Healthier You Interior Health Spring 2016

Healthier You

Better information, better care: Aboriginal Self Identification – p. 10

easy camping recipes!Page 30

2016Spring

paving the way

Telehealth clinics for post-transplant

follow-uppage 26

Divisionsof familyPracticeGrassroots health-care change in your community

surgicalinitiativePuts patients at the centre of their care

SprIng 2016 Healthier You 3

DIvISIonS of fAmIly prActIce �� pAge 6 Formed to encourage doctors to work in family practice, this grassroots approach has spread to 230 B.C. communities.

QuIck AnD nutrItIouS recIpeS �� pAge 8 Healthy recipes from Interior Health Registered Dietitian Laura Kalina and Cheryl Christian.

Better InformAtIon, Better cAre ��pAge 10 Aboriginal Self Identification helps Interior Health meet human resources needs while supporting the health-care needs of our communities.

teAmwork ActS to help thoSe At rISk ��pAge 14 Assertive Community Treatment teams in Kelowna and Kamloops reach out to help people with significant mental health and substance use issues.

eArly recovery After Surgery ��pAge 22 Surgical initiative puts patients at the centre of their care – where they belong.

rIght cAre keepS SenIorS home ��pAge 24 A project in Kamloops this winter helped frail seniors recover at home instead of in hospital.

paving the wayteleheAlth clInIcS for poSt-trAnSplAnt follow-up

Technology is helping patients in rural communities who otherwise must travel long distances to attend appointments.

Volume 2, Issue 1

p.26

coverstory

inside

2016Spring

Spring is here and many families are anxious to go camping� Here are some healthy, easy-

prep meal ideas for your next trip�

p.30

4 Healthier You SprIng 2016

Healthier You

Interior health

contributors / Healthier You is produced

by the Interior Health communications team

with contributions from public health staff, in

partnership with Glacier Media.

chris mazurkewich, President & CEO Interior Health

WELCOMEmessage

Volume 2, Issue 1 – Spring 2016

Published by:

PUBLISHED BY IntErIOr HEALtH & GLACIEr MEDIACopyright ©2016. All rights reserved. Reproduction of articles permitted with credit.

glacier media group

Sales & marketing Kevin Dergez Director of Special Projects

[email protected]

Ellyn Schriber Newsmedia Features Manager BC [email protected]

Keshav Sharma Manager Specialty Publications [email protected]

Advertising Sales The Daily Courier – Kelowna Kamloops This Week

creative Director / Eric Pinfold [email protected] | www.phitted.com

Advertisements in this magazine are coordinated by Glacier Media. Interior Health does not endorse products or services. Any errors, omissions or opinions found in this magazine should not be attributed to the publisher. The authors, the publisher and the collaborating organizations will not assume any responsibility for commercial loss due to business decisions made based on the information contained in this magazine. Speak with your doctor before acting on any health information contained in this magazine. No part of this publication may be reproduced or transmitted without crediting Interior Health and Glacier Media. Printed in Canada. Please recycle.

Welcome from Interior Health

I love spring. As things green up all around us and the days lengthen and brighten, I am excited to get my bicycle back on the road. Fellow cyclists will understand the clarity of thought that comes through a long ride.

At Interior Health, we greet this spring with a clear focus. An aging population, growing rates of chronic disease, new treatments and technology, and competing demands for health-care dollars make it important we allocate our time, resources, and energy strategically.

www.glaciermedia.ca

There are five strategies that will be our top priority, guiding much of our work for the next three years:

1. Enhance access to appropriate primary health care.

2. Improve primary and community care outcomes and delivery for frail seniors living with complex chronic conditions.

3. Improve primary and community care outcomes for mental health and substance use clients.

4. Improve timely access to elective surgery.

5. Implement a renewed system of care to improve access and service quality across rural and remote communities, including continuing to build relationships with Aboriginal partners to ensure health care is provided in a culturally safe and sensitive way.

Our goal over the next three years is to reduce the growth in demand at hospitals and emergency departments, to free up the facilities to care for the acutely ill while people recovering from illness, coping with chronic medical conditions, or at the end of life, are primarily supported through community-based programs.

These strategies are demonstrated throughout our latest issue of Healthier You. Stories highlight our efforts to build relationships with our physician partners around primary care; help mental health and substance use clients get out of hospital and into new homes; enhance surgical services; increase the number of Aboriginal staff in our work-force; and leverage technology to support patients in rural communities. Watch for icons that represent our strategic areas in the stories throughout the magazine.

Enjoy the read, and whether you are on a bike, a hiking path, or out in the garden, I hope you have an opportunity to celebrate the arrival of spring and reflect on how you can further support your own healthy living.

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FAMILY DOCtOrS ACrOSS B�C� ArE WOrkInG WItH COMMUnItY AnD HEALtH-CArE PArtnErS—InCLUDInG HEALtH AUtHOrItIES—tO EnHAnCE LOCAL PAtIEnt CArE, ACHIEvE COMMOn HEALtH-CArE GOALS, AnD IMPrOvE PrOFESSIOnAL SAtISFACtIOn FOr DOCtOrS� tHIS WOrk IS BEInG DOnE BY COMMUnItY-BASED GrOUPS OF FAMILY DOCtOrS CALLED DIvISIOnS OF FAMILY PrACtICE�

Divisions of family practice were formed as part of an effort to encourage doctors to work in family practice. In 2002, many medical students were opting out of family medicine. So Doctors of BC and the provincial government began looking for new ways of empowering doctors to build relationships in their communities, promote leadership, and inspire health-care change. A grassroots approach was needed to kickstart this change, and the Divisions of Family Practice initiative, funded by Doctors of BC and the provincial government, provided this. The initiative began in 2009 with three local divisions, and there are now 35 divisions of family practice serving more than 230 B.C. communities. More than 4,700 family doctors are members of their local division. Today, health authorities play a critical role in partnering with Divisions of Family Practice at the local level.

