Developing a Prenatal Nutrition Tool: A Process of Evidence, Collaboration, and Consultation

The Prenatal Nutrition Tool was created for care providers that work with pregnant clients and aims to support focused conversations on nutrition topics that influence maternal and infant health outcomes. A systematic 9-step product development process that combined findings from the literature with perspectives of nutrition experts and care providers was used to develop the tool. The results of a literature review and a modified Delphi Process (to obtain expert opinion) laid the foundation for the tool content. The final tool incorporated client feedback. More specifically, client feedback helped to refine tool questions. The tool consists of 2 parts: a questionnaire (written survey) and a conversation guide. The questionnaire covers 4 key themes (pregnancy weight gain, multivitamins, life circumstances, overall food intake) in 13 questions. The conversation guide utilizes public health nutrition guidance documents to lead care providers in focused discussions with clients. The tool is not intended to be a screening tool for medical conditions or replace an in-depth prenatal nutrition assessment. The tool can be accessed by any care provider in Canada on the Alberta Health Services website at Prenatal Nutrition Tool | Alberta Health Services .

COVID-19 Impact on Alberta Nursing Home Workers: An Interpretive Descriptive Study With Direct Care Providers

COVID-19 has devastated the LTC sector, but we lack systematic information on the impact on frontline staff. Our research, a partnership with the continuing care branches of Alberta Health and Alberta Health Services, was aimed at assessing COVID-19 impacts on staffs’ well-being and quality of work-life and quality of care and life among residents. Here we report on staff. Using an interpretive descriptive approach, we interviewed 140 staff from January through April 2021, in 34 nursing homes. Facilities selected varied in ownership (public/private) and COVID-19 status (high, moderate, or low incidence). Virtual interviews focused on three key areas of impact: (a) staff mental and physical health, well-being, and work-life, (b) the facility, and (c) on residents. Interviews were analyzed using inductive content analysis. Dominant themes included a commitment of staff to resident wellbeing; a norm of stoicism in which accumulative stress of COVID-19 is recognized in participants’ private lives but not their work; the critical role of teamwork in managing extra workload associated with COVID-19 protocols; role flexibility, particularly managers’, enables workers to minimize interruptions to care activities; governmental wage subsidies and the restriction of workers to only one facility benefits residents and workers in terms of time and familiarity, but some health care aides faced a wage reduction of 30-40%. Alongside the research component, we regularly met with stakeholders and end-users to discuss emerging findings and potential areas needing urgent intervention, as well as longer-term programming as the impact of COVID-19 will persist for many years.

Alberta Health Services Emergency Strategic Clinical Network Quality Improvement and Innovation forum 2021

The Alberta Health Services Emergency Strategic Clinical Network Quality Improvement and Innovation forum 2021. Patrick McLane and Eddy Lang on behalf of the Emergency Strategic Clinical Network Evidence-based research and quality improvement work are pivotal to health systems meeting their goals. Translating findings and disseminating innovative practices to new settings occurs in part through knowledge translation events, such as conferences and workshops. The Emergency Strategic Clinical NetworkTM (ESCN) Quality Improvement and Innovation forum fills a gap between local and national events. It is devoted to sharing methods and results of emergency department projects in Alberta among those working in emergency care. 2021 was the third consecutive year the ESCN has held this event. The event provides an opportunity for those working on quality improvement in emergency medicine to network with one another, share innovative projects, share know how and translate promising works to new settings. In addition, the event provides an opportunity to identify projects for potential development through local, provincial, or national funding opportunities. In light of the ongoing pandemic, this year’s forum was held virtually with the support of the University of Calgary Continuing Medical Education group. Funding was kindly provided by the College of Physicians and Surgeons of Alberta. Nineteen teams presented their projects orally. Invited nurse and clinician scientists ranked all submissions to the forum, and the top ranked submissions were recognized in the following categories:Submissions by ESCN staff and the event sponsor were not eligible for recognition. A new feature this year was a presentation by ESCN patient advisors on their perspectives on quality improvement, which was well received by all. Strong attendance shows the value practitioners see in the forum. In 2021, the forum was attended by approximately 140 educators, managers, nurses, physicians and researchers from across Alberta. This is a marked increase over previous years. Post-event evaluation survey feedback suggests that the online format was greatly appreciated and made the event more accessible. Requests for more rural oriented content in event feedback may also indicate that the event drew more rural attendees this year. We are pleased to partner with the Canadian Journal of Emergency Nursing to make abstracts from the event widely available. Individual presenters have had the option of submitting their abstracts for publication in CJEN. In some instances, abstracts have already been published through other conferences and so could not be submitted to CJEN. The findings presented in the abstracts are solely the work of the submitting authors. The ESCN does not guarantee the accuracy of any reported information. The views expressed in the abstracts are solely the views of the authors and do not represent the ESCN or Alberta Health Services. Correspondence to: [email protected]

