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Excellence Canada has developed this Hospital Harm Improvement Resource – a compilation of resources to support patient safety and improvement efforts.","fe2aa94c-215a-4302-89a5-1a8ebb48552a",[495],{"_uid":496,"image":497,"title":501,"format":502,"component":505,"description":506,"key_learning":513,"prerequisite":516},"efc60e6a-070a-4335-af48-979eea4f84ce",{"id":498,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":499,"copyright":16,"fieldtype":288,"meta_data":500,"is_external_url":290},121293751894639,"https://a-ca.storyblok.com/f/850807391887861/2216x1568/ea857fcb8e/shapes.webp",{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Delirium",{"type":12,"content":503},[504],{"type":15},"hero-resource",{"type":12,"content":507},[508],{"type":15,"attrs":509,"content":510},{"textAlign":53},[511],{"text":512,"type":299},"Delirium is a state of confusion that comes on very suddenly and lasts hours to days. It can cause changes in a person’s ability to stay alert, remember, be oriented to time or place, speak or reason clearly.",{"type":12,"content":514},[515],{"type":15},{"type":12,"content":517},[518],{"type":15},[8,76],[521,536,627,687,881,941,989,1060,1144],{"_uid":522,"link":523,"image":524,"title":526,"component":527,"media_type":528,"description":529},"a40f3c31-2be0-450d-8ec3-bc72ad634bf2",[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":288,"meta_data":525},{},"Goal","info-block-program","none",{"type":12,"content":530},[531],{"type":15,"attrs":532,"content":533},{"textAlign":53},[534],{"text":535,"type":299},"To improve the early detection and reduce the incidence of delirium in at risk hospitalized patients in intensive and general care units through implementation of standardized delirium screening and prevention strategies.",{"_uid":537,"content":538,"component":626},"1010ae87-305e-4413-a52a-63495dbe7cf3",[539],{"_uid":540,"content":541,"component":625},"a217acfe-5514-41a9-b405-799b24d56e71",{"type":12,"content":542},[543,550,571,576,581,613],{"type":544,"attrs":545,"content":547},"heading",{"level":546,"textAlign":53},2,[548],{"text":549,"type":299},"Overview",{"type":15,"attrs":551,"content":552},{"textAlign":53},[553,555,569],{"text":554,"type":299},"Healthcare Excellence Canada has developed this ",{"text":556,"type":299,"marks":557},"Hospital Harm Improvement Resource",[558],{"type":559,"attrs":560},"link",{"href":561,"uuid":356,"anchor":53,"custom":562,"target":563,"linktype":564,"story":565},"/resources/hospital-harm-improvement-resource",{},"_self","story",{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},119563150823813,"hospital-harm-improvement-resource","resources/hospital-harm-improvement-resource",{"text":570,"type":299}," – a compilation of resources to support patient safety and improvement efforts.",{"type":15,"attrs":572,"content":573},{"textAlign":53},[574],{"text":575,"type":299},"Delirium can be caused by many things including having an infection, recent surgery, various medical conditions, untreated pain, starting, increasing or stopping some medicines, or not eating or sleeping well. Many things can make delirium worse including physical restraints, bed rest, bladder catheters and certain medications (Coalition for Seniors' Mental Health 2017; American Delirium Society 2015).",{"type":15,"attrs":577,"content":578},{"textAlign":53},[579],{"text":580,"type":299},"Delirium is a common problem in hospitalized ICU patients. It is sometimes not recognized or is misdiagnosed as another condition such as dementia or depression. Patients who experience delirium in the hospital (compared to patients without delirium) are more likely to:",{"type":582,"content":583},"bullet_list",[584,592,599,606],{"type":585,"content":586},"list_item",[587],{"type":15,"attrs":588,"content":589},{"textAlign":53},[590],{"text":591,"type":299},"Stay longer in the hospital and have more hospital associated complications.",{"type":585,"content":593},[594],{"type":15,"attrs":595,"content":596},{"textAlign":53},[597],{"text":598,"type":299},"Experience higher mortality rates in the hospital and up to six to 12 months later.",{"type":585,"content":600},[601],{"type":15,"attrs":602,"content":603},{"textAlign":53},[604],{"text":605,"type":299},"Lose physical function in the hospital and need long-term care after the hospital.",{"type":585,"content":607},[608],{"type":15,"attrs":609,"content":610},{"textAlign":53},[611],{"text":612,"type":299},"Develop dementia or similar types of cognitive impairment even if the delirium clears (American Delirium Society 2015).  ",{"type":15,"attrs":614,"content":615},{"textAlign":53},[616,618,623],{"text":617,"type":299},"Delirium can be prevented. The most important step in delirium management is early recognition and prevention making it an important strategy for quality improvement (",{"text":619,"type":299,"marks":620},"Safer Healthcare Now! ",[621],{"type":622},"italic",{"text":624,"type":299},"2013).","simple-richtext","wysiwyg-program",{"_uid":628,"content":629,"component":626},"2b3dce56-63dc-4fd8-bc67-0a39ac6cbfb7",[630],{"_uid":631,"content":632,"component":625},"32d0ac83-1a8e-428e-b5eb-bff8e0da107f",{"type":12,"content":633},[634,639,650,656,662,667,672,677,682],{"type":544,"attrs":635,"content":636},{"level":546,"textAlign":53},[637],{"text":638,"type":299},"Importance to Patients and Families",{"type":15,"attrs":640,"content":641},{"textAlign":53},[642,644,648],{"text":643,"type":299},"Delirium can also be referred to as \"sundowning\" or \"ICU psychosis\" (American Delirium Society 2015). It may be frightening to family members who are often more aware of the changes in a family member's mental status than are the care providers. With the proper care, delirium can be prevented or minimized (",{"text":645,"type":299,"marks":646},"Safer Healthcare Now!",[647],{"type":622},{"text":649,"type":299},", 2013). Family involvement, particularly in critical care, does not reduce delirium incidence but improves psychological recovery (Black 2011).",{"type":544,"attrs":651,"content":653},{"level":652,"textAlign":53},3,[654],{"text":655,"type":299},"Patient Story",{"type":544,"attrs":657,"content":659},{"level":658,"textAlign":53},4,[660],{"text":661,"type":299},"Let's Respect",{"type":15,"attrs":663,"content":664},{"textAlign":53},[665],{"text":666,"type":299},"Mr. Graham was admitted to hospital with dysphagia and weight loss. He was very confused and uncooperative, believing that staff were trying to poison him. On admission, Mr. Graham's wife explained that he had Alzheimer's disease and described to staff how he usually presented and what he was able to do for himself. She also advised that he had recently been admitted in a confused state to another hospital. Mr. Graham was in fact in the early stages of dementia and had retained good insight into his problems. To many people, he would not usually have appeared 'confused' because of his good social skills.",{"type":15,"attrs":668,"content":669},{"textAlign":53},[670],{"text":671,"type":299},"Unfortunately, the diagnosis of 'dementia' became dominant in his hospital notes, to the degree that this prevailed over his presenting health problems. Despite the details his wife had given, it was assumed that all of Mr. Graham's confusion was due to his dementia and that this was 'normal' and therefore did not warrant further investigation. Mrs. Graham did not feel that all her husband's confusion was due to his dementia, but staff did not seem to be listening, and so she contacted their mental health liaison nurse. The nurse's assessment revealed that Mr. Graham was suffering from anaemia and she recommended further investigation.",{"type":15,"attrs":673,"content":674},{"textAlign":53},[675],{"text":676,"type":299},"It was found that he had indeed been admitted to another local hospital just two months earlier with the same problem. He had received four units of blood and his delirium improved. Mr. Graham received a further blood transfusion and much of his confusion cleared, but his haemoglobin levels were not maintained, and he continued to lose weight due to his difficulty with swallowing. By now, Mr. Graham had become very quiet and subdued. Further investigations eventually followed, and Mr. Graham was found to have a malignant growth in his oesophagus. He died in hospital two weeks later.",{"type":15,"attrs":678,"content":679},{"textAlign":53},[680],{"text":681,"type":299},"Mr. Graham's case demonstrates the dangers of failing to recognize Delirium in people