Divisions of Family practice:

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Grassroots health-care change in your community

ABove: South okanagan Similkameen Division of family practice executive Director terrie crawford with Board chair Dr. tim phillips.


There are seven divisions of family practice within Interior Health:

1 Central Interior Rural, covering the towns of 100 Mile House, Williams Lake, and Tatla Lake

2 Central Okanagan, covering Kelowna, Westbank, Lake Country, and Peachland

3 East Kootenay, covering Cranbrook, Creston, Fernie, Golden, Invermere, and Kimberley

4 Kootenay Boundary, covering Castlegar, Christina Lake, Fruitvale, Grand Forks, Greenwood, Kaslo, Midway, Nakusp, Nelson, New Denver, Rock Creek, Rossland, Salmo, and Trail

5 South Okanagan Similkameen, covering Keremeos, Oliver, Osoyoos, Penticton, Naramata, Summerland, and Princeton

6 Shuswap North Okanagan, covering Armstrong, Enderby, Lumby, Salmon Arm, Sicamous, Sorrento, and Vernon

7 Thompson Region, covering the Kamloops area

Family doctors in local divisions meet with community partners and health-care stakeholders through committees called Collaborative Services Committees (CSCs). CSCs include representatives from the division, the local health authority, Doctors of BC, and the Ministry of Health. These partners work with other health-care stakeholders (e.g., representatives from municipalities, other nonprofits, local First Nations, and patients) to identify and address local health-care challenges. “The CSC structure enables family doctors and their partners to identify shared goals and determine where and how to focus collective efforts to meet local health-care needs,” says Andrew Earnshaw, Executive Director of the Kootenay Boundary Division. “In Kootenay Boundary, the CSC includes Interior Health’s local leadership from all portfolios: Community, Mental Health and Substance Use, Acute, Residential Care and Allied Health.”

One goal of divisions is to increase access to primary care for local residents. This is done in a number of different ways, including recruiting new doctors to communities; creating health-care teams by incorporating allied health care providers such as nurse practitioners, dietitians, and social workers into group practices; supporting doctors to practice more efficiently so they can take on more patients; and providing access to telehealth technology in rural communities to connect patients with follow-up care.

One example of how divisions are working to improve access to primary care is the Martin Street Outreach Centre in Penticton, a partnership of the South Okanagan Similkameen Division of Family Practice and Interior Health. The centre opened in May 2015, and is now providing primary care to 350 patients with mental health and substance use issues. Care for these patients is provided by a team that includes doctors, Interior Health Mental Health and Substance Use counsellors, a social worker, and a STOP HIV nurse.

Team-based care projects in East Kootenay, Kootenay Boundary, and Thompson regions are also underway, to help patients access the care and social supports they need. These projects focus on the integration of registered nurses, social workers, and life skills workers into practices. “The broad health authority representation on the Kootenay Boundary CSC is particularly important as we expand team-based care in our region,” says Earnshaw. “With perspectives from across the spectrum of care, family doctors and their health-care partners are well positioned to identify approaches to best suit the health-care needs of their communities.”

Divisions are also working in communities around the province to improve care for seniors living in residential care facilities, through the Residential Care initiative. Changes implemented by the initiative will ensure that facility residents are provided with 24/7 access to a doctor, proactive doctor visits, and medication reviews to identify harmful interactions and eliminate unnecessary medications.

To learn more about projects being worked on by the division of family practice in your community, visit www.divisionsbc.ca.

rIght: Division representatives regularly meet with Interior health staff and others involved in local

health-care planning.


Quick and nutritious recipes to make healthy eating a breezeThese recipes are from the Low-Glycemic Meals in Minutes cookbook, co-authored by Interior Health Registered Dietitian Laura Kalina and Cheryl Christian. Learn more at www.lowgimeals.com.

For more information about healthy eating, visit www.healthyfamiliesbc.ca or call HealthLink BC at 8-1-1 (toll-free). Registered dietitians are available Monday to Friday from 9 a.m. to 5 p.m. to answer your nutrition questions.

Homemade Sweet Potato Fries This recipe makes six servings.

• 3 medium sweet potatoes or yams

• 2 tbsp (30 mL) olive oil• 1 tbsp (15 mL) paprika• Seasonings of choice (for

example, oregano and basil)• Salt and pepper to taste

Directions1) Preheat the oven to 400 F.2) Wash and peel sweet potato (or

leave skin on if desired).3) Cut each sweet potato into one-

inch strips or wedges, and put into a large bowl.

4) Add the olive oil, paprika and spices to the bowl and toss sweet potato to coat.

5) Place sweet potato strips on a foil covered baking sheet.

6) Bake for 15 minutes on one side and turn them over. Bake 15 minutes on the other side. If you want to crisp further, put under broiler for two to three minutes.

Calories 112; carbs 16g; protein 1g; fat 5g; fibre 2g

Amazing QuicheMakes four to six servings.

