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Sharing ideas

NorWest diabetes and kidney disease screening project singled out for praise

Soni, Letourneau, Fransoo,
NorWest team members, from left: Kazel Ebora, Sandra Marriott-Silver and Shannon Milks, with some of the screening equipment.

BY MIKE DALY
Winnipeg Health Region
Wave, January / February 2017

NorWest Co-op Community Health Centre has been recognized for its efforts to use a mobile screening clinic to detect diabetes and kidney problems in patients.

The initiative was one of three singled out by the Winnipeg Regional Health Authority’s Quality Improvement & Patient Safety department in partnership with the Manitoba Patient Safety Institute as part of an effort to celebrate improvements in patient safety and quality.

Cheryl Harder, improvement education consultant with Quality Improvement & Patient Safety, says the campaign is designed to promote sharing of ideas among health-care providers working throughout the Region.

 “What we’re trying to do is highlight good ideas,” says Harder. “So each year we ask health-care providers to submit entries to a contest for initiatives that achieve certain goals,” she says.

This year’s theme was patient flow, the goal of which is to provide treatment to patients in a timely and effective manner. A total of 29 entries were received during the competition, which ran during Patient Safety Week last October.

Although there is a small prize for the top three winners, the point of the exercise is to showcase how care can be improved.

“Health-care workers are extremely busy and their efforts are often focused on their own units,” she says. “They think of an amazing idea and run with it, but the mechanisms to share that success outside their units aren’t always there; they aren’t always thinking to do that. The Patient Safety Week contest helps bring those ideas to a wider audience, where others can benefit from them and be inspired.”

NorWest’s Mobile Diabetes, Kidney Screening and Intervention Project was itself inspired by another project called FINISHED (First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis).

As chronic disease co-ordinator Shannon Milks explains, the NorWest project uses specialized mobile equipment to test patients at various locations throughout the community. “This model is an excellent example of community outreach,” says Milks. “It’s an innovative way of offering health services to populations at higher risk for developing diabetes, hypertension or kidney disease, or individuals with diabetes who may not have been screened for complications.”

Using urine, blood and blood pressure tests, mobile clinic staff are able to generate a five-year kidney failure risk prediction score. Results are shared with the participant’s primary-care provider or, in some cases, a kidney specialist, for follow-up. If participants don’t have a primary-care provider, they are linked to one, or to experts in diabetes education, nutrition counselling, or other health-care related fields. Test results are available in 15 minutes, and the entire process takes 30 minutes.

Developed in partnership with the Diabetes Integration Project and the Manitoba Renal Program, and funded through a $200,000 grant from the Lawson Foundation with in-kind support from NorWest, the project has resulted in 526 participants being screened since May 2015. Of these, 173 required follow-up care.

“With this kind of early detection, we are able to help participants address a condition they often didn’t know they had, helping prevent unnecessary disease progression and complications,” Milks says. Based on its success, funding for the program was recently extended for two years.

One of the other top three initiatives to be recognized is the take-home naloxone kit distribution project initiated by the Region’s Healthy Sexuality and Harm Reduction program. Naloxone is a medication used to block the effects of opioids, especially in cases of overdose.

Based on a similar initiative undertaken on Vancouver’s East Side, the project is aimed at helping users of street drugs at high risk of opioid overdose – an important undertaking, given the recent rise of fentanyl and carfentanyl in Winnipeg’s illicit drug market. From 2010 to 2012, overdose deaths exceeded those from motor vehicle accidents.

“Fentanyl has recently been found in crack cocaine, ecstasy, and crystal meth,” says Shelagh Polischuk, public health nurse with the Healthy Sexuality and Harm Reduction team. “There’s no doubt that distributing naloxone kits saves lives.”

Since January, more than 400 laypeople have received training on overdose prevention and response, and 230 naloxone kits have been distributed. The ratio of kits used in overdose situations to the number of kits distributed is about one in 12.

The Patient Safety Week contest’s third main prize winner is a multi-faceted initiative aimed at eliminating “hospital holds” related to the Region’s Home Care Program.

“Ultimately, the goal is that no person should be staying in the hospital just because their home care services aren’t ready yet,” says Arjun Kaushal, process improvement specialist with The George and Fay Yee Centre for Healthcare Innovation, a partnership between the University of Manitoba and the Region.

To achieve that vision, the initiative spearheaded six projects that build more “upstream” efficiency in hospitals (where home care case co-ordinators are consulted and requests for home care services are created), and more “downstream” efficiency in the community offices (where these referrals are processed and services are provided).

The end result for patients, Kaushal says, will be a smoother, more effective transition from hospital to home care.

“The most important thing from a patient perspective is that we are looking at the entire continuum of patient discharge. We’re looking at both capacity building and process improvement measures. For example, we now have seven-days-a week hospital case co-ordinator coverage in the hospitals so people don’t wait over weekends. We’re also working on creating electronic workflows that remove inefficiencies due to paper-based workflows, with the goal of being able to measure system performance in real time.”

Sharing the success of projects like these has a positive effect not only on patient flow, but on overall patient safety, says Sharon Romaniw, a quality system support analyst with the Region.

“Sharing success stories and great ideas is energizing,” she says. “When attention is brought to these types of initiatives, good things happen. It’s a signal to staff that no matter what position you hold in the health-care system, your ideas are valued and we want to hear about them.”

 Mike Daly is a communications specialist with the Winnipeg Regional Health Authority.

Wave: January / February, 2017

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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