Airwaves Fall 2014

RTSO Airwaves

Fall 2014

In this issue:

Updates from the RTSO

Nancy Garvey Retirement Tea

Air Quality Health Index What you need to know

Telehomecare

The Law and You

Regular Features:Management’s Corner

Student’s Corner

What is the buzz about Mindfulness?

Proud to be a Respiratory Therpaist

RT Week October 26 - November 1, 2014

1.855.991.8191

Support for your COPD patients

RxTelehomecare.ca More than 37% decrease in ED visits

More than 44% decrease in hospital admissions

High patient satisfaction

Remote monitoring in your patient’s own home

Monitoring and health coaching by RNs and RTs

Telehomecare is a program of the Ontario Telemedicine Network, a non-profit organization supported by the Ontario Ministry of Health and Long-Term Care and Canada Health Infoway.

President’s Message

RTSO Airwaves Fall 2014

160-2 County Court Blvd, Suite 440Brampton, ON L6W 4V1Tel: 647-729-2717/Fax: 647-729-2715Toll Free: 1-855-297-3089E-Mail: o�[email protected] www.rtso.ca

Greetings! On behalf of the RTSO Board of Directors, I would like to welcome you to another edition of the RTSO Airwaves and I’d like to also wish all of you a happy RT Week 2014! I hope everyone has had a great summer and is settling in with the back to school chaos and the hustle and bustle of the post vacation season.

I would like to take this opportunity to thank Shawna MacDonald and Elisabeth Biers for all their hard work in putting together another fantastic issue of RTSO Airwaves. This is Shawna’s first edition as Editor and we are very excited that she has joined our team.

Passing of the TorchThis will be my last President’s Message. Next month, I will be passing the torch on to Kyle Davies, who is transitioning into the President’s chair on the RTSO Board of Directors. I would like to express my deepest respect and sincere

gratitude to all the volunteers on the RTSO Special Interest Groups (SIG) and Committees this past year including the Leadership Committee, Student Affairs, Research Committee, RTSO Airwaves Editorial Board, CME Programs and Conferences, Anaesthesia Assistant Special Interest Group (SIG) and the Community RT SIG, RTSO Executive Committee and the RTSO Board of Directors. Please join me in extending our heartfelt thanks to all of these individuals for taking time away from their personal lives in the pursuit of practice excellence and professional advocacy on our behalf. Member or not, every Respiratory Therapist in Ontario benefits greatly from the hard work and commitment of RTSO volunteers – work that keeps us engaged with various stakeholders in both the provincial and national healthcare landscape - keeping us on the forefront of a variety of advocacy projects and representing our

RTSO Airwaves - Fall 2014 Page 2

Rob bRyan a-EMCa, RRT, aa

President’s Message - Fall 2014

professional interests with passion, credibility and distinction.

I would be remiss if I did not acknowledge the incredible work of our front office. I would like to especially thank Stephen Laramee, Business Manager of the RTSO; and Elisabeth Biers, Coordinator of Communications. Stephen and Elisabeth run all of our day-to-day operations and communications, as well as maintain the infrastructure for the RTSO to function. They support us with a passion and enthusiasm that is truly inspirational. Thank you to Stephen for all of your guidance and expertise and a special thank you to Elisabeth for your tireless dedication to our communication programming.

What’s New?I would like to welcome three new volunteers to the RTSO Board: Clement Hui, who will be looking after our social media programs and will represent RT’s Without Borders on the RTSO Board; Tina Shum, who will be taking over the Student Affairs portfolio from Brook Gerace (Sobczak); and Sara Han, who will be replacing Dr. Mika Nonoyama as the Co-Chair of the Community RT SIG along with Ginny Myles.

Membership Gives Us a VoiceThe RTSO has worked hard to put the best possible value added membership program together. October kicks off the launch of our new membership season. Historically we’ve offered a pro-rated membership program that begins on October 1st; this allows for a reduced six month rate for those who wish to take advantage of our full membership program for the balance of the RTSO membership year. The RTSO is proud to offer a very robust membership portfolio,

which currently includes enhanced membership programs with two societies - the RTSO and the Ontario Respiratory Care Society (ORCS) - as well as liability insurance. The 2014-2015 RTSO membership revenue goes to professional and political advocacy campaigning around lung health strategies, expanding the role of the RT in the out of hospital settings, research and best practice initiatives, advanced practice bursaries, professional development and continuing education programming, as well as our peer recognition programs.

The RTSO has been very busy in 2014 working on several initiatives to promote the profession and assert our position with key healthcare stakeholders in Ontario with regards to professional advocacy and continuing education. The RSTO continues to work collaboratively with the Ontario Lung Association and the CRTO in an effort to provide a broad range of CME programs and workshop based programs for our provincial evening education series and fall education programs.

I would like to highlight a couple of excellent education events we are co-hosting this fall open to all Respiratory Therapists in which all conference registrants will receive a certificate of attendance for your professional portfolio and can be used towards your regulatory mandates for continued education.

Eastern Ontario RT Week Educational Forum - October 22, Ottawa

The RTSO co-hosted a full day educational conference in Ottawa in collaboration with a committee of practice leaders, educators and

Page 3 RTSO Airwaves - Fall 2014


managers from the Ottawa area/Champlain LHIN. This collaboration was an effort to establish an annual full day education program for the RT’s in the eastern part of the province. The Planning Committee volunteered an incredible amount of time and energy into creating a fantastic program that includes world-class speakers and relevant clinical topics for RT’s. If you value having a marquee annual education event focusing on your unique practice needs close to home in the Ottawa area, please support the RTSO-Champlain LHIN CME initiative and help make this an annual event.

We were also very fortunate to receive incredible engagement from 10 of our industry leaders and vendors in support of RT practice, experiential learning, and unique networking opportunities. I would like to thank Dave Dafoe, Sylvie Bourbonnais, Aaron Nesom and Kyle Davies for organizing this event; and, to our valued vendors that support our practice through sponsorship: Boehringer Ingelheim, Alere Canada, Drager, Fisher & Paykel Healthcare, Cardinal Health, McArthur Medical, ProResp, Trudell Medical Marketing, Praxair and VitalAire.

We would like to thank all of the participants and supporters that contributed to make this event a success.

