Knowledge Translation Challenge 2017 Recipients

Vancouver Coastal Health Research Institute (VCHRI) supports health improvements and innovation through its Knowledge Translation Challenge, a program run in collaboration with Providence Health Care. This competition challenges health care practitioners to translate research discoveries and evidence into everyday practice with the aim of improving patient care. The challenge brings together practitioners who do not have knowledge translation experience and researchers who provide knowledge translation mentorship and resources. The Knowledge Translation Challenge facilitates innovative research projects that advance patient care.

These projects are made possible through a Providence Health Care & Vancouver Coastal Health Knowledge Translations Grant, funded in part by the Robert H.N. Ho Enhancing Patient Care Fund.

The team leads of the 2017 Knowledge Challenge Award winners are:

• Tanya Dunne Ahn, physiotherapist
• Michelle Carter, clinical nurse specialist
• Christine Poirier, physiotherapist 
• Jacob Rowe, speech language pathologist
• Jenifer Tabamo, clinical nurse specialist
• Gill Walker, occupational therapist

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Reducing falls in hospital

Falls are the number one cause of preventable harm to patients in hospital settings. To prevent falls from happening, it is important to talk with patients and their families, as well as care team members, about the risks.

Currently, patients at high-risk of falling have a visual identifier placed on their charts and at their bedsides. This project will offer red non-slip socks to these patients during their stay in hospital. “The red socks visual identifier will enable hospital staff and volunteers to provide supervision and offer assistance without accessing their chart,” explains Ahn.  

This project aims to help communicate fall risk to anyone who may come in contact. Hospital staff and family members could more easily identify and support patients who are struggling with their balance and mobility. 

 

Promoting safe management of patients on clozapine

Clozapine is widely recognized as a highly effective medication for treatment-resistant schizophrenia (TRS), a condition used to describe a subset of patients who do not respond to conventional antipsychotic therapy. Current international guidelines endorse clozapine as the gold standard for treating TRS; however, this treatment plan requires structured monitoring due to risk of hematologic and cardiovascular side effects. Despite clear practice recommendations, a number of studies have reported shortfalls in the delivery of clozapine care. An internal review at Vancouver General Hospital showed that 178 patients were prescribed clozapine between January 2016 and January 2018 in the absence of a standardized approach to treatment. 

The overall goal of this project is to implement a clinical tool kit (CTK) to promote safe management of patients on clozapine in an acute psychiatric inpatient setting. The specific objectives are to adapt an existing CTK successfully utilized at St. Paul’s Hospital (including an interdisciplinary guideline, pre-printed orders, and monitoring flowsheet) consistent with best practice standards, to facilitate ongoing evidence-based provision of clozapine prescribing, monitoring and follow-up, and to enhance clinicians’ knowledge and confidence when it comes to clozapine care. 

“This project is one of the first clinical practice collaborations in psychiatry between PHC and VCH, and it could provide a blueprint for future regional initiatives,” says Carter. “On top of this, our project is timely as CST is on its way. If we can come to clinical consensus on best practice, we will be better able to build the tools we need into our future system.”

 

Improving access to effective treatments for spinal cord injury patients

Over 12,000 people in British Columbia live with spinal cord injuries (SCI) that affect every aspect of their lives, and there are approximately 500 new SCI cases every year. Paralysis and loss of sensation often go hand-in-hand with SCI. To improve SCI patient outcomes, physiotherapists use a variety of tools, including Functional Electrical Stimulation (FES). FES is a relatively safe, widely available treatment option that involves stimulating the muscles during an exercise or movement. However, busy physiotherapists find FES application time-consuming and many are not familiar with this modality. As a result, many SCI patients may not receive this effective treatment. 

This project will evaluate and address the barriers and challenges to FES use at GF Strong with the SCI population. It will provide training and mentoring for therapists, as well as resources based on the evidence, and practice standards to support and guide therapists in selecting FES protocols for the lower extremity. The project will also adapt educational resources so that SCI patients can use FES independently or with their families. 

“We believe that by improving therapists’ confidence, knowledge and skills with FES, and providing a supportive learning environment, therapists will be able to use this modality effectively,” says Poirier. “Our vision is that SCI patients at GF Strong will regularly be offered FES as part of their therapy, enabling them to reach their functional goals faster and achieve optimal health outcomes.”

 

Improving communication in the ICU

Difficulty communicating is prevalent among patients in the intensive care unit (ICU), due in part to the nature of intubation, multiple conditions that can occur in critically ill patients, as well as limited supports currently in place to facilitate effective patient-provider communication. The inability to speak while in ICU can cause patients distress, frustration, anxiety, agitation and sleeplessness. It also leads to inaccurate symptom assessment, increased risk of preventable adverse events and increased use of both chemical and physical restraints.

This project will implement a communication training and resource program in the ICU at St. Paul’s Hospital. The program will include training for ICU staff and educational materials for caregivers on the use of communication tools and strategies, easy access to communication tools and resources in the ICU, and increased availability of speech-language pathology consultation for communication.

“Providing tools and training to help facilitate better communication between ICU patients and those around them will help patients who are already in a stressful situation feel more at ease and in control of their life,” explains Rowe. The results of this project will serve as a feasibility study for the implementation of similar training and resource programs across other units, hospitals and health authorities in British Columbia.

 

Partnering with patients and their families to save lives

Sepsis occurs when the body’s response to an invading infection damages its own tissues and organs. If not treated early on, it can lead to devastating complications, such as multi-system organ failure and death. Data collected between August 2016 and July 2017 found that sepsis is one of the top three reasons that patients are admitted to Vancouver General Hospital’s acute medicine units from the emergency department. Despite its prevalence, a 2017 Global Sepsis Alliance (GSA) campaign found that about 71 per cent of Canadians have not heard of sepsis.  

This project aims to increase patient and family awareness of sepsis through the co-development of patient-centred sepsis education tools designed with, and for, patients and their families. Listening to patient stories is a powerful tool in understanding their lived experiences. Part of this research project involves collaborating with school-aged children to transform complex information into easy-to-understand words and pictures that meet the needs of a culturally diverse patient population. The Canadian Public Health Association recommends using plain language and Grades 4 to 6 vocabulary for health information materials.

“We are shifting the culture towards working with our patients as partners in care,” says Tabamo. “Our project team anticipates that concerted efforts in partnering with patients and their families in sepsis care will significantly enhance their in hospital experience, improve patient safety, positively impact the quality of patient care and ultimately save lives.”

 

Broader use of cognitive behaviour therapy for patients with schizophrenia

The effectiveness for psychological therapies for those with psychotic disorders, such as schizophrenia, is increasingly recognized in the recent years. A number of meta-analyses have shown benefits of using Cognitive Behavioural Therapy (CBT) for psychosis symptom reduction; and the Canadian Psychiatric Association has recommended offering CBT to everyone with a psychotic disorder. 

CBT is a talk therapy that works to reduce the distress and functional deficits by assisting people with psychosis to shift their relationship with their distressing thoughts and beliefs—rather than necessarily getting rid of them, which for some is simply not an option.

“We wish to help individuals to cope more effectively with their unique beliefs and experiences,” says Walker. “We named this group ‘Unique State of Mind’ with the goal to minimize fear and stigma often associated with psychosis.” The study team will continue educating staff at the HOpe Center’s Adult Community Mental Health Team, as well as clients and their families about the benefits of CBT with the hope to increase their openness to this relatively new treatment approach.