who have dementia and subsequently denying them the assessment and care they are entitled to.",{"type":15,"attrs":683,"content":684},{"textAlign":53},[685],{"text":686,"type":299},"It also shows the importance of listening to those who know the patient well. The need for improved communication and further training and education for hospital staff is also indicated by this case (Let's Respect 2006).",{"_uid":688,"items":689,"title":834,"component":835,"description":836},"56ab3959-1b16-41e9-818d-10a351c10b24",[690],{"_uid":691,"title":692,"ctaLeft":693,"ctaRight":694,"component":695,"columnLeft":696,"columnRight":718},"610b88a1-8386-4bd1-868e-1ec5ba02ae49","Expand to see a full list of resources",[],[],"accordion-item-columns",{"type":12,"content":697},[698],{"type":15,"attrs":699,"content":700},{"textAlign":53},[701,703,710,712,717],{"text":702,"type":299},"To develop a more in-depth understanding of the care delivered to patients, chart audits, incident analyses and prospective analyses can be helpful in identifying quality improvement opportunities. Links to key resources for conducting chart audits and analysis methods are included in the ",{"text":704,"type":299,"marks":705},"Hospital Harm Improvement Resources Introduction",[706],{"type":559,"attrs":707},{"href":561,"uuid":356,"anchor":53,"custom":708,"target":563,"linktype":564,"story":709},{},{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"text":711,"type":299},".",{"text":713,"type":299,"marks":714}," ",[715],{"type":716},"bold",{"text":713,"type":299},{"type":12,"content":719},[720,726],{"type":15,"attrs":721,"content":723},{"textAlign":722},"left",[724],{"text":725,"type":299},"If your review reveals that your cases of delirium are linked to specific processes or procedures, you may find these resources helpful:",{"type":582,"content":727},[728,735,748,760,772,784,822],{"type":585,"content":729},[730],{"type":15,"attrs":731,"content":732},{"textAlign":53},[733],{"text":734,"type":299},"American Delirium Society. https://www.americandeliriumsociety.org/",{"type":585,"content":736},[737],{"type":15,"attrs":738,"content":739},{"textAlign":53},[740,742],{"text":741,"type":299},"Australian Commission on Safety and Quality in Health Care:  Delirium Clinical Care Standard. ",{"text":743,"type":299,"marks":744},"https://www.safetyandquality.gov.au/publications-and-resources/resource-library/delirium-clinical-care-standard-improve-care-and-prevention",[745],{"type":559,"attrs":746},{"href":743,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":747},"url",{"type":585,"content":749},[750],{"type":15,"attrs":751,"content":752},{"textAlign":53},[753,755],{"text":754,"type":299},"Canadian Coalition for Seniors' Mental Health. ",{"text":756,"type":299,"marks":757},"http://www.ccsmh.ca/projects/delirium/",[758],{"type":559,"attrs":759},{"href":756,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":747},{"type":585,"content":761},[762],{"type":15,"attrs":763,"content":764},{"textAlign":53},[765,767],{"text":766,"type":299},"Critical Care Medicine; Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. (2018) ",{"text":768,"type":299,"marks":769},"https://journals.lww.com/ccmjournal/fulltext/2018/09000/Clinical_Practice_Guidelines_for_the_Prevention.29.aspx",[770],{"type":559,"attrs":771},{"href":768,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":747},{"type":585,"content":773},[774],{"type":15,"attrs":775,"content":776},{"textAlign":53},[777,779],{"text":778,"type":299},"European Delirium Association. ",{"text":780,"type":299,"marks":781},"http://www.europeandeliriumassociation.org/",[782],{"type":559,"attrs":783},{"href":780,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":747},{"type":585,"content":785},[786,796],{"type":15,"attrs":787,"content":788},{"textAlign":53},[789,791],{"text":790,"type":299},"National Institutes for Clinical Excellence (NICE) ",{"text":792,"type":299,"marks":793},"https://www.nice.org.uk/",[794],{"type":559,"attrs":795},{"href":792,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":747},{"type":582,"content":797},[798,810],{"type":585,"content":799},[800],{"type":15,"attrs":801,"content":802},{"textAlign":53},[803,805],{"text":804,"type":299},"Delirium: prevention, diagnosis and management Clinical guideline (Published 2010, updated 2019) ",{"text":806,"type":299,"marks":807},"https://www.nice.org.uk/guidance/cg103",[808],{"type":559,"attrs":809},{"href":806,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":747},{"type":585,"content":811},[812],{"type":15,"attrs":813,"content":814},{"textAlign":53},[815,817],{"text":816,"type":299},"Delirium in adults Quality standard (2014) ",{"text":818,"type":299,"marks":819},"https://www.nice.org.uk/guidance/qs63",[820],{"type":559,"attrs":821},{"href":818,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":747},{"type":585,"content":823},[824],{"type":15,"attrs":825,"content":826},{"textAlign":53},[827,829],{"text":828,"type":299},"Registered Nurses Association of Ontario (RNAO) - Delirium, Dementia, and Depression in Older Adults: Assessment and Care (2016). ",{"text":830,"type":299,"marks":831},"https://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression",[832],{"type":559,"attrs":833},{"href":830,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":747},"Clinical and System Reviews, Incident Analyses","accordion-2-columns",{"type":12,"content":837},[838,843,848],{"type":15,"attrs":839,"content":840},{"textAlign":53},[841],{"text":842,"type":299},"Given the broad range of potential causes of Delirium, clinical and system reviews should be conducted to identify potential causes and determine appropriate recommendations.",{"type":15,"attrs":844,"content":845},{"textAlign":722},[846],{"text":847,"type":299},"Occurrences of harm are often complex with many contributing factors. Organizations need to:",{"type":849,"attrs":850,"content":852},"ordered_list",{"order":851},1,[853,860,867,874],{"type":585,"content":854},[855],{"type":15,"attrs":856,"content":857},{"textAlign":53},[858],{"text":859,"type":299},"Measure and monitor the types and frequency of these occurrences.",{"type":585,"content":861},[862],{"type":15,"attrs":863,"content":864},{"textAlign":53},[865],{"text":866,"type":299},"Use appropriate analytical methods to understand the contributing factors.",{"type":585,"content":868},[869],{"type":15,"attrs":870,"content":871},{"textAlign":53},[872],{"text":873,"type":299},"Identify and implement solutions or interventions that are designed to prevent recurrence and reduce risk of harm.",{"type":585,"content":875},[876],{"type":15,"attrs":877,"content":878},{"textAlign":53},[879],{"text":880,"type":299},"Have mechanisms in place to mitigate consequences of harm when it occurs.",{"_uid":882,"items":883,"title":927,"component":928,"description":929},"be3b7a82-b7ec-4b53-a512-e4112073c052",[884,895,903,911,919],{"_uid":885,"image":886,"title":890,"component":891,"description":892},"458f36cf-6776-4902-a081-12df8c65ad9f",{"id":887,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":888,"copyright":16,"fieldtype":288,"meta_data":889,"is_external_url":290},119537678778928,"https://a-ca.storyblok.com/f/850807391887861/600x600/c301964117/checkmark-icon.png",{},"Whenever possible, use measures you are already collecting for other programs.","small-text-image-item",{"type":12,"content":893},[894],{"type":15},{"_uid":896,"image":897,"title":899,"component":891,"description":900},"498e534c-913a-4ac0-90da-3396951645da",{"id":887,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":888,"copyright":16,"fieldtype":288,"meta_data":898,"is_external_url":290},{},"Evaluate your choice of measures in terms of the usefulness of the final results and the resources required to obtain them; try to maximize the former while minimizing the latter.",{"type":12,"content":901},[902],{"type":15},{"_uid":904,"image":905,"title":907,"component":891,"description":908},"5c88ef3c-3fd2-442e-b9cf-478a0643de91",{"id":887,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":888,"copyright":16,"fieldtype":288,"meta_data":906,"is_external_url":290},{},"Try to include both process and outcome measures in your measurement scheme.",{"type":12,"content":909},[910],{"type":15},{"_uid":912,"image":913,"title":915,"component":891,"description":916},"6c6d04c8-d218-424c-945d-1f645847d838",{"id":887,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":888,"copyright":16,"fieldtype":288,"meta_data":914,"is_external_url":290},{},"You may use different measures or modify the measures described