InspirEvolution - November 21 & 22, Toronto

In celebration of 20 years of self-regulation In Ontario under the RHPA the RTSO and the CRTO are collaborating with a fall education conference InspirEvolution 2014. This event will be held at the Li Ka Shing Knowledge Institute in downtown Toronto on November 21st and 22nd. This two-day program, jointly hosted by the CRTO and the RTSO,

will include clinical and regulatory topics of interest and a celebration of the evolution of Respiratory Therapy practice in Ontario. You can register online on either the CRTO or RTSO websites. From the RTSO website home page www.rtso.ca and click on the InspirEvolution thumbnail. If you register and need a hotel, we’ve secured a block of rooms at the Phantages Hotel Toronto, which is across the street from the conference venue. If you haven’t yet registered, space is limited so don’t miss out - register early to secure your spot!

Looking ForwardProjects on the radar for 2015 include a new Ministry (MOHLTC) Navigator Committee, which will focus on Ministry of Health initiatives, programs and policies that may impact the practice of RT’s and lead to new RTSO projects or professional advocacy engagement; grant and proposal development focusing on IT/IS and communications technology upgrades and a new association software program for a robust front office information management system and practice resources tools and membership downloads readily accessible for tablets and smart phones.

Keep your ear to the ground for the new membership program for 2015-2016. If you have any thoughts regarding membership initiatives or suggestions please forward them to [email protected]. Please take time to read about our current events in this issue of RTSO Airwaves.

Celebrations & FundraisingThe RTSO would like to congratulate Respiratory Therapists Without Borders (RTWB) on obtaining their charity status with Revenue Canada, now making it possible for charitable contributions to



be made, both financially and in kind, to the first ever Canadian-Led, Respiratory Therapy driven global charity. Proceeds go to RTWB sponsored mission work, teaching and promoting cardio-respiratory health care and strategies to our medical colleagues in third world countries, across patient populations. This charity is a unique way to demonstrate to the world how Respiratory Therapists can use their unique knowledge, skills and abilities to make a difference in the global theatre, particularly in places where there are so many that suffer from a variety of respiratory conditions and diseases, but simply do not have access to the most basic respiratory health care resources that many of us in the developed world take for granted.

The RTSO had hoped to launch a new annual fund raising program in support of the RTWB and the RTSO Neonatal Research Grant Program through a fun run, Zombie Run Undead Unleashed, this past October 4th at Downview Park, Toronto; due to unforeseen circumstances and lower than expected runner registration, the RTSO was informed by the event promoter and coordinator on September 15th that all Zombie Run events across Ontario for the remainder of 2014 will be cancelled, including the RTSO event in Toronto. You can imagine our extreme disappointment considering the incredible amount of time and energy invested in this project, with the goal of helping RTWB and fundraising for our own Neonatal Respiratory Care Research program. Fortunately, we did not lose any money but it did leave a void in our fundraising Program for 2014, which in the past supported our Research Committee.

With that in mind, the intention and spirit of this program remains the same and we have continued to extend the fundraising challenge to our RT academic partners, in hopes of nurturing and supporting a culture of global citizenship and charity in the RT community. I would also like to encourage you all to fundraise for RTWB and the RTSO Neonatal Research Grant Program. Direct donation to RTWB can be made at www.rtwb.ca on their donate page.

Emergency PreparednessAs we head into the Flu season (and this year appears to be a cornucopia of outbreaks and potential pandemics) I would encourage everyone to be prepared and take time to review many of the online resources provided to you by the RTSO, CRTO and your employer.

This year has seen many threats, from the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), to Avian Influenza A Virus (H7N9), to the Ebola outbreak in West Africa, to the Enterovirus D68 (EV-D68) affecting many children across North America. We are just heading into the influenza season, and in response to the growing threats of outbreaks in our communities and workplaces, the RTSO will endeavour to collaborate and communicate with local and provincial health authorities to provide timely Infection Prevention And Control (IPAC) alerts and updates. The RTSO strives to provide information that may assist members in their practice and help keep you, your families and your patients as safe as possible. The RTSO is also communicating with the CRTO to make sure any relevant information from Public Health and the Ministry of Health is readily available to all RT’s and stakeholders.



While we can’t control pandemics or outbreaks, we can control our readiness and response; our best defense includes prevention, awareness, immunizations, adequate rest, proper nutrition, and most importantly, incorporating best IPAC practices into our daily routines to deliver care that is both smart and safe! Please see online resources on the RTSO home page (www.rtso.ca) and click on the IPAC alert thumbnail, or visit the CRTO website (www.crto.on.ca) Members section, to view the Emergency Preparedness page.

Final RemarksRemember, the RTSO belongs to all Respiratory Therapists in Ontario! As a regulated healthcare profession, we have the right to be heard and we need to be engaged and collaborative with our peer associations and key stakeholders in our healthcare system, through our professional society. As you have read, these are exciting times for the RTSO and the practice of Respiratory Therapy in this province.

If you are interested in volunteering with the RTSO, please contact the RTSO Head Office at [email protected] Thank you for your continued membership and please encourage others to join, so that together, we can ensure our voice is heard well into the future.

Thank you for allowing me to serve the RT’s of Ontario as the President of the RTSO. It has truly been an honour and a great growing experience. On that note, let us continue to build collaborative relationships and maintain a strong united voice so that we continue to grow our profession, be well represented, and forge the foundation of credibility and viability for current and future generations of RT’s.

Enjoy another great edition of RTSO Airwaves!

Rob

It’s Almost Here - November 21 & 22at Li Ka Shing Knowledge Institute

Time is running out to register!Hurry to www.rtso.ca

for further information and to registerDon’t miss the excitement!


Leadership

RTSO Committee Reports

KylE DaviEs RRT, RTso lEaDERship ChaiR

With the summer weather now behind us, the committee is back in full swing with new ideas as we gear up to the Inspire Evolution Conference in November. The Leadership stream will include presentations from:• Connie Martins from SMH around the RESP

Rounds Initiative and, • A follow up presentation from CIHI on the RT

Workload Measurement System.