• 4 large eggs• 1 ½ cups 1% milk• ¼ cup whole wheat flour• 3 tbsp cornmeal• 3 green onions, chopped• ½ red bell pepper, finely chopped• 1 cup low-fat cheddar cheese, grated• ½ tsp salt• ½ tsp pepper

Directions1. Preheat oven to 400 F. Spray a 9-inch

pie plate with vegetable oil. 2. In a blender or food processor, combine

eggs, milk, flour, and cornmeal. Blend for 30 seconds, until well blended.

3. In the prepared pie plate, gently toss green onions, red pepper, grated cheese, salt and pepper. Pour the milk and egg mixture over the cheese mixture.

4. Bake 30 minutes, or until a knife inserted in the centre comes out clean.

Calories 168; carbs 14g; protein 14g; fat 6g; fibre 2g

NutritioN tip: Adequate intake of both calcium and vitamin D can reduce the risk of developing osteoporosis. Both children and adults need 1,000 to 1,500 mg of calcium daily, depending on age. In terms of food, that means consuming at least three servings of milk products every day. One serving includes one cup of milk or enriched soy milk, ¾ cup of yogurt, or 1 ½ oz of cheese. Most people can’t get enough calcium and vitamin D in their diets, so we recommend a pharmaceutical grade calcium supplement containing magnesium and vitamin D. From the Low-Glycemic Meals in Minutes cookbook.

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Better information, better care: Aboriginal Self Identification

ABove: home health team leader kirsten tallio is one of more than 700 Interior

health employees to self-identify as Aboriginal so far under the Aboriginal Self

Identification initiative.

GrOWInG UP In tHE nUxALk nAtIOn On B�C�’S rEMOtE nOrtH COASt, kIrStEn tALLIO WAS ALWAYS tAUGHt tO HOnOUr HEr ELDErS�

“In our culture you give high regard to the elderly,” she says. “I was raised by my grandparents and was taught that from a very young age.”Now, in her work as an LPN with Home Health in Kamloops, the teachings of her grandparents are at the forefront as Kirsten provides care and support for frail elders in their homes.Kirsten is one of more than 700 employees who have self-identified as Aboriginal since June 2011 when Interior Health’s Aboriginal Self Identification initiative was launched for staff.

continued on page 12

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More info:visit Interior Health at www.interiorhealth.ca to learn more about the Aboriginal Self Identification initiative�

“I really enjoy community care. I feel I can provide care in a very personal way. I enjoy getting to know our clients well and spending that one-on-one time with them.”“I think it’s really important for our Aboriginal patients and clients to have Aboriginal people working here and providing care,” says Kirsten. “If you look at something like pain level, or other issues that are bothering them, sometimes people may not tell the truth. They may view it as complaining, which is not their custom. But if I start talking to them about what band they are from, their family relations and cultural practices, they feel more comfortable and open up more.” “The information helps us develop and implement Aboriginal human resource strategies that encourage Aboriginal people to pursue health-care careers,” says Brad Anderson, Director of Aboriginal Health in Interior Health. “We know the availability of Aboriginal health-care professionals is linked to improved health outcomes for Aboriginal people. There is a great opportunity to meet the human resource needs of our organization while also supporting the health-care needs of our communities.”

The Aboriginal Self Identification initiative supports various elements of Interior Health’s Aboriginal Health and Wellness Strategy, as well as its Aboriginal Human Resources Strategy. “From a staff perspective, I think it’s important to see other Aboriginal staff and to hear their stories. I find it inspiring. I’d love to eventually become an RN, and knowing others have been on that journey and accomplished their goals is inspiring,” says Kirsten. Another important part of the Aboriginal Self

Identification program is patient and client self-identifying. At registration, patients and clients are asked whether they self-identify as Aboriginal or Métis. Like the staff program,

participation is voluntary. If they answer “yes”, there are additional questions, including whether or not they would like to be put in touch with unique programs and services such as Interior Health’s Aboriginal Patient Navigators. “It’s important to us that we provide culturally sensitive care,” says Brad. “Ultimately, the information helps us develop, implement and assess services that support those receiving care.”

“from a staff perspective, I think it’s important to see other Aboriginal staff and to hear their stories. – kirsten tallio

continued from page 10

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“We need to talk about these things,” she says passionately. “We need to talk about mental health, affordable housing, and poverty. Our lives are not set in stone. I really want people to know that anyone could end up like I was.”

Jeanette was found by an Assertive Community Treatment (ACT) team

member living on the streets in Kamloops last summer, deep in crisis. She had been in and out of shelters for years, struggling to manage her mental health and make ends meet.

Interior Health’s ACT team helped Jeanette stabilize and connected her with important social and health-care supports.

JEAnEttE JUDSOn, 54, HAS A POWErFUL vOICE� EvEn WHEn SPEAkInG ABOUt HEr StrUGGLES WItH MEntAL ILLnESS, POvErtY AnD ABUSE, SHE IS UnABASHED�

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to help those at risk

teamwork aCts


ABove: kelowna Act team lead lisa wensink.


aCt client Jeanette credits members of the aCt team for being an

important part of her current well-being. “i

know they want me to be healthy,” she says.

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Kamloops Dental and Implant SolutionsWe unDerStanD that miSSing one tooth or all teeth can have a Significant impact on your lifeStyle. miSSing teeth can cauSe a variety of health concernS, incluDing iSSueS relateD to Speaking anD eating anD can affect your overall Well-being.