below to make them more appropriate and/or useful to your particular setting. However, be aware that modifying measures may limit the comparability of your results to others.",{"type":12,"content":917},[918],{"type":15},{"_uid":920,"image":921,"title":923,"component":891,"description":924},"76a237f7-6280-4c10-9b4e-c9f00114db74",{"id":887,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":888,"copyright":16,"fieldtype":288,"meta_data":922,"is_external_url":290},{},"Posting your measure results within your hospital is a great way to keep your teams motivated and aware of progress. Try to include measures that your team will find meaningful and exciting (IHI 2012).",{"type":12,"content":925},[926],{"type":15},"Measures","small-text-image",{"type":12,"content":930},[931],{"type":15,"attrs":932,"content":933},{"textAlign":53},[934],{"text":935,"type":299,"marks":936},"Vital to quality improvement is measurement, and this applies specifically to implementation of interventions. The chosen measures will help to determine whether an impact is being made (primary outcome), whether the intervention is actually being carried out (process measures), and whether any unintended consequences ensue (balancing measures). In selecting your measures, consider the following:",[937],{"type":938,"attrs":939},"textStyle",{"color":940},"#575757",{"_uid":942,"items":943,"title":976,"component":835,"description":977},"ed575e2d-c13a-4a32-9df1-afe3f84c8465",[944,960],{"_uid":945,"title":946,"ctaLeft":947,"ctaRight":948,"component":695,"columnLeft":949,"columnRight":953},"31df90e3-3c2a-448e-8c03-8cbb7c9f6e6f","Selection Criteria",[],[],{"type":12,"content":950},[951],{"type":15,"attrs":952},{"textAlign":53},{"type":12,"content":954},[955],{"type":15,"attrs":956,"content":957},{"textAlign":53},[958],{"text":959,"type":299},"F05.–: Identified as diagnosis type (2)",{"_uid":961,"title":962,"ctaLeft":963,"ctaRight":964,"component":695,"columnLeft":965,"columnRight":969},"b9b8c1e0-53ae-4f62-8dc7-54e61e464643","Codes & Code Descriptions",[],[],{"type":12,"content":966},[967],{"type":15,"attrs":968},{"textAlign":53},{"type":12,"content":970},[971],{"type":15,"attrs":972,"content":973},{"textAlign":53},[974],{"text":975,"type":299},"F05.–: Delirium, not induced by alcohol and other psychoactive substances","Discharge Abstract Database",{"type":12,"content":978},[979,984],{"type":15,"attrs":980,"content":981},{"textAlign":53},[982],{"text":983,"type":299},"Discharge Abstract Database (DAD) Codes included in this clinical category: A05: Delirium",{"type":15,"attrs":985,"content":986},{"textAlign":53},[987],{"text":988,"type":299},"Concept: Temporary disturbance in consciousness with changes in cognition identified during a hospital stay.",{"_uid":990,"items":991,"title":1055,"component":835,"description":1056},"42ac371a-afd2-4bc4-90ef-f04fd7c47843",[992,1023],{"_uid":993,"title":994,"ctaLeft":995,"ctaRight":996,"component":695,"columnLeft":997,"columnRight":1001},"1206198e-595d-425e-8728-addb2417da98","Covenant Health",[],[],{"type":12,"content":998},[999],{"type":15,"attrs":1000},{"textAlign":53},{"type":12,"content":1002},[1003,1008,1013,1018],{"type":15,"attrs":1004,"content":1005},{"textAlign":53},[1006],{"text":1007,"type":299},"Covenant Health has implemented a data collection tool and processes to ensure 100 per cent of intensive care unit (ICU) patients are screened for Delirium. Delirium is very difficult to recognize in a critical care setting and very often goes undiagnosed. The most important step in Delirium management is early recognition. When Alberta Health Services asked its Edmonton zone to standardize and implement Delirium screening, the team at Covenant Health's Misericordia Hospital site, along with other teams in Edmonton, looked for help from the Safer Healthcare Now! Delirium and Medication Reconciliation Collaborative to improve care for critically ill patients.",{"type":15,"attrs":1009,"content":1010},{"textAlign":53},[1011],{"text":1012,"type":299},"To increase Delirium awareness for staff on the unit, Covenant Health created and put into practice a comprehensive education program. From this program came strategies to arm families of Delirium patients with support and information. The team has also developed noise reduction strategies to minimize sleep disturbance for patients in the ICU and a mobilization protocol to ensure that patients are out of bed when appropriate. A new pain assessment tool is under development for intubated patients who cannot express their pain level.",{"type":15,"attrs":1014,"content":1015},{"textAlign":53},[1016],{"text":1017,"type":299},"The Covenant Health team included the nurse practitioner, educator, supervisor, manager, pharmacist, respiratory therapist and two physiotherapists – all instrumental in the development of Delirium reduction strategies and making the mobilization protocol a reality. A physician group provided support in the ongoing management of appropriate medications.",{"type":15,"attrs":1019,"content":1020},{"textAlign":53},[1021],{"text":1022,"type":299},"\"The Covenant Health team has made huge strides in implementing a significant change in practice and improved care,\" says Kim Scherr, Nurse Practitioner. \"Our efforts to manage and prevent delirium have had a positive impact on the health and quality of life for countless ICU patients.\" (Safer Healthcare Now! One pager, 2013)",{"_uid":1024,"title":1025,"ctaLeft":1026,"ctaRight":1033,"component":695,"columnLeft":1034,"columnRight":1038},"8d6634e1-93b3-4851-b7cc-a77b09e6f538","Safer Elder Care Delirium Prevention Program",[1027],{"_uid":1028,"link":1029,"label":1025,"component":1032},"8e65e242-820f-4c2f-af23-a3113dd4f7e4",{"id":16,"url":1030,"linktype":747,"fieldtype":1031,"cached_url":1030},"https://healthstandards.org/leading-practice/safer-elder-care-delirium-prevention-program/","multilink","simple-link-only",[],{"type":12,"content":1035},[1036],{"type":15,"attrs":1037},{"textAlign":53},{"type":12,"content":1039},[1040],{"type":15,"attrs":1041,"content":1042},{"textAlign":53},[1043,1045,1053],{"text":1044,"type":299},"Of the patients admitted to Halton Healthcare's Oakville Hospital, 65 per cent are aged 65 and over; among this group, those 85 and over represent the fastest growing age group in the Halton Region. Clinical staff at Halton Healthcare Services (HHS) recognized the unique needs of this population, and initiated an interdisciplinary Delirium prevention project in 2007 which would later evolve into the ",{"text":1046,"type":299,"marks":1047},"Hospital Elder Life Program (HELP)",[1048],{"type":559,"attrs":1049},{"href":1050,"uuid":53,"anchor":53,"custom":1051,"target":1052,"linktype":747},"https://www.haltonhealthcare.on.ca/services_/28763/s29695-geriatric-and-senior-specialty-services/s30124-hospital-elder-life-program--help-",{},"_blank",{"text":1054,"type":299}," in 2016. The Hospital Elder Life Program (HELP) is designed to prevent delirium by keeping hospitalized seniors oriented to their surroundings, meeting their needs for nutrition, fluids, and sleep, and keeping them mobile within the limitations of their physical condition. (Health Standards Organization, Leading Practice Library, 2010)","Prevention Success Stories",{"type":12,"content":1057},[1058],{"type":15,"attrs":1059},{"textAlign":53},{"_uid":1061,"items":1062,"title":1139,"component":835,"description":1140},"d27e0ee6-d543-4ffe-ba19-0beac7b5077d",[1063],{"_uid":1064,"title":1065,"ctaLeft":1066,"ctaRight":1067,"component":695,"columnLeft":1068,"columnRight":1072},"d1d27db9-bb85-49f3-bb9e-7342f7791eb1","Expand to see a full list of references",[],[],{"type":12,"content":1069},[1070],{"type":15,"attrs":1071},{"textAlign":53},{"type":12,"content":1073},[1074,1079,1089,1094,1104,1114,1124,1129],{"type":15,"attrs":1075,"content":1076},{"textAlign":53},[1077],{"text":1078,"type":299},"Health Standards Organization, Leading Practices Database: Safer Elder Care Program. Ottawa, ON: Health Standards Organization. Safer Elder Care' Delirium Prevention Program - HSO Health Standards Organization",{"type":15,"attrs":1080,"content":1081},{"textAlign":53},[1082,1084],{"text":1083,"type":299},"American Delirium Society. What is delirium? 