With the current infection control events around the world the committee also has been looking closely at IPAC practices for such things as Ebola and the new EV-D68. This leads us closely in discussions around Emergency Preparedness and Disaster planning and we want to hear from any organizations that practice Mock Code Oranges. This is also going to be a focus at the Inspire Evolution Conference with a special interactive presentation on Emergency Preparedness from Dr. Laurie Mazurik!

With RT Week upon us October 26th – November 01, 2014 and the InspirEvolution Conference on November 21st-22nd we have

busy time ahead preparing, so that everything will go off without a hitch.

We look forward to seeing everyone at the conference as well as hearing about how your Department is celebrating RT week.

Cheers,

Kyle Davies

Kyle


Community Respiratory Therapy

saRa han RRT, RTso CoMMuniTy RT

Co-ChaiRThe RTSO Community Respiratory Therapy

Committee has had two productive

telephone meetings and plans a meeting every

month with an in person “meet and greet” (some of

us have not met face to face yet) at the CRTO/RTSO

forum November 21-22, 2014.

During this time, we have been taking care of the

administrative side of the committee equation,

setting up terms of reference, a framework and we

soon hope to have a work plan with tangible action

attached to priorities that have been identified by

surveying the membership. To better determine

what those priorities may be, we are conducting an

environmental scan of what community activities RT’s

are involved in by each LHIN, so if you are, or know of

someone, employed, engaged or involved as an RT in

community/primary care work and programs, please

ensure they are included in the scan. You can e-mail

me [email protected] and I can put you in touch

with the appropriate person in your LHIN.

The committee welcomes Sara Han as new co-chair

of the committee (along with Ginny Myles). Sara

comes with a wealth of community experience

and enthusiasm. Sara is the Primary Care Asthma

Program (PCAP) provincial coordinator at the

Ontario Lung Association, where she plays a role in

implementing an evidence-based asthma program

supporting best practice standards throughout

primary care in Ontario. Through this role, she is a

resource to various healthcare professionals working

in respiratory health. She comes from working in

acute care for 6 years and she is now focusing on her

passion for chronic respiratory disease management.

After obtaining her Certified Respiratory Educator

(CRE) designation in 2009, she worked as a respiratory

educator in various primary care settings including

physician’s offices and a Family Health Team before

joining the Ontario Lung Association in 2013. She

has served on the Health Quality Ontario (HQO) QBP

for COPD in the Community expert panel in the past

year.

We bid a fond farewell to Mika Nonoyama who is

stepping down from the position of co-chair, but

thankfully, Mika will continue on as a committee

member with valued input, experience and passion

for all things RT in the community setting.

Thank you, Mika, for all your work to date on this

committee and the RTSO Board!

Ginny MylEs RRT, CRE, BHA (Hons).

RTso CoMMuniTy RT Co-ChaiR


Research Committee

After an enjoyable summer break, the members of the Research Committee (RC) met this September, energized and excited about the presentations and research results colleagues will be sharing at this year’s Forum, November 21st and 22nd! The Research stream will include:• A panel presentation with three RRT’s sharing

their experience in research;• Robyn Klages from the William Osler Health

Centre describing their use of clinical simulation to translate intubation knowledge, guidelines and best practice, into an ongoing process to ensure competency and current knowledge; and

• A poster review session where colleagues will share results of research, evaluation or program development activities they’ve been involved with, in a variety of practice settings. The posters and presentations will be part of a review process with awards to be presented at the end of the Forum.

In preparation for the Forum, the RC will be busy with the review process during the month of October, as well as celebrating RRT researchers

during RT Week!! Along with the abstract submission review, a key focal point will be submissions for the Advanced Practice Education Awards. The successful candidates for the Advanced Practice Education Awards, including the Abbvie Awards, will be announced at this year’s Forum. Another key RC initiative has focused on the establishment of a research group on LinkedIn. RTSO policies on general communication, social media, electronic media and a group policy for the use of the LinkedIn research group have been developed and approved by the Board. The site should be set up in time for an announcement at the Forum! We hope you’ve found the additional information that’s been posted on the Research Committee part of the RTSO website useful and look forward to seeing you all November 21st and 22nd at the Forum! Thanks to all our amazing RC members!!

Respectfully submitted,Nancy Garvey RRT, MAppSc, Co-chair, GeorgetownAkhilesh Patel RRT, BSc, Co-chair, Ottawa On behalf of Research Committee members:Louise Chartrand RRT, MA, PhD(c), OttawaMarianne Ng RRT, CRE, BSc, TorontoShelley Prevost RRT, MAppSc, Thunder BayBrooke Read BSc, MHS(c), RRT, LondonAshley Waugh RRT, B.Sc. Hons, LondonMika Nonoyama RRT, PhD, RC Clinical Scientist, RTSO


Editorial

Editorials can serve many different functions. They can provide commentary; they can be stimulating; they can provide a platform for raising awareness; they can be innovative or just plain out there; they can analyze; they can rally, and so much more. Over the last few months, I have learned that the best editorials should be thought provoking and contentious pieces, leaving editor open to either criticism or positive support. To be honest, I’m still in the wind as to where I want to take RTSO Airwaves but I do like the direction Dave McKay set us on, being a publication that highlights the people, places, products and practices of Respiratory Therapists in Ontario, and I also love a good story. We have so many stories to tell, and I truly feel that this is our time to shine, to celebrate, to have our voices heard and to story our many successes with enthusiasm, pride and determination. Our fifty year evolution as a profession finds us heading into a bright and successful future!

It has been a very busy and interesting few months since the last edition of RTSO Airwaves. I bid adieu to one of the finest Respiratory Therapists I have encountered in my career, on her retirement after 30 years of practice. I’ve witnessed some exciting leadership changes at work, and also many unexpected pressures and challenges. On a personal note, early September back-to-school was bittersweet – watching my youngest head into SK and my oldest head into Grade 4.

Time seems to pass so quickly these days…the dazzling Fall colours in their splendor, and that crisp, cool breeze in the air - the winds of change are strong, both in the great outdoors and in the healthcare environment within which we practice. Everyday heroes like you are leading the way towards healthcare transformation through their passion and innovation in promoting good health as well as disease and injury prevention, providing health education, directly caring for patients in many different contexts, indirectly improving patient care through leadership, management or education, and leading or participating in respiratory research.