Dr. ho-young chung, DDS, founDer of kamloopS Dental anD implant SolutionS proviDeS innovative Dental anD implant SolutionS in a Safe, gentle, anD caring Setting. With a moDel of patient-centreD care, Dr. chung anD hiS DeDicateD implant anD Surgical team are committeD to helping their patientS regain their Self-confiDence anD quality of life.

Q What innovative dental and implant solutions do you provide?

A Whether it’s having wisdom teeth removed or dental implants placed, many of our patients have some level of dental anxiety. We understand that even the thought of having dental work done can be a challenge for many; this is why we offer several levels of sedation for our patients.

our goal is to provide same-day implant solutions to help minimize the number of procedures and visits. if you have a broken front tooth that cannot be saved, we can remove that tooth, place an implant, and attach a new tooth all in one appointment. this is an alternative to waiting many months for grafting to heal and wearing a partial denture that you have to take in and out.

if you have a loose, floppy denture and want to be able to eat better, we can place implants and have your denture “clip on” all in one appointment. patients who pursue this option at other clinics potentially wait 6-12 months before they have their denture securely fitted into their implants. We want our patients to heal as quickly as possible, and at the same time, provide affordable and predictable dental implant solutions.

Q What makes your dental implant centre unique?

A We want our patients to eat better, smile more, and feel younger. it’s the story of our patients who come to us that truly makes an impact. Whether it’s a 93-year-old widower who wants to eat better, the husband who wants his wife to have her smile back, or the young woman who is about to get married and has a broken front tooth — they all have a story to tell. We are here to listen to our patients and want them to feel at home.

Q What makes you different from other dentists?

A We are a referral-based centre with patients coming from kelowna, vernon, penticton, chilcotin valley, and of course, kamloops and its surrounding areas. We want to provide exceptional care by focusing our practice on implant dentistry.

Q How do you share your passion for implant dentistry with other dentists?

A i am a faculty instructor at the bites institute for implant training in burnaby, bc, a dental implant educational centre dedicated to teaching other dentists incorporate implant dentistry into their everyday practice. as part of bites institute, i have the pleasure of lecturing across canada to fellow dentists. i also am a mentor for a monthly dental study group at our clinic in which other local dentists meet and share ideas.

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Now she has a safe place to lay her head and access to a health-care team. Most of all, she has the ACT team – members of which she considers friends.

“I was isolated. For years, I had no family, I had no friends. I was outside. It was cold and it was terrifying,” she says. “I am so thankful for the ACT team. I know they want me to be healthy and we are working together to the same goal. If it weren’t for them I honestly don’t know where I would be.”

Jeanette is one of approximately 30 ACT clients in Kamloops, while a similar team in Kelowna also has about 30 clients registered. After launching in mid-April 2015, the teams are actively reaching out to those in Kamloops and Kelowna with severe and persistent mental illness. They will eventually serve 80 clients in each community.

ACT teams are actively involved in outreach and are on hand to stabilize crises whenever they occur. The team has on-call coverage 24/7.

“These are individuals who frequently have substance use issues. They are homeless or at risk of homelessness, and

Kelowna committee brings partners together to help vulnerable clientsIn kelowna, a new Community Advisory Committee has been established to advise around social issues that impact ACt clients� this year, housing has been the Committee’s focus� the group now includes close to 20 members including: rCMP; Canadian Mental Health Association; John Howard Society; kelowna General Hospital; Ministry of Justice; Outreach Urban Health/rutland Aurora Health Centre; Gospel Mission; Métis Commission; ki-Low-na Friendship Society; Alexandra Gardner; City of kelowna; a person with lived experience; a family member; Ministry of Social Development; BC Housing; and the ACt team�

the Committee serves as an advisory body to the clinical and support staff and management of the ACt teams and provides valuable input into the planning and delivery of ACt team services in the kelowna area�

An individual with personal experience sits on the advisory committee along with a family member to ensure the client voice is present at the table during discussions� this unique committee meets quarterly and provides community input�


they are high users of hospital and police services. Their care needs are complex and they have not benefitted from our traditional mental health and substance use programs,” explains Lisa Wensink, ACT team leader in Kelowna. “Many are referred to the team from Interior Health’s Mental Health programs but we also hear from our partners, such as local police.”

It is these partnerships and the multidisciplinary team behind ACT that makes the program so unique.

The ACT team consists of: a team leader; occupational therapist; four nurses; a social worker; two community mental health workers; vocational rehab specialist; substance use specialist; peer support worker; administrative support; and a psychiatrist.

“The team approach is powerful and that extends to our partners,” says Lisa. “A big part of our work is liaising with them to provide a really comprehensive service. We frequently are in contact with police, the Canadian Mental Health Association, and probation services, because many of our clients have had legal issues. We also work with the hospital to ensure the transition from hospital to home is seamless. We work with the Ministry of Social Development around financial support, and also with agencies such as food banks and shelters.”

“The Kelowna RCMP work very closely with street entrenched individuals who reside in the city’s downtown core, and who are often prime candidates for the ACT team,” says Corporal Carrie Seale, a regular member of the RCMP for 18 years and currently working in the detachment’s Downtown Enforcement Unit (DEU). “Having worked in this area of policing for over half my service, I have personally noted that more and more of our clients who end up homeless on the streets, often also suffer from persistent mental health concerns, as well as various substance abuse and addiction issues.”