2015. ",{"text":1085,"type":299,"marks":1086},"https://americandeliriumsociety.org/what-delirium",[1087],{"type":559,"attrs":1088},{"href":1085,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":747},{"type":15,"attrs":1090,"content":1091},{"textAlign":53},[1092],{"text":1093,"type":299},"Black P, Boore JR, Parahoo K. The effect of nurse-facilitated family participation in the psychological care of the critically ill patient. J Adv Nurs. 2011; 67 (5): 1091–1101. doi: 10.1111/j.1365-2648.2010.05558.x.",{"type":15,"attrs":1095,"content":1096},{"textAlign":53},[1097,1099],{"text":1098,"type":299},"Canadian Coalition for Seniors' Mental Health. Delirium. 2017. ",{"text":1100,"type":299,"marks":1101},"https://ccsmh.ca/projects/delirium/",[1102],{"type":559,"attrs":1103},{"href":1100,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":747},{"type":15,"attrs":1105,"content":1106},{"textAlign":53},[1107,1109],{"text":1108,"type":299},"Institute for Healthcare Improvement (IHI). How-to Guide: Prevent harm from high-alert medications. Cambridge, MA: IHI; 2012. ",{"text":1110,"type":299,"marks":1111},"http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventHarmfromHighAlertMedications.aspx",[1112],{"type":559,"attrs":1113},{"href":1110,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":747},{"type":15,"attrs":1115,"content":1116},{"textAlign":53},[1117,1119],{"text":1118,"type":299},"Let's Respect. Mr. Graham's Story. Department of Health, England. 2006. ",{"text":1120,"type":299,"marks":1121},"https://www.dignityincare.org.uk/",[1122],{"type":559,"attrs":1123},{"href":1120,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":747},{"type":15,"attrs":1125,"content":1126},{"textAlign":53},[1127],{"text":1128,"type":299},"Safer Healthcare Now! Prevention and Management of Delirium: Getting Started Kit. Canadian Patient Safety Institute. 2013. Getting Started Kit: (patientsafetyinstitute.ca)",{"type":15,"attrs":1130,"content":1131},{"textAlign":53},[1132,1134],{"text":1133,"type":299},"Safer Healthcare Now! Delirium management and prevention: one pager. Canadian Patient. ",{"text":1135,"type":299,"marks":1136},"http://www.patientsafetyinstitute.ca/en/toolsResources/Documents/Interventions/Prevention%20and%20Management%20of%20Delirium/Prevention%20of%20Delirium%20One%20Pager.pdf",[1137],{"type":559,"attrs":1138},{"href":1135,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":747},"References",{"type":12,"content":1141},[1142],{"type":15,"attrs":1143},{"textAlign":53},{"id":16,"_uid":1145,"items":1146,"component":1173},"99790bbd-3608-440e-bc3a-a36b27d64581",[1147],{"_uid":1148,"link":1149,"image":1160,"title":1164,"component":1165,"description":1166},"2a855f2a-1298-45bf-af3b-5550b16a0e78",[1150],{"_uid":1151,"link":1152,"label":1158,"component":1159},"1c655002-bbb9-4b07-a259-d910e3f4fd0a",{"id":1153,"url":16,"linktype":564,"fieldtype":1031,"cached_url":1154,"story":1155},"e810da59-1dac-470d-a9fa-5791fc96027f","resources/topics/hospital-harm",{"name":1156,"id":1157,"uuid":1153,"slug":9,"url":1154,"full_slug":1154,"_stopResolving":461},"Hospital Harm",147250689243354,"See all resources","simple-link",{"id":1161,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1162,"copyright":16,"fieldtype":288,"meta_data":1163,"is_external_url":290},121293076058734,"https://a-ca.storyblok.com/f/850807391887861/2068x1484/1aea4e8fb2/senior-woman-holding-doctors-hand.webp",{},"Hospital Harm Resources","image-text-colored-item",{"type":12,"content":1167},[1168],{"type":15,"attrs":1169,"content":1170},{"textAlign":53},[1171],{"text":1172,"type":299},"Healthcare Excellence Canada has developed Hospital Harm Improvement Resources – a compilation of resources to support patient safety and improvement efforts.","image-text-colored",[129,150,136,122,143,115,157],[185,192,200],"hec-page-resource-single","delirium","resources/delirium",-18600,[],"94606976-69f9-464d-bf1f-720674979d3b","2025-12-05T19:49:54.872Z",[],[1185],{"path":1186,"name":1187,"lang":469,"published":461},"ressources/le-delirium","Le délirium",{"name":1189,"created_at":1190,"published_at":1191,"updated_at":1192,"id":1193,"uuid":440,"content":1194,"slug":2206,"full_slug":2207,"sort_by_date":53,"position":2208,"tag_list":2209,"is_startpage":290,"parent_id":462,"meta_data":53,"group_id":2210,"first_published_at":2211,"release_id":53,"lang":300,"path":53,"alternates":2212,"default_full_slug":2207,"translated_slugs":2213},"UTI","2025-12-08T15:55:33.186Z","2026-03-10T16:40:51.248Z","2026-03-10T16:40:51.301Z",120912827454023,{"new":290,"seo":1195,"_uid":493,"hero":1197,"type":174,"topics":1218,"Noindex":290,"content":1219,"audience":2204,"duration":16,"regional":2205,"component":1176},{"_uid":491,"title":1189,"plugin":279,"og_image":16,"og_title":16,"description":1196,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},"Urinary Tract Infection (UTI) can be divided into upper tract infections, which involve the kidneys (pyelonephritis), and lower tract infections, which involve the bladder (cystitis), urethra (urethritis), and prostate (prostatitis).",[1198],{"_uid":496,"image":1199,"title":1201,"format":1202,"component":505,"description":1205,"key_learning":1212,"prerequisite":1215},{"id":498,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":499,"copyright":16,"fieldtype":288,"meta_data":1200,"is_external_url":290},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: UTI",{"type":12,"content":1203},[1204],{"type":15},{"type":12,"content":1206},[1207],{"type":15,"attrs":1208,"content":1209},{"textAlign":53},[1210],{"text":1211,"type":299},"Urinary Tract Infection (UTI) can be divided into upper tract infections, which involve the kidneys (pyelonephritis), and lower tract infections, which involve the bladder (cystitis), urethra (urethritis), and prostate (prostatitis). Infection may spread from one site to the other. Although urethritis and prostatitis are infections that involve the urinary tract, the term UTI usually refers to pyelonephritis and cystitis (Imam, 2020a).",{"type":12,"content":1213},[1214],{"type":15},{"type":12,"content":1216},[1217],{"type":15},[76,8],[1220,1231,1344,1381,1979,2027,2159,2186],{"_uid":522,"link":1221,"image":1222,"title":526,"component":527,"media_type":528,"description":1224},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":288,"meta_data":1223},{},{"type":12,"content":1225},[1226],{"type":15,"attrs":1227,"content":1228},{"textAlign":53},[1229],{"text":1230,"type":299},"Prevention of urinary tract infection by implementing recommended components of care.",{"_uid":1232,"content":1233,"component":626},"505d370d-0052-4f79-9349-5bb00c9999a7",[1234,1263,1277,1311,1325],{"_uid":1235,"content":1236,"component":625},"977d04a2-16c7-4e97-85fe-5e7d2fc1ada2",{"type":12,"content":1237},[1238,1242,1253,1258],{"type":544,"attrs":1239,"content":1240},{"level":546,"textAlign":53},[1241],{"text":549,"type":299},{"type":15,"attrs":1243,"content":1244},{"textAlign":53},[1245,1246,1252],{"text":554,"type":299},{"text":556,"type":299,"marks":1247},[1248],{"type":559,"attrs":1249},{"href":561,"uuid":356,"anchor":53,"custom":1250,"target":563,"linktype":564,"story":1251},"[object Object]",{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"text":570,"type":299},{"type":15,"attrs":1254,"content":1255},{"textAlign":53},[1256],{"text":1257,"type":299},"Most cases of cystitis and pyelonephritis are caused by bacteria. The most common nonbacterial pathogens are fungi (usually candidal species), and, less commonly, mycobacteria, viruses, and parasites. Nonbacterial pathogens usually affect patients who are immunocompromised; have diabetes, urinary tract obstruction, or structural abnormalities; or have had recent urinary tract instrumentation. Urethritis is usually caused by sexually transmitted infections (STI). Prostatitis is usually caused by bacteria and sometimes STIs (Imam, 2020a).",{"type":15,"attrs":1259,"content":1260},{"textAlign":53},[1261],{"text":1262,"type":299},"Infections in the elderly often have atypical clinical presentation and residents of LTC can also be cognitively impaired or have comorbidities like dementia and stroke that impede communication of symptoms (Happe et al., 2017). Up to 50 per cent of elderly Canadians in long-term care facilities have bacteria in their urine without symptoms of a urinary tract infection. This is referred to as asymptomatic bacteriuria representing a colonization state — not an infection. The inappropriate use of antibiotics for elderly patients with asymptomatic bacteriuria exposes them to considerable harm and promotes antimicrobial resistance, which ultimately affects the health of all Canadians (Blondel-Hill et al., 2018).",{"_uid":1264,"content":1265,"component":625},"720dfb2c-cc61-4bc3-9660-a1885a75646a",{"type":12,"content":1266},[1267,1272],{"type":544,"attrs":1268,"content":1269},{"level":652,"textAlign":53},[1270],{"text":1271,"type":299},"Healthcare-Associated