Fall brings action- packed opportunities for professional growth and development -- a bounty of conferences and workshops available to attend, and many other professional events to get involved in. As I am personally hooked on mindfulness-based practices, I enrolled in a Mindfulness Based Stress Reduction course for Healthcare Providers, and you’ll see a brief article on mindfulness in this edition.

I certainly encourage you to share your commitment and your passion with others, by contributing to this publication and advocating for growth in membership of the RTSO to strengthen our collective voice. Please consider sharing your stories, your time, or both, with the RTSO.

I look forward to hearing from you soon!

Regards,Shawna

shawna MaCDonalD RRT, RTso aiRwavEs EDiToR

anD FaMily


Nancy Garvey Retirement Tea

September 10, 2014

In September The Ontario Lung Association hosted a retirement tea for Nancy Garvey. Many respiratory therapists were in attendance, especially those who have worked with Nancy on the Asthma Action Program. Carole Madely introduced several speakers including Andrea Stevens-Lavigne (VP Provincial Programs, Ontario Lung Association), Sheila Gordon-Dillane (Manager of the Ontario Respiratory Care Society), Dr. Itamar Tamari (chair of the Advisory group for the Primary Care Asthma Program) and Dr. Teresa To (Senior Scientist at Sick Kids and Institute for Evaluative Clinical Scientist).

The Tea ended with Nancy saying a few words, including noting one of the keys to her success: collaboration. Although Nancy is retiring as Senior Program Consultant with the Ministry of Health and Long-term Care, she will always remain a dedicated respiratory therapist.

Above: Nancy Garvey and Andrea Stevens-Lavigne

Below Right: Nancy cutting special cake

Below Middle: Dilshad Moosa, Nancy Garvey, Mika Nonoyama

Below Left: Nancy Garvey and Sheila Gordon-Dillane

Photos Courtesy of Mika Nonoyama

Page11 RTSO Airwaves - Fall 2014

Health Canada’s Air Quality Health Index (AQHI):

Ginny Myles, Registered Respiratory Therapist, Certified Respiratory Educator

Exercise is an important component of healthy living, but do you discuss with your patients the environment in which they do it? Should you be concerned if they bike to work every summer day along a busy road?

Air pollution is often not considered a factor by practicing clinicians in the cause of mortality and disease or aggravation of disease; however, evidence concludes the opposite, especially in chronic respiratory and cardiovascular/cardiac diseases. Epidemiological studies have shown that mortality, emergency room visits and hospitalizations increase in a linear fashion with air pollution levels. There is also evidence that the long and short term health effects of air pollution exposure and the mechanism of how air pollution exposure can trigger a harmful inflammatory reaction in the cardiovascular system will lead to exacerbations of COPD, asthma, angina, hypertension, arrhythmias and myocardial infarction.

This article is intended to increase the respiratory clinician’s awareness of the adverse health effects of air pollution and that the Air Quality Health Index (AQHI). AQHI is a nation wide, 0-10 scale monitoring system that is easily incorporated into patient’s action plans or care plans.

The AQHI connects air quality to health risk that allows clinicians and patients to self calibrate depending on how at risk or sensitive they are to air pollution and adjust their outdoor activities accordingly. Sources of air pollution can be natural, such as forest fires or sand dust, or man made, such as the products of combustion from cars and manufacturing.

The AQHI is the sum of measurements of small (2.5 micrograms) particulate matter, nitrogen oxide and ozone. Please refer to the website for Ontario AQHI readings http://ec.gc.ca/cas-aqhi/default.asp?lang=En&n=55517B0A-1


<AQHI Scale>

In Ontario, measuring stations are found at the locations noted below, with Barrie and St. Catharines as the most recent measuring stations added.

Patients and clinicians can access this data and use the risk scale to avoid triggering or exacerbations of their chronic diseases. At risk populations are identified on the website as the elderly, those active outdoors, young children and those with pre-existing chronic lung or heart disease.

As clinicians, we want to encourage an active lifestyle. On days when the AQHI is high enough to be considered possibly detrimental to health for those at risk, we can offer alternative strategies such as exercising indoors or postponing activity until level of health risk is lower.

More information on AQHI, including many tools and resources to order, can be found at http://www.ec.gc.ca/cas-aqhi/default.asp?lang=En&n=CB0ADB16-1


AnchorFast GuardOral Endotracheal Tube Fastener

Now with tube protection

Provide an extra measure of protection— with confidence.

The new AnchorFast Guard oral endotracheal tube fastener features an integrated tube protection sleeve to help prevent tube occlusion.

See how we’re helping you put patients first— with confidence. Call 1.800.263.7400 or visit www.anchorfast1.com

Confidenceis in the air.

Hollister and logo and AnchorFast Guard are trademarks of Hollister Incorporated.

© 2013 Hollister Incorporated

Caution: Prior to using the AnchorFast Guard oral endotracheal tube fastener, be sure to read the entire product Instructions for

Use package insert that accompanies the product.

Helping a patient with congestive heart failure (CHF) improve her quality of life has been a real victory for Respiratory Therapist Ana MacPherson, MASc, RRT, a Telehomecare clinician at Southlake Regional Health Centre in Newmarket, Ont.

The patient, an older woman with uncontrolled CHF, was depressed and retaining more than 40 pounds of excess body fluid. The patient’s husband was equally despondent, feeling helpless and burned out.

The patient was then enrolled in Telehomecare, a program that provides health coaching and remote patient monitoring. With Ana’s coaching, the woman has learned to better control her symptoms.

“She and her husband report that they are living a much more active and satisfying life,” Ana says. “Months after being enrolled in the program, she has not been admitted to hospital once for her condition.”

Ana, who brings 25 years of experience as a Respiratory Therapist (RT) to the role, monitors and coaches patients who have been hospitalized with CHF and Chronic Obstructive Pulmonary Disease (COPD). Ana is also a Certified Respiratory Educator, smoking cessation counsellor and seniors’ fitness instructor.

