September 2022

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Medical Staff Newsletter

Read the latest VCH news for Medical Staff (Physicians, Nurse Practitioners, Midwives & Dentists).​

The goal of the newsletters are to communicate timely & relevant updates; to create awareness around existing and upcoming groups, committees and events; and to invite and inspire individuals to get involved by showcasing existing medical s​taff and innovative projects.​

 Message from Leadership

 In the Spotlight

​Nurse practitioners provide life-altering treatment during opioid crisis

Sherry Katz (Left) and Jennifer Crockett (Right)

Health care workers across B.C. have worked tirelessly as toxic street drugs continue to ravage communities and nurse practitioners (NPs) are among those making a crucial impact.

One of said NPs, Sherry Katz, has seen the effects of the opioid crisis firsthand, as she prescribes opioid agonist treatment (OAT) to vulnerable populations dealing with addiction. 

Sherry, who works at Anne Vogel Clinic in Richmond, says she jumped at the opportunity to prescribe OAT when it first became available for NPs in B.C. in 2018.​

“This work is truly my passion," says Sherry. “So as soon as NPs were granted prescription authorization, I did the training right away and began prescribing OAT." 

She has spent her entire career working with vulnerable populations, both as a nurse and a NP, and says OAT often leads to a positive shift in behaviour, and most importantly, saves lives. 

“These treatments can be life altering, and not only in terms of overdose prevention and harm reduction, but once people stabilize, they become more engaged in their health care overall," says Sherry. 

The COVID-19 pandemic compounded the already grim situation for many struggling with addiction; however as Sherry points out, there were also some unintended benefits.

​“Expanded telehealth options and mobile pharmacies have had a huge positive impact on care delivery, especially for clients who live in more rural areas and aren't able to travel, or visit in person," says Sherry. 

She feels fortunate to be among the most experienced NPs providing OAT at VCH, as she is able to assist and mentor those who are newer to it – like Jennifer Crockett.

Jennifer works at HealthConnection Clinic in North Vancouver, and is part of a team providing care for residents with complex mental health and addictions and/or socioeconomic needs. She began prescribing OAT around eight months ago, and says it has been a whirlwind experience to say the least.

“It's been a steep learning curve, that's for sure," says Jennifer. “It's very fast moving and we're constantly pivoting in reaction to the street supply of opioids, which is quickly becoming increasingly more toxic."

​She also says it has been a hugely positive and fulfilling experience, and she relishes the opportunity to help people manage their addiction issues, and improve their overall health in doing so. 

“People who are street entrenched and suffer from addiction can sometimes feel cast aside by the health care system," says Jennifer. “So when we see people feeling more connected after receiving OAT, and begin taking a more holistic approach to their health care as a result – that's really rewarding."

​​Jennifer feels blessed that her clinic is able to serve as a sanctuary of sorts for those seeking support with complex substance use and other issues. “It's so critical that people dealing with addiction have access to a safe space like this, where they can walk in without feeling judged and get the care they need." 

Both Sherry and Jennifer are viewed as shining stars by their VCH colleagues for the outstanding care they provide – along with all the other NP's prescribing OAT to vulnerable populations throughout this crisis. ​

 News

Making communities SAFER in the fight against toxic street drugs

Dr. Mark Lysyshyn 

The continued rise in overdose deaths from toxic drugs in B.C. has prompted the development of innovative programs in an attempt to save lives. 

The Safer Alternative for Emergency Response (SAFER) program – a collaboration between Vancouver Coastal Health (VCH), PHS Community Services Society (PHS) and the BC Centre on Substance Use (BCCSU) – provides a flexible and low-barrier supply of pharmaceutical-grade opioids to those in greatest need. 

“This innovative and evidence generating program integrates harm reduction, addiction medicine, public health and social services to help those at greatest risk of dying from an overdose," says Dr. Lysyshyn.