UTI",{"type":15,"attrs":1273,"content":1274},{"textAlign":53},[1275],{"text":1276,"type":299},"Urinary tract infections (UTIs) are the fifth most common type of healthcare-associated infection, with an estimated 62,700 UTIs in acute care hospitals (US) in 2015. UTIs additionally account for more than 9.5 per cent of infections reported by acute care hospitals. Virtually all healthcare associated UTIs are caused by instrumentation of the urinary tract. (Centers for Disease Control and Prevention, 2021).",{"_uid":1278,"content":1279,"component":625},"9fdc9233-b802-4f15-b6d6-f9480198dd98",{"type":12,"content":1280},[1281,1286,1291,1296,1301,1306],{"type":544,"attrs":1282,"content":1283},{"level":652,"textAlign":53},[1284],{"text":1285,"type":299},"Catheter-Associated Urinary Tract Infection (CAUTI)",{"type":15,"attrs":1287,"content":1288},{"textAlign":53},[1289],{"text":1290,"type":299},"A catheter-associated urinary tract infection (CAUTI) is a UTI in which the positive culture was taken when an indwelling urinary catheter had been in place for > 2 calendar days. Patients with indwelling bladder catheters are predisposed to bacteriuria and UTIs. Symptoms may be vague or may suggest sepsis. Diagnosis depends on the presence of symptoms (Imam, 2020b).",{"type":15,"attrs":1292,"content":1293},{"textAlign":53},[1294],{"text":1295,"type":299},"A urinary catheter provides a portal of entry into the urinary tract. The source of bacteria causing CAUTI is usually endogenous — typically via meatal, rectal, or vaginal colonization — but rarely may be exogenous, from equipment or contaminated hands of healthcare personnel (Association for Professionals in Infection Control and Epidemiology, 2014).",{"type":15,"attrs":1297,"content":1298},{"textAlign":53},[1299],{"text":1300,"type":299},"The most important risk factor for development of CAUTI is the duration of catheterization. Daily risk of acquisition of bacteriuria with urinary catheters is around seven per cent (Saint, 2000). Other factors predispose CAUTI including patient-related factors such as diabetes, fecal incontinence, incomplete emptying of the bladder, dehydration etc.; care provider related factors such as poor hand hygiene practices, poor insertion technique, etc.; and hospital, equipment, and/or environmental systems (APIC, 2014) and female sex (Imam, 2020b).",{"type":15,"attrs":1302,"content":1303},{"textAlign":53},[1304],{"text":1305,"type":299},"CAUTIs account for the majority of healthcare-associated UTIs and have been associated with increased morbidity, mortality, hospital cost, and length of stay (APIC, 2014). During hospitalization, from 12 to 16 per cent of patients may receive short-term indwelling urinary catheters. The average rate of CAUTI is higher in ICU patients than in non-ICU patients (APIC, 2014).",{"type":15,"attrs":1307,"content":1308},{"textAlign":53},[1309],{"text":1310,"type":299},"An estimated 17 to 69 per cent of CAUTIs may be preventable with implementation of evidence-based practices. Although there has been modest improvement in CAUTI rates, progress has been much slower than other device-associated infections (APIC, 2014).",{"_uid":1312,"content":1313,"component":625},"a1c7251e-5f45-4117-9636-2efeb947132a",{"type":12,"content":1314},[1315,1320],{"type":544,"attrs":1316,"content":1317},{"level":652,"textAlign":53},[1318],{"text":1319,"type":299},"Post-partum UTI",{"type":15,"attrs":1321,"content":1322},{"textAlign":53},[1323],{"text":1324,"type":299},"Post-partum UTI may begin as asymptomatic bacteriuria during pregnancy and is sometimes associated with bladder catheterization to relieve urinary distention during or after labor (Imam 2020). Compared with intended vaginal delivery, intended caesarean delivery was significantly associated with a higher risk of postpartum urinary tract infection. The timing of the postpartum UTI diagnosis did not vary by mode of delivery because 75 per cent of the postpartum UTIs occurred within 15 days post partum, irrespective of mode of delivery (Gundersen et al., 2018). Physiological changes in the bladder occur during pregnancy and predispose women to develop post-partum urinary retention (PUR) during the first hours to days after birth which can lead to UTI (Leach, 2011).",{"_uid":1326,"content":1327,"component":625},"044b76be-1f40-4743-ac0e-f26e2ff6ebda",{"type":12,"content":1328},[1329,1334,1339],{"type":544,"attrs":1330,"content":1331},{"level":652,"textAlign":53},[1332],{"text":1333,"type":299},"UTIs Among Neonates",{"type":15,"attrs":1335,"content":1336},{"textAlign":53},[1337],{"text":1338,"type":299},"The characteristics of UTI in neonates differ from UTIs in infants and children. Its prevalence is much higher, male sex is affected predominantly non-Escherichia coli infections are more frequent, and there is a higher risk of urosepsis than in older age groups. UTI in neonates may be the first indicator of underlying abnormalities of kidneys and the urinary tract (Beetz, 2012). Some 35 to 50 per cent of term and preterm neonates with UTI have abnormal urinary tract ultrasounds (Bonadio & Maida, 2014; Goldman et al., 2000; Ismaili et al., 2011; Sastre et al., 2007).",{"type":15,"attrs":1340,"content":1341},{"textAlign":53},[1342],{"text":1343,"type":299},"The prevalence of UTIs among full-term neonates has been reported to be up to 1.1 per cent, increasing up to seven per cent among those with fever. Evidence indicates that up to approximately 15 per cent of febrile neonates have positive urine culture (Bonadio & Maida, 2014; Ismaili et al., 2011) and most UTI in neonates is related to pyelonephritis as compared to cystitis in older children. The presence of UTI is significantly higher in uncircumcised vs circumcised boys (Beetz, 2012).",{"_uid":628,"content":1345,"component":626},[1346],{"_uid":631,"content":1347,"component":625},{"type":12,"content":1348},[1349,1353,1358,1365,1376],{"type":544,"attrs":1350,"content":1351},{"level":546,"textAlign":53},[1352],{"text":638,"type":299},{"type":15,"attrs":1354,"content":1355},{"textAlign":53},[1356],{"text":1357,"type":299},"Steps that can reduce the risk of UTIs include drinking plenty of liquids, especially water and possibly cranberry juice, and wiping from front to back (Mayo Clinic, 2020). ​​Catheters should be removed as soon as they are no longer clinically indicated. This often makes patients more comfortable, reduces their exposure to infections, and shortens their time in hospital (IHI, 2012).",{"type":544,"attrs":1359,"content":1360},{"level":652,"textAlign":722},[1361],{"text":1362,"type":299,"marks":1363},"Patient Story​​",[1364],{"type":716},{"type":15,"attrs":1366,"content":1367},{"textAlign":722},[1368],{"text":1369,"type":299,"marks":1370},"Don't get 'caught' in the CAUTI trap",[1371,1375],{"type":559,"attrs":1372},{"href":1373,"uuid":53,"anchor":53,"custom":1374,"target":1052,"linktype":747},"https://www.myamericannurse.com/dont-get-caught-in-the-cauti-trap/",{},{"type":716},{"type":15,"attrs":1377,"content":1378},{"textAlign":722},[1379],{"text":1380,"type":299},"One nurse's story: My father died of a heart attack at age 39, and our mother raised my siblings and me. We were all close to mom; however, as the oldest she and I had a special bond. At age 46 she had undergone a mitral valve replacement and her aortic valve was replaced about nine years later. She had survived a cardiac arrest and pulmonary artery rupture. When she was hospitalized with dehydration and acute kidney injury, we believed she would spend some time in the hospital and be discharged. Her kidney function improved with fluids, and her output was carefully monitored with a urinary catheter. She had a history of atrial fibrillation and her rate control medications were held. One day, her temperature soared to 102.8 F and her heart rate increased to 130 beats per minute. She developed sepsis, which placed further stress on her pulmonary and cardiovascular system. In June 2001 my mother died from complications related to a catheter associated urinary tract infection. She was 61 years old; I still miss her (Townsend et al, 