Evaluation of an Oral Sodium Bicarbonate Protocol for High-Dose Methotrexate Urine Alkalinization

Purpose: Intravenous (IV) sodium bicarbonate is considered standard therapy for high-dose methotrexate (HDMTX) urine alkalinization. Due to a national IV sodium bicarbonate shortage, an oral (PO) sodium bicarbonate protocol was implemented by Alberta Health Services (AHS) for HDMTX urine alkalinization. This study aims to evaluate the efficacy and safety of the PO sodium bicarbonate protocol compared to IV sodium bicarbonate for HDMTX urine alkalinization. Methods: A retrospective chart review of adult patients who received HDMTX (>500 mg/m2) with sodium bicarbonate for urine alkalinization at 4 hospitals in Alberta was conducted. Patients who received IV sodium bicarbonate between January-June 2017 and PO sodium bicarbonate between July-December 2017 were compared for the primary outcome of time to methotrexate clearance. Results: A total of 84 and 78 HDMTX cycles were included in the IV and PO cohorts, respectively. No difference in time to methotrexate clearance was seen between the IV and PO cohorts, 91.6 (± 35.4) hours and 95.2 (± 44) hours respectively; p=0.5. The proportion of HDMTX cycles that experienced a >25% increase in serum creatinine was not statistically significant, IV protocol 12% and PO protocol 5%; p=0.13. Nausea and emesis occurred more frequently in the PO cohort than the IV cohort, though rarely resulted in refused doses or change to alternate sodium bicarbonate formulations.Conclusions: The results of this study indicate that the AHS PO sodium bicarbonate protocol was no different in time to methotrexate clearance or rates of increased serum creatinine when compared to IV sodium bicarbonate.

The Provincial Patient and Family Group (PFG) for Alberta Health Services Transforms How Care is Planned and Delivered: A Decade of Experience

Although many health care organizations made significant headway in building relationships with patients and families at the point of care, there continues to be opportunities to partner with them at the system level. One such opportunity is the Patient and Family Advisory Group (PFG) at Alberta Health Services (AHS). Developed 10 years ago as a formal group of patient and family volunteers, PFG has provided advice on over 350 key organization initiatives, including the Patient First Strategy and the Family Visitation policies and guidelines. Through the formal partnership with PFG and its members who bring their lived experiences with the health system and its services, AHS has demonstrated its commitment to designing and improving services with the user in mind. Now entering its second decade, PFG, supported by AHS leadership, continues to explore new strategic approaches with internal and external stakeholders to reinforce the importance of Patient and Family-Centered Care.