​He goes on to say that, based on initial informal assessments, the program has the potential to increase the options for helping people who use illicit substances. “SAFER can be an effective alternative to conventional forms of treatment and harm reduction which may not have worked for people in the past." 

VCH and others have been advocating for safer supply initiatives to provide alternatives to the contaminated illegal drug supply, as B.C. experiences record numbers of overdose deaths. The COVID-19 pandemic further exacerbated the already rampant overdose crisis, as people found themselves using increasingly toxic drugs in isolation.

As of June 2022, there were 60 participants enrolled in the SAFER program, which is located at 73 East Hastings Street in Vancouver. The program is targeted to people in Vancouver who are at risk of overdose from accessing toxic street drugs, but do not qualify for, or have not benefited from, other available treatments. 

Dr. Lysyshyn points out that people who use substances often face stigma, including when they interact with the health care system, and suggests a patient and considerate approach be taken when dealing with them.

“It is critical that health care professionals provide kind and compassionate care to people suffering from addictions, and connect them with the services that are right for them," says Dr. Lysyshyn.

The SAFER program will be rigorously evaluated by the BCCSU to assess the impacts of this model, generating evidence that will inform program delivery and the development of clinical guidance to support other prescribed safer supply programs in B.C.


 

Improving delivery of care for patients with substance use disorders

 

Dr. Ashley Smith

The grip of substance use on our society is only strengthening, with one in five Canadians now meeting criteria for the diagnosis of a substance use disorder (SUD) at some point during their lifetime. More people are developing downstream health consequences as a result, leading to increased emergency department (ED) visits. 

This grim conundrum piqued the curiosity of Dr. Ashley Smith, a consultant physician at Vancouver General Hospital (VGH), who spearheaded a Physician Quality Improvement (PQI) project aimed at increasing access to addiction medicine specialist care, and in turn, improving care delivery in the ED.

Dr. Smith, who works in the Complex Pain and Addiction Service (CPAS) at VGH, says she relishes the opportunity to help people with SUDs. 

​​“I find it rewarding to work with individuals dealing with substance use issues, as it combines many aspects of medicine – pharmacology and toxicology, population health and psychiatry, to name a few," says Dr. Smith.

She says the involvement of an in-patient addiction medicine team, like the CPAS, has been shown to not only decrease 30-day readmission rates, but also to increase patient engagement with outpatient care.

Perhaps more importantly, however, she says that the CPAS appears to be greatly underutilized, as depicted by the numbers.

“As many as one out of 11 visits to the ED are directly related to SUDs, yet only about half of the patients who might benefit from an addiction medicine consult cite primary substance use disorder as their chief concern," says Dr. Smith.

A key factor in Dr. Smith's strategy involved a large time investment upfront to understand the culture and process in the ED, and to build effective relationships.

“I found the interdepartmental nature of this work very exciting," says Dr. Smith. “Building and strengthening these relationships helped to increase the referral number, by increasing awareness around the goal to improve the CPAS presence in the ED."

She says although the project work was a valuable and enjoyable experience overall, it was not without its challenges.

“Communication was the most difficult aspect of this project," says Dr. Smith. “The ED is comprised of a large multidisciplinary group of health care professionals, patients and services, all intersecting at once, so learning how to communicate salient information effectively was crucial."

Dr. Smith says she was fortunate to have two doctors with emergency medicine and addiction medicine training, Drs. Jessica Hann and Anne Sutherland, to help inform the flow through the ED.

“I relied heavily on discussions and meetings with colleagues and other stakeholders to better understand the process and culture in the ED, and Drs. Hann and Sutherland were both instrumental in this regard," says Dr. Smith.

She looks forward to Dr. Sutherland's PQI project in the ED this fall, and encourages others who might be interested in quality improvement (QI) to enroll in an upcoming training session, and see what inspires them.