2013).",{"_uid":688,"items":1382,"title":834,"component":835,"description":1941},[1383],{"_uid":691,"title":692,"ctaLeft":1384,"ctaRight":1385,"component":695,"columnLeft":1386,"columnRight":1403},[],[],{"type":12,"content":1387},[1388],{"type":15,"attrs":1389,"content":1390},{"textAlign":53},[1391,1392,1398,1399,1402],{"text":702,"type":299},{"text":704,"type":299,"marks":1393},[1394],{"type":559,"attrs":1395},{"href":561,"uuid":356,"anchor":53,"custom":1396,"target":563,"linktype":564,"story":1397},{},{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"text":711,"type":299},{"text":713,"type":299,"marks":1400},[1401],{"type":716},{"text":713,"type":299},{"type":12,"content":1404},[1405,1410,1444,1473,1852,1910],{"type":15,"attrs":1406,"content":1407},{"textAlign":53},[1408],{"text":1409,"type":299},"If your review reveals that your cases of UTI are linked to specific processes or procedures, you may find these resources helpful:",{"type":582,"content":1411},[1412],{"type":585,"content":1413},[1414,1424],{"type":15,"attrs":1415,"content":1416},{"textAlign":53},[1417,1419],{"text":1418,"type":299},"ACTT - Accelerating Change Transformation Team ",{"text":1420,"type":299,"marks":1421},"https://actt.albertadoctors.org/CPGs",[1422],{"type":559,"attrs":1423},{"href":1420,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},{"type":582,"content":1425},[1426],{"type":585,"content":1427},[1428],{"type":15,"attrs":1429,"content":1430},{"textAlign":53},[1431,1433,1437,1439],{"text":1432,"type":299},"Toward Optimized Practice (TOP). ",{"text":1434,"type":299,"marks":1435},"Diagnosis and Management of Urinary Tract Infection in Long Term Care Facilities: Clinical Practice Guideline.",[1436],{"type":622},{"text":1438,"type":299}," TOP; 2015. ",{"text":1440,"type":299,"marks":1441},"https://actt.albertadoctors.org/CPGs/Pages/Urinary-Tract-Infection---Long-Term-Care-Facilities.aspx",[1442],{"type":559,"attrs":1443},{"href":1440,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":747},{"type":582,"content":1445},[1446],{"type":585,"content":1447},[1448,1459],{"type":15,"attrs":1449,"content":1450},{"textAlign":53},[1451,1453],{"text":1452,"type":299},"Association of Medical Microbiology and Infectious Disease Canada (AMMI Canada) ",{"text":1454,"type":299,"marks":1455},"ammi.ca",[1456],{"type":559,"attrs":1457},{"href":1458,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},"http://www.ammi.ca/",{"type":582,"content":1460},[1461],{"type":585,"content":1462},[1463],{"type":15,"attrs":1464,"content":1465},{"textAlign":53},[1466,1468],{"text":1467,"type":299},"Association of Medical Microbiology and Infectious Disease Canada. Asymptomatic Bacteriuria. ",{"text":1469,"type":299,"marks":1470},"https://www.ammi.ca/?ID=127",[1471],{"type":559,"attrs":1472},{"href":1469,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":747},{"type":582,"content":1474},[1475,1515,1548,1600,1632,1664,1698,1726,1755,1787,1819],{"type":585,"content":1476},[1477,1494],{"type":15,"attrs":1478,"content":1479},{"textAlign":53},[1480,1482,1486,1488],{"text":1481,"type":299},"Association for Professionals in Infection Control and Epidemiology (APIC",{"text":1483,"type":299,"marks":1484},")",[1485],{"type":622},{"text":1487,"type":299}," ",{"text":1489,"type":299,"marks":1490},"apic.org",[1491],{"type":559,"attrs":1492},{"href":1493,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},"http://www.apic.org/",{"type":582,"content":1495},[1496],{"type":585,"content":1497},[1498],{"type":15,"attrs":1499,"content":1500},{"textAlign":53},[1501,1503,1507,1509],{"text":1502,"type":299},"Association for Professionals in Infection Control and Epidemiology. ",{"text":1504,"type":299,"marks":1505},"APIC Implementation Guide: Guide to Preventing Catheter-Associated Urinary Tract Infections",[1506],{"type":622},{"text":1508,"type":299},". APIC; 2014. ",{"text":1510,"type":299,"marks":1511},"https://apic.org/professional-practice/implementation-guides/#implementaion-guide-7454",[1512],{"type":559,"attrs":1513},{"href":1510,"uuid":53,"anchor":53,"custom":1514,"target":1052,"linktype":747},{},{"type":585,"content":1516},[1517,1528],{"type":15,"attrs":1518,"content":1519},{"textAlign":53},[1520,1522],{"text":1521,"type":299},"Canadian Urological Association Journal ",{"text":1523,"type":299,"marks":1524},"cuaj.ca",[1525],{"type":559,"attrs":1526},{"href":1527,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},"http://www.cuaj.ca/",{"type":582,"content":1529},[1530],{"type":585,"content":1531},[1532],{"type":15,"attrs":1533,"content":1534},{"textAlign":53},[1535,1537,1541,1543],{"text":1536,"type":299},"Hill TC, Baverstock R, Carlson KV, et al. Best practices for the treatment and prevention of urinary tract infection in the spinal cord injured population. ",{"text":1538,"type":299,"marks":1539},"CUAJ",[1540],{"type":622},{"text":1542,"type":299},". 2013;7(3-4):122-130. doi:10.5489/cuaj.337. ",{"text":1544,"type":299,"marks":1545},"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3650772/",[1546],{"type":559,"attrs":1547},{"href":1544,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},{"type":585,"content":1549},[1550,1562],{"type":15,"attrs":1551,"content":1552},{"textAlign":53},[1553,1555],{"text":1554,"type":299},"Centers for Disease Control and Prevention (CDC). ",{"text":1556,"type":299,"marks":1557},"www.cdc.gov",[1558],{"type":559,"attrs":1559},{"href":1560,"uuid":53,"anchor":53,"custom":1561,"target":1052,"linktype":747},"https://www.cdc.gov/",{},{"type":582,"content":1563},[1564,1582],{"type":585,"content":1565},[1566],{"type":15,"attrs":1567,"content":1568},{"textAlign":53},[1569,1571,1575,1577],{"text":1570,"type":299},"Centers for Disease Control and Prevention. ",{"text":1572,"type":299,"marks":1573},"Urinary Tract Infection (Catheter-Associated Urinary TractInfection [CAUTI] and Non-Catheter-Associated Urinary TractInfection [UTI]) Events",[1574],{"type":622},{"text":1576,"type":299},". CDC; 2021. ",{"text":1578,"type":299,"marks":1579},"https://www.cdc.gov/nhsn/pdfs/pscmanual/7psccauticurrent.pdf",[1580],{"type":559,"attrs":1581},{"href":1578,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},{"type":585,"content":1583},[1584],{"type":15,"attrs":1585,"content":1586},{"textAlign":53},[1587,1589,1593,1595],{"text":1588,"type":299},"Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, Healthcare Infection Control Practices Advisory Committee (HICPAC). ",{"text":1590,"type":299,"marks":1591},"Guideline for Prevention of Catheter-Associated Urinary Tract Infections 2009.",[1592],{"type":622},{"text":1594,"type":299}," Centers for Disease Control and Prevention (CDC); 2010. ",{"text":1596,"type":299,"marks":1597},"http://www.cdc.gov/hicpac/pdf/cauti/cautiguideline2009final.pdf",[1598],{"type":559,"attrs":1599},{"href":1596,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},{"type":585,"content":1601},[1602,1612],{"type":15,"attrs":1603,"content":1604},{"textAlign":53},[1605,1607],{"text":1606,"type":299},"Cochrane Library ",{"text":1608,"type":299,"marks":1609},"https://www.cochranelibrary.com/",[1610],{"type":559,"attrs":1611},{"href":1608,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},{"type":582,"content":1613},[1614],{"type":585,"content":1615},[1616],{"type":15,"attrs":1617,"content":1618},{"textAlign":53},[1619,1621,1625,1627],{"text":1620,"type":299},"Flodgren G, Conterno L, Mayhew A, Omar O, Pereira C, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device‐related infections. ",{"text":1622,"type":299,"marks":1623},"Cochrane Database of Systematic Reviews",[1624],{"type":622},{"text":1626,"type":299},". 2013;(3). doi:10.1002/14651858.CD006559.pub2 ",{"text":1628,"type":299,"marks":1629},"https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006559.pub2/full",[1630],{"type":559,"attrs":1631},{"href":1628,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},{"type":585,"content":1633},[1634,1644],{"type":15,"attrs":1635,"content":1636},{"textAlign":53},[1637,1639],{"text":1638,"type":299},"Heart & Lung - The Journal of Cardiopulmonary and Acute Care ",{"text":1640,"type":299,"marks":1641},"https://www.heartandlung.org/",[1642],{"type":559,"attrs":1643},{"href":1640,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},{"type":582,"content":1645},[1646],{"type":585,"content":1647},[1648],{"type":15,"attrs":1649,"content":1650},{"textAlign":53},[1651,1653,1657,1659],{"text":1652,"type":299},"Conway LJ, Larson EL. Guidelines to prevent catheter-associated urinary tract infection: 1980 to 2010. 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Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. 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Recurrent Urinary Tract Infection. ",{"text":1877,"type":299,"marks":1878},"Journal of Obstetrics and Gynaecology Canada",[1879],{"type":622},{"text":1881,"type":299},". 