“The ACT team liaises directly with the RCMP on a regular basis for referrals and will then follow-up with these

Kamloops team helps house homelessSince May 2015, ASk Wellness rapid rehousing team and the ACt team have worked together to provide safe and affordable housing and community supports to mutual clients in kamloops� this working partnership is already proving to be beneficial to landlords and tenants�

Called the rapid rehousing team, they secure housing throughout the community in ASk’s name with the intention that clients will take over tenancy when deemed ready� ASk provides necessary support to the tenant/ landlord relationship, which is imperative to securing and maintaining housing�

the ACt team provides the necessary clinical services, which reassures participating landlords that each tenant is adequately supported and available to them as needed�

“ACt team members are always easy to get a hold of for assistance and consultation� their service is 24 hours each day, whether it be in person or by telephone, which reassures landlords that they have a support team to turn to if they need guidance,” says ASk Wellness Social Worker kim Galloway� “One landlord in the program reported a 15 minute response time from the time she called for assistance� An ACt member along with a rapid rehousing member addressed her concern immediately and tenancy was maintained�”

“As part of the rapid rehousing team, I have seen the success of this program grow very quickly� the roles of ASk and ACt are distinct; however, we work together to ensure the success of the program� Landlord response is very positive and there is a recognised appreciation for the level of commitment to both housing support and clinical services� We are excited for continued work with the ACt team and further expansion and development of our program�”

SPH ProvideS HealtH care workforce SolutionS from our domeStic and international databaSe.We are a placement agency with access to nurses, pharmacists, physical therapists and more in the field of health care.

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target clients countless times a day. ACT has often been the light at the end of the tunnel for officers who deal with the repetitive calls for service directly related to these troubled individuals,” explains Cpl. Seale. “As a result, the Kelowna RCMP has noted a decrease in calls for service with these specific clients. When circumstances arise that require police to intervene, ACT is usually just a quick call away,” adds Cpl. Seale. “When called upon, the ACT team provides a varied and comprehensive response, which ranges from attending the detachment’s cell block, to providing assistance in navigating a burdensome system, to taking over the care of clients at the hospital. ACT has been a valued partner of the RCMP, as the variety of services provided by this team is a recipe for success.”

Peer support is another key aspect of the ACT approach. The team includes a person with lived experience - someone who has been in the clients’ shoes and is able to advocate and ensure their voices are heard during planning and discussions.

Peer support puts the person first. It is not a replacement for clinical services, rather, a powerful complement to it.

“We are the experts on ourselves and we can learn to self-advocate and use our voices. I would not be here without my vast peer support network. Peer supporters sit shoulder-to-

shoulder, holding each person in unconditional high regard, by role modeling wellness and empowerment, and reminding us that recovery is possible. We are the evidence,” states Davina Kula, peer support specialist with the Kelowna ACT team. “I am so grateful and blessed to bear witness to my peers living outside the illness during group outings, while we explore activities and practices for our wellness toolbox. A lot of healing, hope and validation take place when peers come together. Peer support in action!”

“The peer support role is absolutely vital,” agrees Lisa. “They are often the voice of hope for the client. They are there to show that people can be well and healthy and that recovery is possible. They do a lot of engaging with people to make them feel less alone. They are often seen by the client as a safe person to be with, since clients may not have a positive view of health care.”

Clients with the ACT program may be seen three times a week, or twice a day. They may be part of the program for two years, or indefinitely. The supports are driven by the client’s needs, and it is a long-term commitment.

Although relatively new and still growing its client base, the program is working.

“This is a really well–researched approach with a lot of supporting data in terms of decreasing homeless, decreasing hospital visits, decreasing legal issues,” says Lisa. “We have clients who have had a lot of challenges. They are able to start school, do some work, get housing – and start to trust our health system. They are able to live an optimum life in the community.”

To learn more about the Assertive Community Treatment approach and how these teams are making a difference for some of the most vulnerable clients in Kamloops and Kelowna, visit www.act-bc.com.

A lot of healing, hope and validation take place when peers come together.

– Davina kula, ACt team

left: kelowna Act team lead lisa wensink (centre back) cites teamwork, partnerships and peer support as keys to the program’s success.

www.rihfounda on.ca

For over thirty years, the Royal Inland Hospital Founda on has existed to build long-las ng rela onships and inspire donors to support life-saving medical care at the one and only hospital in our community. With limited hospital funding and resources, the RIH Founda on relies on the gener-osity of our supporters to fund cri cal health care ini a ves that contrib-ute to compassionate, high-quality care and the well-being of pa ents and their families.

When you leave a legacy gi to the Royal Inland Hospital, you are having a direct impact on healthcare excellence at RIH for years to come. Legacy giving is a wonderful way to support the things you care about most, today and far into the future. Legacy gi s provide life-saving care, state-of-the-art equipment and medical educa on opportuni es that ensure the medical team at our hospital has the tools they need to care for our community.

A legacy gi can take many forms including a bequest in your Will, a gi of life insurance or beneciary designa-on of your RRSP/RRIF. Everyone who makes a legacy gi to RIH Founda on is welcomed into our Legacy Circle

Society. It’s our way of recognizing your generosity and commitment to RIH. Call the RIH Founda on at 250.314.2836 for more informa on on how to create your own legacy at Royal Inland Hospital.

“It is impossible for the government to meet all of our needs. Therefore, those who are capable of contrib-u�ng, no ma�er the amount, should consider suppor�ng RIH. Our hospital is a great community resource and we need to support the talented doctors, nurses and other staff so they are able to properly care for each one of us.”