“I thoroughly enjoyed the process and will definitely make QI part of my practice moving forward," says Dr. Smith. “I am excited to be building a culture of QI on the CPAS team, and I look forward to further improving delivery of care in the ED."

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Take-home fentanyl test strips prove useful as low-barrier drug checking approach

A B.C.-led research study compared fentanyl detection rates using take home test strips with those tested by trained staff at harm reduction sites. Research was conducted by VCH, BC Centre on Substance Use, BC Centre for Disease Control, Interior Health and the First Nations Health Authority and was published this year in the International Journal of Drug Policy. Read more about the study.


 

Innovative washroom system aims to keep clients safe

A first-of-its-kind in the region, a site implemented new procedure to help ensure clients remain safe in a washroom. New sensor alert technology that tells staff when someone may be in distress or need help. Read more on oneVCH.


 

Preparation for changes to Medical Assistance in Dying eligibility in 2023

In March 2023, patients with a sole underlying diagnosis of a mental illness will be able to apply for, and where eligible, receive Medical Assistance in Dying (MAiD). This is one of the key changes from the passing of Bill C-7 by the Canadian Federal Government in March 2021. The Bill aims to balance the autonomy of individuals who are eligible to receive MAiD with the protection of vulnerable individuals who are seeking information to address their intolerable suffering.

VCH's Assisted Dying Program (ADP) and Regional Mental Health and Substance Use (RMHSU) Program are collaborating to ensure that VCH staff and medical staff receive accurate and consistent information about the coming changes related to individuals with a sole diagnosis of mental illness.

This includes creating an education plan, leadership engagement strategy and resources for staff and health service users and their families. This is with consultation and strategic direction provided by medical and operational leadership from RMHSU and ADP, representation from Indigenous Health, VCH Ethics, Legal, Client Relations and Risk Management, as well as a member with lived/living experience with mental health issues and psychiatric care within our system. In addition to these regional efforts, VCH MHSU operational and medical leadership are part of the provincial MHSU/MAiD subcommittee that brings together leadership from each health authority and several ministries.

VCH recognizes that there are questions and concerns about this legislation and its potential implications. Medical staff are encouraged to participate in dialogue with committee members or regional leaders, in upcoming MAiD roundtable discussions planned for fall 2022, or with one-on-one conversations and support any time by contacting: Laurel Plewes, Director, ADP, at laurel.plewes@vch.ca or Andrew MacFarlane, Regional Director, RMHSU, at andrew.macfarlane@vch.ca.

​VCH is committed to supporting medical staff through this process and to providing safe, appropriate, timely access to clients who choose the care option of MAiD. 


Update: Mental Health Act

B.C.'s Mental Health Act (MHA) mandates the involuntary admission and treatment of individuals with serious mental health concerns to protect themselves and/or others. As involuntary admissions involve an extraordinary use of power, procedural safeguards are established and maintained through the timely completion of MHA Forms.

While the recent Ombudsperson's investigative report identified progress in MHA compliance since the release of the Committed to Change report in 2019, there remain ongoing challenges with Form completion and quality. To support MHA education, all medical staff who admit and/or treat under the MHA are required to complete the BC Mental Health Act course within one month of hire, and every two years thereafter. For questions about the training, please contact Maja Kolar at mkolar@providencehealth.bc.ca.

 Resources: mental health and substance use

For medical staff to live well and healthy

VCH Physician Peer Support Program

VCH offers informal peer support to physicians experiencing a difficult time. Physicians can connect with a physician peer for support and guidance that is empathetic, safe, confidential, one-to-one, short-term, and at no cost. Learn more.

 

Physician Health Program (PHP)

The PHP is a responsive, high quality care provider and community services navigator for physicians, trainees and their families. They offer 24-hour intake and a crisis support line operated in partnership with Lifeworks. It is not an emergency care provider but can facilitate access to emergency care, if required. Learn more.