2010;32(11):1082-1090. doi:10.1016/S1701-2163(16)34717-X",{"type":585,"content":1883},[1884,1895],{"type":15,"attrs":1885,"content":1886},{"textAlign":53},[1887,1889],{"text":1888,"type":299},"Government of Saskatchewan –eHealth ",{"text":1890,"type":299,"marks":1891},"www.ehealthsask.ca",[1892],{"type":559,"attrs":1893},{"href":1894,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},"https://www.ehealthsask.ca/",{"type":582,"content":1896},[1897],{"type":585,"content":1898},[1899],{"type":15,"attrs":1900,"content":1901},{"textAlign":53},[1902,1904,1908],{"text":1903,"type":299},"Government of Saskatchewan Ministry of Health. ",{"text":1905,"type":299,"marks":1906},"Guidelines for the Prevention and Treatment of Urinary Tract Infections (UTIs) in Continuing Care Settings.",[1907],{"type":622},{"text":1909,"type":299}," Government of Saskatchewan; 2013.",{"type":582,"content":1911},[1912],{"type":585,"content":1913},[1914,1926],{"type":15,"attrs":1915,"content":1916},{"textAlign":53},[1917,1919],{"text":1918,"type":299},"The Joint Commission ",{"text":1920,"type":299,"marks":1921},"www.jointcommission.org",[1922],{"type":559,"attrs":1923},{"href":1924,"uuid":53,"anchor":53,"custom":1925,"target":1052,"linktype":747},"https://www.jointcommission.org/",{},{"type":582,"content":1927},[1928],{"type":585,"content":1929},[1930],{"type":15,"attrs":1931,"content":1932},{"textAlign":53},[1933,1935,1939],{"text":1934,"type":299},"The Joint Commission. Surgical Care Improvement Project (SCIP). SCIP-Inf-9: Urinary catheter removed on postoperative day 1 (POD 1) or postoperative day 2 (POD 2) with day or surgery being day zero. ",{"text":1936,"type":299,"marks":1937},"Specifications manual for national hospital inpatient quality measures.",[1938],{"type":622},{"text":1940,"type":299}," Joint Commission; 2013. 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However, be aware that modifying measures may limit the comparability of your results to others.",{"type":12,"content":2005},[2006],{"type":15},{"_uid":2008,"image":2009,"title":2011,"component":891,"description":2012},"9e41e082-bfdc-43b9-9572-3826795c8d91",{"id":887,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":888,"copyright":16,"fieldtype":288,"meta_data":2010,"is_external_url":290},{},"Posting your measure results within your hospital is a great way to keep your teams motivated and aware of progress. Try to include measures that your team will find meaningful and exciting (IHI, 2011).",{"type":12,"content":2013},[2014],{"type":15},{"type":12,"content":2016},[2017,2022],{"type":15,"attrs":2018,"content":2019},{"textAlign":53},[2020],{"text":2021,"type":299},"Vital to quality improvement is measurement, and this applies specifically to implementation of interventions. 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[They] were recognized in the \"all cases\" category for outcomes in … urinary tract infection... Using validated, risk-adjusted data from NSQIP, sites are able to compare their data provincially, nationally, and internationally as well as identify specific areas on which to focus their improvement efforts. (BC Patient Safety & Quality Council, 2021).",{"id":16,"_uid":2187,"items":2188,"component":1173},"aa499916-7a48-4002-b47b-f0c284a2a78b",[2189],{"_uid":2190,"link":2191,"image":2196,"title":1164,"component":1165,"description":2198},"a5693411-d442-4518-aadb-672a5005c6ec",[2192],{"_uid":2193,"link":2194,"label":1158,"component":1159},"baf98971-ae69-4fac-a979-802cbec6f986",{"id":1153,"url":16,"linktype":564,"fieldtype":1031,"cached_url":1154,"story":2195},{"name":1156,"id":1157,"uuid":1153,"slug":9,"url":1154,"full_slug":1154,"_stopResolving":461},{"id":1161,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1162,"copyright":16,"fieldtype":288,"meta_data":2197,"is_external_url":290},{},{"type":12,"content":2199},[2200],{"type":15,"attrs":2201,"content":2202},{"textAlign":53},[2203],{"text":1172,"type":299},[129,150,136,122,143,115,157],[185,192,200],"uti","resources/uti",-18580,[],"d40689f8-5c6f-40f0-8de3-e5cde9c62206","2025-12-08T16:05:33.442Z",[],[2214],{"path":2215,"name":2216,"lang":469,"published":461},"ressources/infections-urinaires","Infections urinaires",{"name":2218,"created_at":2219,"published_at":2220,"updated_at":2221,"id":2222,"uuid":314,"content":2223,"slug":3995,"full_slug":3996,"sort_by_date":53,"position":2208,"tag_list":3997,"is_startpage":290,"parent_id":462,"meta_data":53,"group_id":3998,"first_published_at":3999,"release_id":53,"lang":300,"path":53,"alternates":4000,"default_full_slug":3996,"translated_slugs":4001},"Birth Trauma","2025-12-04T22:06:52.561Z","2026-03-10T16:41:01.042Z","2026-03-10T16:41:01.342Z",119588505956750,{"new":290,"seo":2224,"_uid":493,"hero":2226,"type":174,"topics":2247,"Noindex":290,"content":2248,"audience":3993,"duration":16,"regional":3994,"component":1176},{"_uid":491,"title":2225,"plugin":279,"og_image":16,"og_title":16,"description":492,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},"Birth Trauma ",[2227],{"_uid":496,"image":2228,"title":2230,"format":2231,"component":505,"description":2234,"key_learning":2241,"prerequisite":2244},{"id":498,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":499,"copyright":16,"fieldtype":288,"meta_data":2229,"is_external_url":290},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Birth Trauma",{"type":12,"content":2232},[2233],{"type":15},{"type":12,"content":2235},[2236],{"type":15,"attrs":2237,"content":2238},{"textAlign":53},[2239],{"text":2240,"type":299},"Birth injuries are those sustained during the birth process, which includes labor and delivery. They may be avoidable, or they may be unavoidable and occur despite skilled and competent obstetric care, as in an especially hard or prolonged labor or with an abnormal presentation (Prazad et al., 2019).",{"type":12,"content":2242},[2243],{"type":15},{"type":12,"content":2245},[2246],{"type":15},[76,8],[2249,2260,2446,2548,2576,3025,3057,3457,3792,3859,3975],{"_uid":522,"link":2250,"image":2251,"title":526,"component":527,"media_type":528,"description":2253},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":288,"meta_data":2252},{},{"type":12,"content":2254},[2255],{"type":15,"attrs":2256,"content":2257},{"textAlign":53},[2258],{"text":2259,"type":299},"Reduce the incidence of injuries to the newborn during non-instrumented or instrument-assisted vaginal delivery, or Caesarean section.",{"_uid":537,"content":2261,"component":626},[2262],{"_uid":540,"content":2263,"component":625},{"type":12,"content":2264},[2265,2269,2280,2285,2290,2295,2300,2421,2426,2431,2436,2441],{"type":544,"attrs":2266,"content":2267},{"level":546,"textAlign":53},[2268],{"text":549,"type":299},{"type":15,"attrs":2270,"content":2271},{"textAlign":53},[2272,2273,2279],{"text":554,"type":299},{"text":556,"type":299,"marks":2274},[2275],{"type":559,"attrs":2276},{"href":561,"uuid":356,"anchor":53,"custom":2277,"target":563,"linktype":564,"story":2278},{},{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"text":570,"type":299},{"type":15,"attrs":2281,"content":2282},{"textAlign":53},[2283],{"text":2284,"type":299},"Since 1981, because of refinements in obstetric techniques and the increased use of cesarean deliveries over difficult vaginal deliveries, a dramatic decline has occurred in birth injuries as a cause of neonatal death. Statistics reported for 2013-2014 did not cite birth injury as one of the 10 leading causes of postnatal death. Despite a reduction in related mortality rates, birth injuries still represent an important source of neonatal morbidity and neonatal intensive care unit admissions. Of particular concern are severe intracranial injuries after vacuum-assisted and forceps vaginal delivery and failed attempts at instrument-assisted vaginal delivery. Although many injuries are mild and self-limited, others are serious and potentially lethal (Prazad et al., 2019).",{"type":15,"attrs":2286,"content":2287},{"textAlign":53},[2288],{"text":2289,"type":299},"The incidence of neonatal injury resulting from difficult or traumatic deliveries is decreasing due to increasing use of cesarean delivery in place of difficult versions, vacuum extractions, or mid- or high-forceps deliveries. There is an increased risk of trauma when the infant is large for gestational age which is sometimes associated with maternal diabetes, or when there is a breech or other abnormal presentation, especially in a primipara (Stavis, 2019).",{"type":15,"attrs":2291,"content":2292},{"textAlign":53},[2293],{"text":2294,"type":299},"On the basis of frequencies alone, some of the major