Robbie Dunn, RIH Founda on Legacy Circle Member


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surgical initiative: Putting patients at the

centre of their care

ABove: kelowna anesthesiologist Dr. ron collins is an advocate for

enhanced recovery, an approach that puts more control in patients’ hands

and results in fewer complications post-surgery.

creDIt: photo courtesy of the royal college of physicians and

Surgeons of canada.

Most of us regard surgery as something that is done to patients by physicians and nurses. But that thinking is going by the wayside at Interior Health hospitals, thanks to a quality initiative called Enhanced Recovery after Surgery (ERAS).

“Enhanced Recovery is about doing WITH patients, and not TO patients,” says Garth Vatkin, Interior Health’s Quality Improvement Consultant for surgical initiatives. “When patients are partners in their care, it results in better outcomes.”

Enhanced Recovery is designed to help patients recover from major surgery more safely and easily than ever before. It’s a multidisciplinary approach – every health-care professional who touches the patient is included and involved along the way, from initial consultation in the surgeon’s office, to pre-surgical screening, to the anesthesiologist and operating room staff, to the post-operative recovery team which includes nurses, pharmacists, physiotherapists, occupational therapists, and dietitians.


“This team approach has a huge benefit – everyone works in conjunction, with the goal of best patient care in mind,” Garth says. “Patients themselves take a larger role and responsibility in their care. They are given more information than ever before about what to expect with their surgery, before, during and after. They are really willing partners in their treatment and recovery.”

Enhanced Recovery was introduced within Interior Health in 2011, through a pilot project at Kelowna General Hospital led by Dr. Ron Collins, which focused on colorectal surgery. Colorectal was chosen because research is strong in this area and indicated that patient outcomes can be improved by implementing an Enhanced Recovery program.

It was a groundbreaking initiative because the actions associated with Enhanced Recovery challenged traditional practices, such as: carbohydrate loading before surgery, as opposed to starving patients; chewing gum in post-op, and feeding people earlier, to stimulate bowels; speeding up mobility by encouraging patients to walk from the stretcher to his or her bed; and removing the catheter earlier.

Dr. Collins and his team began seeing positive outcomes from the work. Length of stay for patients started to decrease and patients expressed higher level of satisfaction by being more involved and accountable in their care.

“I think the real success of ERAS is that it demonstrates how a multidisciplinary team of committed front-line providers can positively impact the health-care system,” Dr. Collins says. “This initiative very deliberately mobilized patients to participate more actively in their own recovery, and they prove to be willing and capable partners. We also now clearly understand that many, if not most, complications can be avoided by changing the way we provide care.”

Others in Interior Health took notice

of KGH’s results. By October 2013, through the sponsorship of Doctors of BC’s Special Services Committee, ERAS had spread to six other hospitals: Royal Inland Hospital in Kamloops; Penticton Regional Hospital; Vernon Jubilee Hospital; Kootenay Boundary Regional Hospital in Trail; East Kootenay Regional Hospital in Cranbrook; and Cariboo Memorial Hospital in Williams Lake. Each site has introduced ERAS in varying ways, depending on what best suited their individual hospital and patient needs.

Royal Inland in particular was an enthusiastic participant and has shown great gains. For example surgical site infections have dropped by nearly 65 per cent, and the average length of patient stay has dropped to 5.2 days, from 7.6 days before ERAS.

One reason Royal Inland has been able to excel is that it has coupled its Enhanced Recovery program with its National Surgical Quality Improvement Program (NSQIP). NSQIP is a data-driven, outcomes-based surgical quality improvement program that enables hospitals to identify opportunities for improvement for patient care and outcomes. The program follows the entire surgical patient’s journey from pre-operative, through intra-operative, to 30 days after their surgery.

Donna Lineker, Royal Inland’s manager of post-anesthetic recovery, day care surgery and pre-surgical screening, says the key to the Kamloops hospital’s success has been the teamwork of the care providers, championed by surgeon Dr. Tom Wallace.

“It’s a group effort. The entire team is doing what’s best for the patient, based on good, scientific research and best practice,” Donna says. “It makes it easy. Everyone knows the expectations and can see the results. Patients are going home in two-and-a-half, three days, and they aren’t coming back. This is excellent quality patient care that is patient-centred.”

Interior Health’s success with Enhanced Recovery has made it a provincial leader in the initiative. In November 2014, Royal Inland and Kelowna General joined the Provincial ERAS Collaborative, which is co-chaired by Garth and Dr. Collins, along with Dr. Ahmer Karimuddin, general surgeon at St. Paul’s Hospital in Vancouver. The Collaborative’s goal is that every patient undergoing surgery in B.C. will be part of an ERAS pathway as part of his or her surgical experience.

“People know this is the best way to practice,” Garth says. “We know that complications are avoidable, and improved ‘processes of care’ equate to improved results. We are all accountable for our patients’ outcomes – and the multidisciplinary approach of Enhanced Recovery has shown to result in positive outcomes.”

More info:Please visit www.enhancedrecoverybc.ca

The proof is in the patient feedback. Consider these follow-up comments from patients:

“Excellent personalized care. Had great follow up by surgeon, surgical resident, anesthetist, recovery room nurse and nurse in charge.”

“Excellent nursing care. They really helped me mobilize which sped my recovery.”

“(Enhanced Recovery) was pivotal in my recovery and it should be used in all surgeries it is applicable to. It provided me and my family with all the information we needed to be comfortable and ‘in the know’ with my recovery and all the steps along the way. This was a ‘top notch’ experience and I fully credit (Enhanced Recovery) with my great outcome and surgical experience.”