 

Lifeworks Digital Platform

Provided by VCH, the platform gives access to personalized wellness resources. The digital wellness resources are available 24/7 from anywhere on mobile or web at no cost to medical staff. The platform offers expert-led online audio, video and article content, as well as assessments, toolkits and programs on topics such as family, health, life, money and work. Look for an email with an invitation and unique code for details, or contact MedicalStaffHealth@vch.ca.​

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For medical staff in the provision of patient care

VCH Mental Health and Substance Use Education Portal

​​​​The online portaloffers medical staff access to a wide range MHSU education, evidence-based resources and VCH policies and practice guidelines for healthcare practice settings.


Tertiary Mental Health and Substance Use Services

​VCH offers specialized, inpatient mental health services for individuals who are experiencing acute and complex mental illness. The goal of tertiary care is to help people achieve a level of wellness that will allow them to continue their recovery in a community setting. Learn more


​BC ECHO for Post-COVID-19 Recovery

​​This free virtual learning community, which ran from July 2021 to July 2022, presented specialists and community health care providers with support and resources to care for patients experiencing symptoms after COVID-19 infection. Learn more.


​​​​​Families in Recovery (FIR) Program – BC Women's Hospital + Health Centre

​​​​​​​This unique program provides specialized services for women using substances and infants exposed to these substances. A multidisciplinary team provides care and support to women throughout their pregnancy, and afterwards, to help with the transition back to the community. Learn more.


​​Rapid Access to Consultative Expertise (RACE)​

RACE is an innovative tool that providers can use to speak directly with a specialist, and ultimately, to enhance patient care. The RACE line offers timely guidance and advice for patients who may not require, or benefit from, a face-to-face consultation or referral to an emergency department. Learn more.​​​​


 Upcoming events and training

​​Webinar: Indigenous Patient Experience in Health Care: October 28

Hosted by VCH Indigenous Health and UBC iCON, this next Indigenous Health Round will have Elder Xwechtaal Dennis Joseph and Lori Quinn join us in circle to share their knowledge on Indigenous patient experience in health care. Learn more or register.


VCH Medical Staff Forum: December 15 

Join us for a presentation on the latest Health Human Resources (HHR) and Wellness status updates at VCH, including staffing challenges and wellness resources and initiatives for medical staff (Guest speaker TBC). There will also be a COVID-19 update and live Q&A session. Look for registration details soon.


 

OAT Training Program for physicians and nurse practitioners

VCH and the BC Centre on Substance Use are offering VCH medical staff funded training opportunities that can build provider capacity and skill sets for prescribing opioid agonist therapy. To date, over 200 VCH healthcare providers have completed the funded OAT training. Learn more.

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Communicating Unexpected Outcomes Disclosure Training Course​

​Conversations about unexpected outcomes and disclosing errors can be difficult. To support medical staff, VCH offers a training course that can enhance the communication skills for disclosing clinical errors with honesty, empathy and respect. Participants will also learn to improve their support of team members. This four-hour course is delivered in-person and online, is at no cost to medical staff and eligible for continuing education credits. Learn more and register for upcoming sessions on the LearningHub.



 In case you missed it: medical staff featured on oneVCH

Celebrating Pride

A four-part series about inclusivity and belonging features lived experiences VCH medical staff from the 2SLGBTQIA+ community. Read their stories


​Quality improvement projects lead to enhanced health care outcomes

Physican-Led Quality Improvement (PLQI) program graduates celebrated another successful completion of QI projects. Read the full story on oneVCH.​

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VCH women of distinction 2022

Celebrating several VCH women leaders who received awards and recognition for making a difference in health care this year including nurse practitioners Leah Christoff and Lana Moroz and physicians Andrea MacNeill and Elizabeth Bryce. Read the full story on oneVCH.


From sports to science and medicine – it's all an art of precision

B.C. has one physician who is fully subspecialized providing services in male infertility and sexual medicine practices, and he practices right here with us. Meet Dr. Ryan Flannigan.

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