Telehomecare was launched at Southlake through funding by the Central Local Health Integration Network (LHIN) last November. A program of the Ontario Telemedicine Network (OTN), Telehomecare provides patients with simple equipment they can use at home to monitor oxygen

SUPPORTING CHRONIC DISEASE PATIENTS WITH TELEHOMECARE

RT Ana MacPherson puts decades of experience to work remotely coaching patients in their own homes


saturation, weight, blood pressure and heart rate on a daily basis. Patients also answer a few questions about how they are feeling. The data are then transmitted to a specially-trained Registered Respiratory Therapist or Registered Nurse who also provide weekly telephone health coaching to discuss goal setting and how best to achieve optimal health. The monitored data is also provided on an agreed schedule to the patient’s primary healthcare provider.

“What interests me is working with patients and doing daily monitoring, not just seeing them every two weeks. I had always found it a challenge to not know how the patients are doing between appointments,” says Ana, who worked in pulmonary rehabilitation with the Barrie and Community Family Health Team prior to joining Southlake. She credits the Registered Nurse and other colleagues at Southlake and OTN in particular for helping her translate heart failure guidelines into practice.

For several years, Ana also worked with the Ontario Lung Association and the Ministry of Health and Long-Term Care, implementing the Lung Health Program. Now she likes being able to share the knowledge and skills she has acquired over the years with patients, watching them benefit from the Telehomecare interventions. “In this case I’m putting everything into practice. It’s knowledge transfer.”

Telehomecare complements the care patients continue to receive from their physicians and other care providers. By the end of the six-month program, patients are better equipped to monitor

their condition, and better educated in terms of medication compliance and the impact of behaviours like exercise and diet on their condition.

Co-funded by the Ministry of Health and Long-Term Care and Canada Health Infoway, Telehomecare is implemented by LHIN’s which designate the organization that will deliver the program in the region, usually a hospital or Community Care Access Centre. Currently seven LHIN’s have Telehomecare in place. It is expected to grow and eventually be available province-wide.

Telehomecare data collected at Southlake show a 57% reduction in hospital admissions and a 48% reduction in Emergency Department visits six months after discharge from the program compared to pre-Telehomecare usage.

“At the start of the program, some of our patients were seeing their providers as often as several times a week. Now they are down to every month or two,” says Ana, who noted that two-way communication is the key to success. “The response to the program from patients, caregivers and clinicians has been amazing.”

Patients can self-refer or be referred to Telehomecare by any member within their circle of care. Some patients are enrolled at discharge from hospital. Telehomecare is also piloting a service for patients with COPD and CHF who also have Diabetes.

Ana works alongside a Registered Nurse, Cathy Mansour. Mary Bayliss, MA, RRT, who manages Telehomecare at Southlake, was determined to set up the program with an interprofessional model.


Mary advocated for including an RT on the team, stressing that suitability for the monitoring/coaching role should be based on core competencies in chronic disease management, such as how to teach and promote behaviour change; competence should not be simply based on a healthcare provider’s professional designation.

“Ana has lots of experience, and the depth and breadth of knowledge to undertake this role successfully,” says Mary, noting that, as a Certified Respiratory Educator, Ana has not only completed the necessary training in asthma, COPD and education theory, but she also now teaches the course to other RT’s. “She has a wonderful partnership with Cathy, and she goes above and beyond for her patients.”

Ana stressed that regardless of which healthcare provider delivers the program, it really is supplemental to the care patients receive from their regular care providers. “It addresses the gap – that period when the patient is not being seen by their regular care provider,” she says, “and it prepares patients to manage on their own at home, avoiding potentially upsetting and unnecessary trips to the hospital.”

Telehomecare took off quickly and enrollment targets were quickly surpassed, says Mary, who is also manager of the Health Links Project and the Respiratory Therapy department at Southlake. “Even the more senior patients respond very positively to learning to use the technology,” Ana says. “They’re willing, able and actively involved in their care. Plus, they can call any time they have a question.”

Ana has helped patients determine whether to start antibiotics when their COPD flares. “Early recognition is important for COPD and CHF. It has helped us to avoid many ER visits.” In another instance, a patient’s oxygen readings had been low for several days; Ana was able to quickly order oxygen from Southlake’s Heart Function Clinic when she could not reach the patient’s family physician.

Telehomecare processes and protocols are based on Best Practice Guidelines including those of the Canadian Thoracic Society, the Canadian Cardiovascular Society and the Registered Nurses Association of Ontario (RNAO) interdisciplinary best practice guidelines.

“Counselling is very individualized, tailored to the patient’s needs and goals,” she says. “The first step is to conduct a health education assessment on each individual patient to see how much they know about the condition and it’s management.”

Counselling topics covered include: generating an action plan; healthy lifestyle; being active and exercising; managing breathing and saving energy; preventing symptoms and taking medications; learning about self-management; and practicing for the weekend.

While the standard Telehomecare program is six months in length, some patients can request more help and be re-enrolled. Ana informs them of the resources in their community to help them continue to self-manage, and she also follows up with patients after they have completed the program.

More information on this program is available at www.RxTelehomecare.ca


The Root of Brain Function MonitoringA more complete picture starts with more complete data

© 2014 Masimo. All rights reserved.

For professional use. See instructions for use for full prescribing information, including indications, contraindications, warnings, precautions and adverse events.

SedLine® brain function monitoring for the Root® patient monitoring platform helps clinicians improve

anesthetic management by enabling more individualized titration.

> Connects to Root via Masimo Open Connect™ (MOC-9™)

> 4 simultaneous EEG channels provide continuous assessment of information about both sides of the brain

> A single sophisticated algorithm provides accurate, reliable information about a patient’s response to anesthesia

> Instantly interpretable, high-visibility display of Masimo’s breakthrough rainbow®

and SET®

measurements from

Masimo’s Radical-7®

handheld monitor

www.masimo.com

1492N_Ad_Canada_Anesthesia_Journal_Sept_2014_Root_SedLine_8.5x11.indd 1 8/13/14 4:01 PM

All regulated health professionals should have an understanding of administrative law because administrative law guides how the government exercises its legal powers, including the powers delegated to authorities such as agencies, boards, and commissions. Specifically, all health professionals, including respiratory therapists, are subject to the Regulated Health Professions Act (1990) (“RHPA”), profession-specific regulations, and their own regulatory college. In this article, I will discuss administrative law, generally, and highlight some of the key provisions of the RHPA.