Developments in asthma incidence and prevalence in Alberta between 1995 and 2015

Background Asthma is a chronic respiratory disease characterized by reversible bronchoconstriction and airway inflammation. According to Statistics Canada in 2014, 8.1% of Canadians aged 12 and older reported having asthma diagnosed by a health care professional. Therefore, in 2014 there were an estimated 274,661 persons with asthma in Alberta. Most epidemiological studies estimate prevalence and incidence using survey-based data, which has limitations. The Ontario Asthma Surveillance Information System (OASIS) group has developed and validated an algorithm for epidemiologic asthma studies using provincial health databases. In Alberta, there are some studies using provincial databases, but most are restricted to emergency department visits and do not represent the entire asthma population. Using the validated asthma definition for epidemiologic studies, we performed an analysis of the Alberta Health administrative databases to investigate and report province-wide asthma prevalence, incidence and mortality in Alberta from 1995 to 2015. Methods Data from administrative databases, provided by Alberta Health, was analyzed to determine age and sex specific prevalence, incidence and mortality of the asthma population. The population cohort was all individuals residing in the province of Alberta, ages 0 to 99 from 1995–2015. Kendall’s Tau coefficient test was used to ascertain whether the observed trends were statistically significant. Results Between 1995 and 2015, the age-standardized incidence of asthma decreased by more than 50% in both males and females. Prevalence, however, increased threefold over the 20 years (for both genders) from 3.9 to 12.3% (Tau = 1.00, p < 0.0001) in females and from 3.5 to 11.6% (Tau = 1.00, p < 0.0001) in males. Thus, in 2015 there were 496,927 people with asthma in Alberta. All-cause mortality in the asthma population decreased over time, in both females (Tau = − 0.71, p < 0.0001) and males (Tau = − 0.69, p = 0.0001). For the last several years, all-cause mortality was higher in those with asthma. There were ~ 7 deaths/1000 in the population with asthma versus ~ 5 deaths/1000 in those without asthma. Conclusions The incidence of asthma decreased in both females and males while prevalence continued to increase, although at a slower rate than previously. All-cause mortality in asthma patients was higher than in those without asthma, but both decreased over time.

A 6-Year Review of Carbapenemase-Producing Organisms in Alberta, Canada

Background: This review describes the epidemiology of carbapenemase-producing organisms (CPO) in both the community and hospitalized populations in the province of Alberta. Methods: Newly identified CPO-positive individuals from April 1, 2013, to March 31, 2018, were retrospectively reviewed from 3 data sources, which shared a common provincial CPO case definition: (1) positive CPO results from the Provincial Laboratory for Public Health, which provides all referral and confirmatory CPO testing, (2) CPO cases reported to Alberta Health, and (3) CPO surveillance from Alberta Health Services Infection Prevention and Control (IPC). The 3 data sources were collated, and initial CPO cases were classified according to their likely location of acquisition: hospital-acquired, hospital-identified, on admission, and community-identified. Risk factors and adverse outcomes were obtained from linkage to administrative data. Results: In total, 171 unique individuals were newly identified with a first-time CPO case. Also, 15% (25 of 171) were hospital-acquired (HA), 21% (36 of 171) were hospital-identified (HI), 33% (57 of 171) were on admission, and 31% (53 of 171) were community identified. Overall, 9% (5 of 171) resided in long-term care facilities. Of all patients in acute-care facilities, 30% (35 of 118) had infections and 70% were colonized. Overall, 38% (65 of 171) had an acute-care admission in the 1 year prior to CPO identification; 59% (63 of 106) of those who did not have a previous admission had received healthcare outside Alberta. A large proportion of on-admission cases (81%, 46 of 57) and community-identified (66%, 33 of 53) cases did not have any acute-care admissions in Alberta in the previous year. Overall, 10% (14 of 171) had ICU admissions in Alberta within 30 days of CPO identification, and 5% (8 of 171) died within 30 days. The most common carbapenemase gene identified was NDM-1 (53%, 90 of 171). Conclusions: These findings highlight the robust nature of Alberta’s provincial CPO surveillance network. We reviewed 3 different databases (laboratory, health ministry, IPC) to obtain comprehensive data to better understand the epidemiology of CPO in both the community and hospital settings. More than half of the individuals with CPO were initially identified in the community or on admission. Most had received healthcare outside Alberta, and no acute-care admissions occurred in Alberta in the previous year. It is important to be aware of the growing reservoir of CPO outside the hospital setting because it could impact future screening and management practices.Funding: NoneDisclosures: None

The Utility of Interaction Design as a Novel Tool to Improve Hand Hygiene Frequency on a Pediatric Hematology-Oncology Ward