Below: Standing outside the door to the er at royal Inland hospital, Allied

health Social worker wendy Sims works to provide a quick response to

frail elderly who find themselves in the er but could go home with supports.

Staff in Kamloops took an active role in a project to help ease the pressure on hospitals this winter by focusing on frail seniors who could get well at home with proper supports.

Karen Cooper, director of Allied Health, IH West, oversees the six disciplines that provide services – primarily to older adults – designed to either prevent an admission to hospital or hasten their recovery so they can go home more quickly.

Physical and occupational therapists from Community Allied Health and a registered dietitian, respiratory therapist, and speech language pathologist from Royal Inland Hospital were on the Winter Surge team for 2016.

As well, Social Worker Wendy Sims, also based at Royal Inland, was the first point of contact by emergency department or Home Health staff to recommend services for a senior who doesn’t need to be in an acute care setting.

“Wrapping the right service around the patient results in higher success rates,” Karen explains.

As an example, she highlights the speech-language pathologist who might discover a patient with recurring pneumonia has a swallowing issue that is causing aspiration of food particles into the lungs.

“We are excited to be able to show the value of bringing in the Allied Health disciplines through a project like this.”

“Winter Surge provides an opportunity to demonstrate what Allied Health professionals can do at any time of the year to help patients reduce their stay in hospital or avert an admission altogether.”

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B U T W E S H O U L D S T I L L D O L E S S O F I T .

The most over-used dramatization currently used in workplace wellness is “sitting is the new smoking”. I disagree. I am sitting right now to write this article and I hardly believe it is having the harmful aff ects that smoking a cigarette would have on my body. I do not require sitting-cessation therapy. Sitting is necessary. We just need to do less of it.

Have you ever summed up all of your hours of sitting and laying down in the day (24 hours)? Does the time spent in inactivity outweigh your physical activity? Large volumes of physical inactivity in the day may put you at risk for a chronic disease. In 2013 The University of Texas School of Pubic Health recorded the training time and inactivity time for 218 distance runners (marathon and half marathon distance). The median training time was 6.5 hours/week. Median total sitting time was 8 – 10.75 hours per day. This study suggests that recreational distance runners can be highly sedentary and highly active at the same time! Just because you go to the gym, go running or walk daily, you are not safe from the risks of excessive sitting.

Movement is medicine. A medication that we should take as often as possible. There are many reasons that we may sit for extended periods. To change the sitting situation sometimes

takes creativity. For example, if you work a job that requires you to sit day in and day out all day without the opportunity for breaks, you may not be able to request walk breaks from your employer but you may however be able to slightly modify your workstation to allow you to sit and stand in rapid succession (also known as a squat) you can do this movement at intervals throughout the day to break up the time spent sitting. Research has shown us that movement at work can result in increased productivity and job satisfaction and decreased absenteeism due to the health improvements movement can have on the body.

As is always the case, speak to your Physician or Nurse Practitioner if you are not currently active and will be increasing your physical activity dramatically.

Sitting is a necessary part of living. We need to sit for at least a small amount of time every day. We do not and have not ever needed smoking. Therefore, sitting is not now nor has it ever been smoking. Movement is however medicine. Take your medicine and ENJOY!

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But for Cranbrook resident Paula Smith, a new telehealth service for post-kidney transplant patients has eliminated all of these.

Paula’s kidney function first started to decline more than 10 years ago. Then, in 2010, while Paula’s kidney was functioning at only 15 per cent, the worst happened – her husband passed away.

“Just five weeks after my husband died, I had a peritoneal dialysis catheter implanted in my abdomen and was getting prepped for dialysis,” recalls Paula.

For three and a half years, Paula was on dialysis waiting for a kidney transplant and in

January 2014 her brother, a perfect match, volunteered one of his.

“Everything just fell into place and then moved really quickly. I had my transplant in February 2014,” says Paula. “There were no complications for either of us – I have never felt this happy, healthy, and alive in my entire life.”

For surgery, Interior Health transplant patients

travel to Vancouver, but routine follow-up appointments occur in clinics across Interior Health. Still, the closest post-transplant clinic to Paula is more than 200 kilometres away in Trail, meaning a drive of three hours each way.

paving the way: Telehealth clinics for

post-transplant follow-up

trAnSPLAnt PAtIEntS LIvInG In rUrAL COMMUnItIES CAn BE FACED WItH A nUMBEr OF CHALLEnGES WHEn

trAvELLInG LOnG DIStAnCES tO AttEnD An APPOIntMEnt�

ABove: paula with her brother, who donated a kidney to her in 2014. the

transplant was a great success.


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Kim McDuff, transplant redesign project coordinator, along with her colleagues at the Kootenay Boundary Regional Hospital Kidney Transplant Clinic in Trail, recognized the need to find other options for patients who have to drive long distances for follow-up appointments. They decided to develop a pilot project where post-transplant patients were given the option to attend their clinic appointment in Cranbrook and connect to Trail via telehealth.

“Telehealth offers a way to provide adequate and continuous care for our post-transplant patients not living in Trail,” says Kim.

In collaboration with BC Transplant, telehealth appointments were offered for the first time for post-transplant patients. The pilot ran from November 2014 to May 2015 with 12 patients using the service.

Georgi Winger is the renal nurse at Cranbrook Wellness Centre who facilitates the appointment between the patient and the Trail Kidney Transplant Clinic.