As mentioned above, administrative law is the body of legal principles that regulates the manner by which the government, and agencies empowered by law, must behave in administering and enforcing the law. Here are some of the basic rules of administrative law: 1. statutorily empowered decision-makers cannot act

beyond the scope of their legal authority or jurisdiction; 2. said decision-makers must be reasonable when given

discretionary power to hand down decisions; 3. decision-makers must follow fair procedures in making

decisions; 4. subject to certain exceptions, an administrative body may

not delegate its statutory power to another party; 5. bylaws and regulations of an administrative body must be

consistent with the statute under which the subordinate or delegated legislation is passed; and,

By William Gregory O


6. violation of any of these principles warrants judicial review and the superior courts may intervene.

After a lengthy consultation process regarding the public accountability of health professionals, the RHPA became effective on December 31, 1993. The RHPA includes a schedule called the Health Professions Procedural Code, which sets out the procedural framework for the regulation of health professionals in areas such as complaints, discipline, and registration. The RHPA affords all regulated health professions the privilege of self-regulation, as it establishes a governing college for every regulated health profession1 and provides for standalone statutes, specific to each regulated health profession2.

The self-regulating health profession colleges are responsible for dealing with allegations of professional misconduct. Such allegations of professional misconduct are generally what trigger an administrative body’s jurisdiction over a disciplinary matter. Notably, a member of a self-regulated profession has a limited expectation of privacy over an authorized investigation when the administrative body has reasonable and probable grounds to believe that the member has committed professional misconduct3.

Professional misconduct is any breach of a professional standard4. Professional misconduct may be found in the act of administering healthcare services or even in the behaviour of a member of a health profession. Therefore, in addition to practising below the standards of a given profession, professional misconduct may include conduct such as improper billing or improper advertising.

Forms of professional misconduct include offences relevant to the health professional’s “suitability to practise”, committing professional misconduct in another jurisdiction, failing to cooperate with a quality assurance committee, and the sexual abuse of a patient or client5. Additionally, RHPA, s. 51(1)(c) entitles the health profession colleges to create additional grounds for professional misconduct.

From a legislative prospective, probably the most interesting aspect of the RHPA is its non-exclusive scope of practice for each profession. Basically, members of a self-regulated health profession college do not have the exclusive right to perform acts within the scope of practice of the regulated health profession. Instead, the RHPA prohibits everyone other than members of a self-regulated health profession college from performing so-called ‘controlled acts’. This approach is meant to promote freedom of choice for consumers by leaving as much healthcare activity as possible to the public domain, while protecting the public from harm by restricting inherently dangerous acts6.

RHPA, s. 27 sets out 13 inherently dangerous activities, which only can be performed by regulated health professionals; however, this does not mean that any regulated health professional can perform each of the defined controlled acts. Just as we would not want an accountant building a bridge, it is probably a good idea that dentists are not delivering newborn babies. Also, a member of a regulated health profession performing a controlled act beyond her scope may be found to have engaged in professional misconduct. For example, a chiropractor who practised acupuncture was found to have committed professional misconduct in Fleuty v. Chiropractic Assn. (Alberta) (1981), 125 D.L.R. (3d) 500 (Atla. C.A.).


Under the RHPA, each regulated health profession has specific title protection and the right to use the title of doctor has been extended to include chiropractors, psychologists, and other health professionals if permitted by regulation7. While the right to communicate under the Canadian Charter of Rights and Freedoms includes the right of professionals to engage in informational advertising8, the freedom of expression does not include the right to misrepresent one’s professional qualifications to the public9 . A practitioner who is not from one of the listed health professions may be precluded from referring to her doctoral degree in a clinical setting since RHPA, s. 33(1) restricts the use of the title of doctor to the provision of healthcare services10.

The administrative process can be daunting, but it does not have to be. Having familiarity with administrative law, the RHPA, and the Respiratory Therapy Act, in addition to getting strong guidance throughout the process will make all the difference. Moreover, having a solid understanding of administrative law and your statutory obligations will help you provide better care to your patients.

About the AuthorWilliam Gregory O is an Associate at Lion Law, where his work focuses on administrative law, business law, and animal law. William is a licensed Barrister, Solicitor, and Notary Public in the Province of Ontario. He is also licensed as an Attorney and Counsellor at Law in the State of Illinois. William may be contacted by telephone at 416.770.6144 or via email at [email protected].

1. The College of Respiratory Therapists of Ontario, in the case of Respiratory Therapists.

2. The Respiratory Therapy Act, 1991, in the case of Respiratory Therapists.

3. Sazant v. College of Physicians and Surgeons of Ontario, [2012] O.J. No. 5076, 2012 ONCA 727.

4. Trace v. Institute of Chartered Accountants (Alberta), [1988] A.J. No. 1019, 54 D.L.R. (4th) 82 (C.A.).

5. RHPA, s. 51.6. Couture v. Canada, [2009] 2 C.T.C. 80 (F.C.A.).7. RHPA, s. 33.8. Rocket v. Royal College of Dental Surgeons

(Ontario), [1990] S.C.J. No. 65, [1990] 2 S.C.R. 232, 71 D.L.R. (4th) 68.

9. R. v. Baig (1992), 1992 CarwsellBC 816, 37 W.A.C. 59, 21 B.C.A.C. 59, 12 C.R.R. (2d) 266, 78 C.C.C. (3d) 260 (B.C. C.A.) reversing in part (1990), [1990] B.C.J. No. 203, 1990 CarswellBC (B.C. Co. Ct.).

10. College of Physicians and Surgeons of Ontario v. Larsen (1987), 45 D.L.R. (4th) 700 (Ont. H.C.J.).


Giving Up Control

Managers, coordinators, team leaders, if you are completing a workplace project or overseeing a particular issue to completion – those who micromanage do a disservice to their department, their teams, their fellow staff members and to themselves. Worse yet, they often prevent their co-workers or staff from growing. One of the smartest things to do is give up control. Here is how:

1. Push down decision-making: If you are making all the decisions you’re only holding back your situation and worse, the team. Push decision making to the front liners or others within the team who can truly give you valuable feedback and information to assist with developing the best possible solution.

2. Accept that mistakes will happen: Sharing responsibilities with others means things don’t always go according to plan. Prepare the team or co-workers to avoid mistakes by being clear about what the expectations are and giving people the tools they need to do their jobs well. When mistakes do happen; remain calm, never lose your temper or raise your voice and know that, no one purposely wants to

make a mistake. Listen and make it a learning experience.