Johanna Blaak, W21C, University of Calgary; Rachel DiMaio, University of Calgary; Julia Kupis, University of Calgary; Ross Sweetzir, Cisco Systems; Conny Betuzzi, Alberta Children’s Hospital, Alberta Health Services; Corey Dowler, Alberta Children’s Hospital, Alberta Health Services; Krista McIntytre, Alberta Children’s Hospital, Alberta Health Services; Jaime Kaufman, University of Calgary; Greg Hallihan, University of Calgary; John Conly, Foothills Medical Centre; Joseph Vayalumkal, Alberta Childrens HospitalBackground: Interaction design offers a novel interventional strategy to enhance hand-hygiene compliance (HHC) and reduce hospital-acquired infections (HAIs) in the pediatric setting. A quality improvement initiative in collaboration with the University of Calgary and Alberta Health Services led to the implementation of a pilot project with sensor-embedded alcohol -based hand rub (ABHR) dispensers at a hematology-oncology and hematopoietic stem cell transplant unit at Alberta Children’s Hospital (ACH). Methods: Internet of things (IoT) sensors were installed in ABHR dispensers (n = 3) on the unit. Usage data were transmitted to a local server using an MQTT messaging protocol for 16 weeks. Real-time data visualization was presented on a central display next to the nursing station with 11 unique pediatric themes including dinosaurs, transportation, and Canadian animals. Data were collected with and without visualization, and frequency of use (FoU) was determined for both periods. Qualitative interviews with unit stakeholders (n = 13) were held to determine perceptions of the intervention. Results: During the first 8 weeks of the study period, the mean daily use without visualization was 47 times (SD, 14.5) versus 99 times (SD, 23.9) with visualization. When accounting for novelty, by removing the first week of data, the mean daily use was 92 (SD 19.6). The percentage increase from period 1 to period 2 was 96.6%, accounting for novelty. Qualitative interviews with stakeholders (n = 13) on the unit indicated that the intervention increased their personal awareness of hand hygiene (75%) and acted as a constant reminder to perform hand hygiene for everyone on the unit including nonclinical staff, patients, and family members (92%). Conclusions: These limited data suggest that interaction design may improve HH frequency and show promise as a tool for increased HH awareness and education. Interaction design provides a unique, innovative, and acceptable hand hygiene improvement strategy for staff, patients, and families in the pediatric inpatient setting.Funding: NoneDisclosures: None

Developments in asthma incidence and prevalence in Alberta between 1995 and 2015

Background: Asthma is a chronic respiratory disease characterized by reversible bronchoconstriction and airway inflammation. According to Statistics Canada in 2014, 8.1% of Canadians aged 12 and older reported having asthma diagnosed by a health care professional. Therefore, in 2014 there were an estimated 274,661 persons with asthma in Alberta. Most epidemiological studies estimate prevalence and incidence using survey-based data, which has limitations. The Ontario Asthma Surveillance Information System (OASIS) group has developed and validated an algorithm for epidemiologic asthma studies using provincial health databases. In Alberta, there are some studies using provincial databases, but most are restricted to Emergency Department visits and do not represent the entire asthma population. Using the validated asthma definition for epidemiologic studies, we performed an analysis of the Alberta Health administrative databases to investigate and report province-wide asthma prevalence, incidence and mortality in Alberta from 1995 to 2015.Methods: Data from administrative databases, provided by Alberta Health, was analyzed to determine age and sex specific prevalence, incidence and mortality of the asthma population. The population cohort was all individuals residing in the province of Alberta, ages 0 to 99 from 1995-2015. Kendall’s Tau coefficient test was used to ascertain whether the observed trends were statistically significant. Results: Between 1995 and 2015, the age-standardized incidence of asthma decreased by more than 50% in both males and females. Prevalence; however, increased 3-fold over the 20 years for both genders from 3.9% to 12.3% (Tau=1.00, p<0.0001) in females and from 3.5% to 11.6% (Tau=1.00, p<0.0001) in males. Thus, in 2015 there were 496,927 people with asthma in Alberta. All-cause mortality in the asthma population decreased over time, in both females (Tau=-0.71, p<0.0001) and males (Tau=-0.69, p=0.0001). For the last several years, all-cause mortality was higher in those with asthma. There were ~7 deaths/1000 in the population with asthma versus ~5 deaths/1000 in those without asthma. Conclusions: The incidence of asthma decreased in both females and males while prevalence continued to increase, but at a slower rate than previously. All-cause mortality in asthma patients was higher than in those without asthma, but both decreased over time.