“Although we’ve only been doing telehealth with post-transplant patients for a short time, the feedback has been nothing but positive,” says Georgi. “They are so grateful to be able to meet with the transplant team and receive the care they need without having to take the time to travel to Trail. Prior to telehealth, Paula would have to take a day off work for her appointments in Trail, plus spend money on gas and meals. I believe telehealth has reduced the emotional and financial stress of many of our patients which, I’m sure, has a positive impact on their health and well-being.”

During the follow-up appointment, Georgi records Paula’s blood pressure, weight, and pulse; checks for edema (excess of fluid); and relays the information via telehealth videoconferencing to the team in Trail. On the receiving end is Teresa Buckley, transplant clinic nurse, and a transplant nephrologist, social worker, and dietitian.

“It’s expensive for people to take an unpaid day off work and stressful to drive the mountain pass to Trail,” says Teresa. “With telehealth, this health-care service is more accessible and increases the continuity of care.”

Through telehealth, Paula is able to connect with each of the care providers involved in her post-recovery care plan without having to drive to Trail each time.

“To me, there is no difference in the service provided,” says Paula. “I’m just glad I don’t have to make the drive… It’s such a benefit for patients who would otherwise have to travel.”

Telehealth for transplant patients is expected to expand to other areas of Interior Health.

“Right now we are looking at other rural sites in Interior Health with renal nurses who can facilitate these appointments,” says Teresa. “We have also just begun to facilitate appointments for pre-transplant patients, before they go to Vancouver for surgery.”

The first pre-transplant appointment took place in early January and more are expected throughout 2016.

Did you know…One organ donor can save eight lives� visit www.transplant.bc.ca to learn more�

ABove: paula Smith (r), standing with renal nurse georgi winger and the telehealth unit in cranbrook, no

longer has to drive to trail for her appointments.

Below: transplant clinic nurse teresa Buckley is part of the transplant team

at the other end of the telehealth video ready to review paula’s post-

recovery progress.

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Since we have a toddler, I make sure we are organized with food. Kids need good nutrition to keep their behaviour in check (i.e. allow us

parents to have a good time). Plus little ones require a lot of attention, which means less time to spend cooking and washing dishes. For this reason I plan for simple meals and make and freeze food before we go. I start by planning each

breakfast, lunch and dinner. I also plan to use certain foods in multiple meals and snacks, such as cheese, yogurt, and bread, to save space in the cooler. Of course we also pack less healthy snacks for around the fire, whether it’s making S’mores or passing around a bag of chips. Having a family favourite camping treat is a fun part of creating traditions. But, like at home, it is important that most of our food be nutritious.

healthy eats for family camping trips

By Interior Health registered Dietitian Simone Jennings

WItH SPrInG WEAtHEr UPOn US, tHE ItCH tO GEt OUtDOOrS EnJOYInG nAtUrE BECOMES DIFFICULt tO IGnOrE� HErE ArE SOME MEAL tIPS FrOM OnE FAMILY WHO LOvES tO CAMP�


MEND is a fun, free program for families with 7-13 year olds interested in becoming more active and healthy through interactive group sessions.

The program facilitates safe, effective and lasting lifestyle changes by improving children’s physical activity levels, nutrition and self-esteem.

To learn more and register, call or email your community. Cranbrook: 250-489-0220 | [email protected]

Kamloops: 250-571-4136 | [email protected]: 250-491-9622 ext. 234 | [email protected]

Penticton: 250-490-2426 | [email protected]

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Things to prepare before you go• Make and freeze whole grain muffins, pancakes,

or loaves • Pre-measure bags of rolled oats with nuts, seeds and

dried fruit to cook on the camp stove• Hard boil eggs for protein at breakfast or lunch• Cook rice, quinoa or pasta the night before you

leave and have it in the first couple of days• Make and freeze chili and/or pasta sauce. It will act

as ice in the cooler and keep for a couple of days• Freeze lean meats or fish with marinade in Ziploc

bags so they are ready for the BBQ • Make and freeze hamburger patties. Use ground

chicken, turkey or lean grass-fed beef

Breakfast • Eggs and toast • Greek yogurt with fruit and granola• Cold cereal (choose something low in sugar) with

milk or yogurt• Peanut butter and jam sandwich with sliced apples

and oranges• Oatmeal (as described above) or packages of plain

instant oats (just add hot water)

Lunch• Whole grain pitas with hummus and cut up veggies• Sandwiches: egg or tuna salad, or veggies and cheese

on whole grain bread• Use leftover chili with grated cheese in wraps to

make burritos• Hot dog alternative: chicken or turkey sausage on a

whole grain bun (choose sausages that are lower in sodium and free of preservatives)

Dinner• Chili and buns• Pasta sauce with whole grain noodles• Lean meat of your choice with a variety

of vegetables • Grilled veggies: toss a variety of chopped veggies in

olive oil with fresh herbs and wrap in tin foil and grill. Try carrots, potatoes, yams, beets and/or onions

• Lean hamburger patties on a whole grain bun

Snacks• Trail mix: nuts, seeds, dried fruit, chocolate chips• Whole grain crackers and cheese• Apple slices and peanut butter• Muffin, yogurt and fruit• Campfire cones: sugar cones, chocolate chips, mini

marshmallows, chopped strawberries and banana. Wrap in tin foil and grill over the fire

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Documents

Healthier You Interior Health Spring 2016