3. Build your team: making yourself comfortable with giving up control requires having people you believe in and trust. So invest both your time and resources to develop the team so that they feel empowered to make decisions and know they are backed by their senior team lead that trusts them.

“Good managers are brave, and generous with trust in their people. They want them to mature in their judgment and grow in their skills, preferring to err on the side of trusting too much than trusting too little. They take pleasure in letting go and giving power away to their staff, accepting that when someone who works for them shines, they shine too”. -- Scott Berkun (author)

Lucy Bonanno, RRT, MA, MBA, CAE, CHE

In this edition I decided to write on ‘giving up control’. When I was a front liner, the style of leadership then was, ‘control and command’, meaning, the front liner had no say or control of their workplace environment. There was no collaboration and worse of all; managers would micromanage every aspect. I am happy to say it is no longer this way, and through some excellent research in the realm of Organizational Development, we have academic PhD’s who have helped change what leadership really means in the workplace.


Succeeding as a New Graduate: From Student to

Registered Respiratory TherapistAshley R. Waugh, B.Sc. Hons, RRT

The transition from student Respiratory Therapist to a registered,

independent practitioner can be daunting. There is an element of culture shock; adjusting to a new workplace environment, establishing rapport with your coworkers, familiarizing oneself with new equipment, policies and procedures. It may be intimidating; working independently with your personal license as opposed to learning under your preceptor’s license. It can be stressful; learning how to manage workloads and prioritize patient care while making both ethical and educated decisions. Many feel unprepared and lack confidence in the beginning stages of this new role. Although this transition is challenging, it can be exciting and rewarding. As a new graduate, in addition to knowledge and skills, there is undeniably an attitude and perspective to develop in order to be successful.

Regardless of the area of practice, many of us experience similar challenges. We must all draw on the knowledge learned in school and translate it into new skills. In an unfamiliar workplace, we must identify the diverse responsibilities and expectations that encompass our new role. Another challenge commonly faced is the loss of

preceptorship as a novice Respiratory Therapist. During student clinical placements, we receive constructive feedback to create awareness around our skills and abilities. As an independently functioning Respiratory Therapist, we must begin to reflect and self-evaluate on a regular basis and seek support when we feel it is necessary.

It is difficult to describe what qualities enable the new Respiratory Therapist to thrive amidst the extensive changes to their working life. At the forefront, it is imperative to foster cooperation and collaboration between yourself and colleagues of all health disciplines. As many Respiratory Therapists enter the field by working in a critical care setting, these areas can be dynamic and stressful environments, especially for inexperienced therapists. It is crucial to become comfortable and proficient in collaborating with other healthcare professionals, not only for patient outcomes, but also for team dynamics. By communicating your suggestions for patient management, participating during interdisciplinary rounds and offering to help your coworkers when needed, you are becoming a valued member of the healthcare team. All Respiratory Therapists entering the field as new practitioners will be challenged with working independently and building confidence in their abilities. With time, confidence will develop and


independence will be further fostered. Sometimes, of course, this is easier said than done!

Most importantly, as new Respiratory Therapists, we must be aware of the support we need to be successful. After acquiring the knowledge base, it is time to apply the “book learning,” advice, tips and tricks from our professors, preceptors and mentors to become our own RT. Hopefully, as a novice therapist, you will have entered a supportive environment where you feel comfortable being inquisitive and receive constructive feedback. We are developing our skills

and should be enhancing our critical and quality thinking, both independently and as an integral member of the healthcare team.

The transitional experience for a new graduate Respiratory Therapist entering professional practice is marked with a significant adjustment to both personal and professional roles. Surround yourself with support, allowing for space to foster critical thinking and expertise in your skills, and time to gain valuable experience within the field. Success comes to those willing to try!

Available NowThe new 6 month RTSO membership

application is available

now at www.rtso.ca

(Membership from

October 1, 2014 to March 31, 2015)

Coming SoonAs of December 1st you can renew your RTSO membership for the 2015/2016 year

through the RTSO web site at www.rtso.ca.

(Membership year April 1, 2015 to March 31, 2016)

Watch for full details.


NeoPAP Infant nCPAP System Advanced Technology Delivered Simply

Patient Comfort, Clinician Peace of Mind. NeoPAP’s leak compensation technology, lightweight patient interface, and innovative bonnet design work in concert to: eliminate the need for a tightly-fitted seal, thereby reducing

pressure on the infant’s face minimize alarms and adjustments during therapy allow you to spend more time caring for your patient and

less time tending to the device encourage an environment where patients can rest more

comfortably and focus energy on growth and development

Learn more at: www.philips.com/neopap

Contact: 1-800-996-6674 www.mcarthurmedical.com 1846 5

th

Concession W. P.O. Box 7, Rockton, Ontario L0R 1X0

Payment OPtiOnsBy mail: Cheque (payable to The Respiratory Therapy Society of Ontario)

Visa or MasterCard are now available via PayPal - please complete the form available on www.rtso.caNote: A PayPal account is not necessary. Visa/MasterCard/American Express/Discover/Interac are all accepted means of payment.

Visa or MasterCard are also available without PayPal - please complete the following:

Cardholder Name: ______________________________________________

VISA/MasterCard #: _____________________________________________ Expiry Date: ______________________

Cardholder Signature: ___________________________________________

RTSO Privacy NoticeThe process of collection and using information about individuals is now more complicated as a result of legislation, the Personal Information Protection and Electronic Documents Act (PIPEDA). PIPEDA applies to personal information. It is information about an identifiable individual, but does not include the name, title, and business address or business phone number of an employee of an organization. It does not apply to information about corporations, PIPEDA applies only to individuals. Any personal information collected by RTSO is used solely for the purposes of providing membership services and will not be used for any other purpose without your consent.

