:  Nurse Practitioner Jennifer Olajos-Clow is leading the way in the new Complex Chronic Disease Optimization Clinic.

Diabetes program keeping on its toes with new best practices

RN Bonnie Stone-Hope with model foot used for teachingAdult and pediatric patients with diabetes are putting their best foot forward thanks to a new, more targeted screening tool in the Diabetes Education & Management Centre at Hotel Dieu Hospital.

Diabetes can cause serious foot problems such as ulcers and poor circulation, along with nerve damage (neuropathy) that can reduce the ability to feel pain, heat and cold and may cause someone to miss a foot injury until the skin breaks and infection sets in.

To help pinpoint foot complications before they get out of hand, the Diabetes Education & Management Centre (DEMC) has introduced the new evidence-based screening tool and practices to more easily and effectively capture information about a patient’s risk factors—e.g., unusual or no sensation in the foot or abnormalities such as calluses or cracked skin—and how well the person is caring for his or her feet in terms of grooming, footwear and regular self-checks.

Research suggests that such screening should start for patients as young as 15 years of age. Until now, this screening was only being done for patients 18 years of age or older. Spreading this care to a younger cohort of patients helps to reinforce the importance of foot care and screening early in life, hopefully helping these young patients prevent future complications. 

“While we always had a good practice for assessing patients for neuropathy, this tool makes it better,” says Registered Nurse Bonnie Stone-Hope.  “It lets us evaluate and score the health of a patient’s foot fully and objectively, which is vital in terms of creating the best treatment plan.”

Getting an objective picture is important, says Bonnie, given that some patients can be way off the mark when asked to gauge their foot health.  She cites the case of one person who unknowingly stepped on a sharp object.

“The patient was completely unaware of having stepped on it but had noticed some other foot problems and appropriately sought care,” says Bonnie.  “Being at a very high risk for infection, the patient was lucky the foreign object was spotted.”

The new screening tool was developed by the interprofessional DEMC team as part of the work they are doing to implement Best Practice Guidelines (BPGs) as Hotel Dieu moves towards completing its candidacy as a Best Practice Spotlight Organization (BPSO®).

Along with reducing foot complications for people with diabetes, the team is also implementing a BPG related to managing foot ulcers in those living with diabetes. 

Left untreated, foot ulcers can lead to amputation, explains Bonnie, which is why the team has introduced educational materials that provide patients and families with a clear understanding of foot ulcers, the importance of checking their feet every day and tips for helping feet heal faster.  And the team has developed a formal protocol for referring patients with ulcers to an appropriate community foot care agency, a process that supports patients in receiving the right care by the right care providers in a timely manner, promoting better patient outcomes.

“Our diabetes team is all about providing excellent care,” says Bonnie.  “We want to be sure that we’re using the best and latest clinical practices with patients as they work to live with a very complex disease.  These new BPGs only strengthen our ability to provide hands-on care that makes a difference in people’s lives.”

Photo:  Registered Nurse Bonnie Stone-Hope welcomes a new, evidence-based foot screening tool for patients living with diabetes:  "We want to be sure we're using the best and latest clinical practices with patients as they manage a very complex disease."

Saying farewell to the caregiver of caregivers

Dr. Walt Emrich with Kelly MonaghanKeeping hospital staff healthy so they can take care of others was a task superbly well done by Dr. Walt Emrich.  But this month, Hotel Dieu Hospital’s longtime Occupational Health physician passed on the stethoscope as he retired after more than 30 years of service.

A primary care physician who also maintained a busy family medicine practice, Dr. Emrich was known to Hotel Dieu staff as the doctor they saw when their health and work collided—when they twisted a back muscle or spiked a temperature or developed a rash.  A trip to Occupational Health for a consult with Dr. Emrich—the perfect combination of professionalism, common sense and good humour—was welcome medicine in and of itself.

Over the 32 years he practiced part-time at Hotel Dieu, he figures he met or treated most of the hospital’s 800-plus employees, including dozens who joined him on the golf course every year in his role as founder and organizer of Hotel Dieu’s Annual Invitational Golf Tournament.  Over the 22-year history of the tournament, he helped to raise $400,000 to $500,000 for hospital equipment, programs and services, while bringing together staff and community members in one of the city’s premier philanthropic events.

“Walt was always kind and compassionate with each interaction, with each individual and with each circumstance,” said Kelly Monaghan at the physician’s retirement party on January 21.  As Director of Patient & Staff Safety, Occupational Health and Infection Prevention & Control, she worked closely with Dr. Emrich for many years and says his intelligence, thoroughness and commitment to both his profession and to Hotel Dieu were unequalled.

For Dr. Emrich, the feeling was reciprocal.

“Hotel Dieu is like a big family—the spirit of this hospital is second to none,” he says.  “It’s a place where people do more than their jobs.  I was happy to be part of that.”

Photo:  On Jan. 21, retiring Occupational Health physician Dr. Walt Emrich joined Kelly Monaghan, Director of Patient & Staff Safety, Occupational Health and Infection Prevention & Control, for a heartfelt farewell party with Hotel Dieu Hospital staff and friends.