160-2 County Court Blvd, Suite 440Brampton, ON L6W 4V1Tel: 647-729-2717/Fax: 647-729-2715Toll Free: 1-855-297-3089E-Mail: o�[email protected] www.rtso.ca

memBershiP aPPlicatiOn October 1, 2014 - March 31, 2015

First Name: __________________________________________ Last Name: ___________________________________________

Mailing Address: __________________________________________City ______________________Postal Code______________

Personal Telephone: _______________________________ Email: ____________________________________________________ Indicate if you prefer correspondence via email or print (RTSO correspondence is primarily conducted via email)

Employer: ________________________________________ Position:______________________________________________

Bus Telephone: ______________________________ ext.: _______________ Fax: ___________________________________

memBershiP OPtiOnsPracticing MeMbershiP - $100 + 13.00 HST (includes Professional Liability & Indemnity Insurance and Ontario Respiratory Care Society (ORCS) Membership & benefits***) = $113.00 CRTO Registration Number__________________ (required for practicing members)

associate MeMbershiP - $125 + 16.25 HST (excludes Professional Liability & Indemnity Insurance) Includes Ontario Respiratory Care Society (ORCS) Membership & benefits*** = $141.25

corPorate MeMbershiP (Vendors) - $125 + 16.25 HST = $141.25

student MeMbershiP - 1 year from date of RTSO membership registration = $30 + 3.90 HST = $33.90 (Indicate Year of Graduation - 20___ )Note: First year Graduates are free, however the graduate MUST complete and register as a Practicing Member on the appropriate membership form. To qualify, the graduate MUST have been an RTSO student member for a minimum of 3 years prior to graduation and MUST provide his/her CRTO Registration Number within one year of graduation. Professional Liability & Indemnity Insurance coverage is free for the first year if the grad is completing their licensing requirements while he/she is under supervision of an RTSO member who is licensed.

HST Registration # 107889339An Associate Member is an individual not holding a certificate of registry from the CRTO.*In choosing to apply for the Professional Liability & Indemnity Insurance**, the undersigned respiratory therapist declares that he or she has never been the recipient of a claim which could be covered under the present policy; or is not aware of any circumstances which could lead to a claim under the present policy.**Professional Liability & Indemnity Insurance coverage: $2M/incident / $4M aggregate; Nil Deductible Disciplinary Defense: $175,000/claim / $175,000 Annual Aggregate Criminal Defense Reimbursement: $200,000/incident / $200,000 Annual Aggregate; Sexual Abuse Counselling & Rehabilitation: $10,000/insured / $250,000 Annual Aggregate Legal Representation Expenses: Subpoenaed as witness $1,500 each claim Complaint $5,000 / Max annual aggregate for both $50,000***Please visit www.on.lung.ca for complete details of ORCS membership

Indicate Area of Interest: Advocacy Research RTSO Airwaves Student Affairs Leadership

(or school if student)

What’s the Buzz?

Shawna MacDonald RRT

“We may eat without really tasting, see without really seeing, hear without really hearing, touch without really feeling, and talk without really knowing what we are saying.” ~Jon Kabat-Zinn

That’s a great quote, and when I encountered it for the first time it certainly made me stop and reflect on the many times I found myself to be on auto-pilot in my busy day, as I am sure many - if not all - of you can relate to. How many have driven home from work and not really been “present” on that drive? How many of you get busy planning a response to a question when the person you’re conversing with is still talking? How many nod or shake their head when listening, but walk away having not really heard the full story being told?

Mindfulness is about paying attention, on purpose, to the present moment, non-judgementally – just observing, noticing but not reacting to thoughts that wander in. It’s about acting with intention and purpose. It’s about quieting the mind by focusing on the breath (or on the experience) without labeling or judging. It’s about giving ourselves permission to experience something - to just sit in it, fully – and not drift focus or plan our next move or rush off to get to the next thing on the list completed.

In our work, we pour a lot of our energy into it and we derive satisfaction from a job well done, and yet the workplace can be a source of great stress as well, and it seems there is an abundance of it to be had. Our busy, fast-paced, multi-tasking lives can lead to a disconnect, and we can find ourselves practicing without awareness of our practice as well - without truly seeing or fully listening, without feeling empathy, conversing on auto-pilot.

Mindfulness is powerful stuff. It’s about self-acceptance, self-awareness and self-compassion. It can soothe and heal mind,


body and spirit. There is a growing body of scientific evidence that mindful practices can reduce anxiety, stress, and chronic pain. Other studies demonstrate psychological benefits, such as elevated emotional intelligence and increased resilience to change and adversity. Formal practice involves learning a basic mindfulness meditation such as following the breath and practicing it on a regular, preferably daily, schedule. Informal practice can literally take place any second of the day, involving focusing the mind on whatever is happening in the present moment, outside of those auto-pilot patterns or responses we have built up over a lifetime.

By paying attention, moment by moment, to where we are and what we’re doing, mindfulness can help us choose how we will behave, knocking us out of auto-pilot. Even a moment of mindful awareness can make any experience richer and more insightful, leading to greater job satisfaction and a happier, more productive workplace. And who wouldn’t want that?

Would you like to learn more about Mindfulness? If you are a smart phone user, there are over 120 Apps related to mindfulness. Courses are popping up all over the province at hospitals, universities, wellness centres and beyond. There are also some samples of great websites and resources listed below:

Websites:www.mindful.orgwww.mindfulnesshamilton.cawww.mindfulnessmeditationtoronto.com

Samples of free guided meditations are available from:

UCLA http://marc.ucla.edu/body.cfm?id=107Tara Brach http://www.tarabrach.com/audioarchives-guided-meditations.html

What did you do for RT Week?

Visit www.rtso.ca and click on the appropriate e-card.

Share the experience.


Home Oxygen Programs VitalAire provides all portable oxygen modalities to meet all clinical and lifestyle needs

Standard Clinical Program> Clinical assessment

> Education on COPD

> Safety instruction

The VitalAire Difference> National Accreditation

> Home Safety Assessment

> Innovative education methods

> Current and potential activity levels

> Walking Diary and ambulation goals

Sleep Apnea? Need CPAP?

VitalAire provides Home Oxygen, CPAP Therapy

and Sleep Apnea Programs across Canada.

Over 30 offices in Ontario to serve you.

Contact us at 1-800-567-0202

> Oxygen saturation (rest, exercise, nocturnal)

> Review of respiratory medications

> 24/7 on call

> Provide all portable options

> Highest standards of quality and safety

> National and International travel needs

> Cutting edge products (tele-monitoring trial)