findings of Pressler's research, Classification of major newborn birth injuries, can be highlighted. For example, of the 20 major categories of neonatal injuries cited, eight (40 per cent) involve blood vessels and some type of hemorrhage. Nerves or the nervous system is involved in six (30 per cent) of the injuries, and a major organ is also involved in six (30 per cent) of the injuries. Only five (24 per cent) of the injuries are the result of some type of bone fracture. The cause of injuries is thought to be associated with the occurrence of shoulder dystocia in six (30 per cent) of the cases. Use of instrumental techniques (e.g., forceps or vacuum extractors) is stated as being involved in at least 11 (55 per cent) of the injuries. Six (30 per cent) of the birth injuries were reported as leading to a potentially fatal prognosis (Pressler, 2008).",{"type":15,"attrs":2296,"content":2297},{"textAlign":53},[2298],{"text":2299,"type":299},"Categories and related sub-categories of common birth injuries include (Stavis, 2019):",{"type":582,"content":2301},[2302,2309,2316,2323,2330,2337,2344,2351,2358,2365,2372,2379,2386,2393,2400,2407,2414],{"type":585,"content":2303},[2304],{"type":15,"attrs":2305,"content":2306},{"textAlign":53},[2307],{"text":2308,"type":299},"Head injury is the most common birth-related injury and is usually minor, but serious injuries sometimes occur.",{"type":585,"content":2310},[2311],{"type":15,"attrs":2312,"content":2313},{"textAlign":53},[2314],{"text":2315,"type":299},"Head molding",{"type":585,"content":2317},[2318],{"type":15,"attrs":2319,"content":2320},{"textAlign":53},[2321],{"text":2322,"type":299},"Scalp abrasions",{"type":585,"content":2324},[2325],{"type":15,"attrs":2326,"content":2327},{"textAlign":53},[2328],{"text":2329,"type":299},"Caput succedaneum",{"type":585,"content":2331},[2332],{"type":15,"attrs":2333,"content":2334},{"textAlign":53},[2335],{"text":2336,"type":299},"Subgaleal hemorrhage*",{"type":585,"content":2338},[2339],{"type":15,"attrs":2340,"content":2341},{"textAlign":53},[2342],{"text":2343,"type":299},"Cephalhematoma*",{"type":585,"content":2345},[2346],{"type":15,"attrs":2347,"content":2348},{"textAlign":53},[2349],{"text":2350,"type":299},"Depressed skull fractures",{"type":585,"content":2352},[2353],{"type":15,"attrs":2354,"content":2355},{"textAlign":53},[2356],{"text":2357,"type":299},"Facial Nerve Injury* - The facial nerve is injured most often. Although forceps pressure is a common cause, some injuries probably result from pressure on the nerve in utero.",{"type":585,"content":2359},[2360],{"type":15,"attrs":2361,"content":2362},{"textAlign":53},[2363],{"text":2364,"type":299},"Brachial Plexus Injuries* - frequently follow lateral stretching of the neck during delivery caused by shoulder dystocia, breech extraction, or hyperabduction of the neck in cephalic presentations.",{"type":585,"content":2366},[2367],{"type":15,"attrs":2368,"content":2369},{"textAlign":53},[2370],{"text":2371,"type":299},"Erb palsy",{"type":585,"content":2373},[2374],{"type":15,"attrs":2375,"content":2376},{"textAlign":53},[2377],{"text":2378,"type":299},"Klumpke palsy",{"type":585,"content":2380},[2381],{"type":15,"attrs":2382,"content":2383},{"textAlign":53},[2384],{"text":2385,"type":299},"Involvement of the entire plexus",{"type":585,"content":2387},[2388],{"type":15,"attrs":2389,"content":2390},{"textAlign":53},[2391],{"text":2392,"type":299},"Phrenic Nerve Injuries* - Most phrenic nerve injuries (about 75 per cent) are associated with brachial plexus injury. Injury is usually unilateral and caused by a traction injury of the head and neck.",{"type":585,"content":2394},[2395],{"type":15,"attrs":2396,"content":2397},{"textAlign":53},[2398],{"text":2399,"type":299},"Spinal Cord Injury* - Trauma usually occurs in breech deliveries after excess longitudinal traction to the spine.",{"type":585,"content":2401},[2402],{"type":15,"attrs":2403,"content":2404},{"textAlign":53},[2405],{"text":2406,"type":299},"Intracranial Hemorrhage - Hemorrhage in or around the brain can occur in any neonate but is particularly common among those born prematurely; about 25 per cent of premature infants \u003C 1500 g have intracranial hemorrhage.",{"type":585,"content":2408},[2409],{"type":15,"attrs":2410,"content":2411},{"textAlign":53},[2412],{"text":2413,"type":299},"Fractures* - Midclavicular fracture, the most common fracture during birth, occurs with shoulder dystocia and with normal, nontraumatic deliveries.",{"type":585,"content":2415},[2416],{"type":15,"attrs":2417,"content":2418},{"textAlign":53},[2419],{"text":2420,"type":299},"Soft -Tissue Injuries - All soft tissues are susceptible to injury during birth if they have been the presenting part or the fulcrum for the forces of uterine contraction.",{"type":15,"attrs":2422,"content":2423},{"textAlign":53},[2424],{"text":2425,"type":299},"*related to instrument-assisted delivery.",{"type":15,"attrs":2427,"content":2428},{"textAlign":53},[2429],{"text":2430,"type":299},"The incidence of birth injuries has dramatically decreased in the last two decades. Macrosomia and instrumental deliveries are major risk factors for birth injuries. Forceps use is the most common cause of facial nerve injury and is usually self-limited. Erb palsy is the most common brachial plexus injury. Shoulder dystocia is a major risk factor for brachial plexus injury. Planned cesarean delivery for breech presentation decreases mortality and morbidity. Posterior fossa hematoma can cause brain stem compression, leading to respiratory compromise (Akangire & Carter, 2016).",{"type":15,"attrs":2432,"content":2433},{"textAlign":53},[2434],{"text":2435,"type":299},"Now that forceps are used less frequently (e.g., especially use of mid- and high forceps), many of the injuries that were common before 1966 (e.g., skull fractures, facial bone fractures, femur fractures, facial) palsy, and cervical spine injuries are rarely seen in the United States today. Breech deliveries are less likely to be completed vaginally, and cesarean deliveries can be performed using a transverse incision instead of a midline incision approach. Nearly half of major birth injuries and serious negative outcomes are potentially avoidable with early detection and intervention. To avoid specific negative outcomes, various evaluative techniques, such as perinatal history, physical examination, radiographs, paracentesis, ultrasonography, computerized tomography scans, and magnetic resonance imaging, can be used to predict more accurately the abnormalities that place the fetus at high risk for major birth injuries. However, predicting the likelihood of an injury's occurrence does not guarantee that it will not happen, but instead may help lessen the severity of the injury approach (Pressler, 2008).",{"type":15,"attrs":2437,"content":2438},{"textAlign":53},[2439],{"text":2440,"type":299},"When assisted vaginal birth is deemed to have a higher risk of not being successful, it should be considered a trial of assisted vaginal birth and be conducted in a location where immediate recourse to Caesarean delivery is available (Hobson et al., 2019).",{"type":15,"attrs":2442,"content":2443},{"textAlign":53},[2444],{"text":2445,"type":299},"Performing a Caesarean section with extraction of a deeply impacted fetal head out of the maternal pelvis is technically challenging even for experienced obstetricians. The difficulty for the surgeon is to disengage the impacted head by hand due to a lack of space between the muscular and bony maternal pelvis and the deeply impacted fetal head. This procedure is associated with serious neonatal complications, for instance skull injuries causing cerebral haemorrhage and newborn hypoxia that result in higher neonatal admission rates. Head pushing is the most commonly practiced technique. However, reverse breech extraction has gradually been given higher priority. Recently assessed neonatal outcome show less morbidity after reverse breech extraction compared to the head pushing method for obstructed labour. The beneficial maternal-fetal results of performing the reverse breech procedure indicate that it is a reliable alternative to the standard head pushing method and should preferably be used in deeply impacted fetal head situations during Caesarean section in advanced labour (Lenz et al., 2019).",{"_uid":2447,"items":2448,"title":2451,"component":835,"description":2544},"877fd3f0-799f-4b84-883b-4a0d1e431ac1",[2449],{"_uid":2450,"title":2451,"ctaLeft":2452,"ctaRight":2453,"component":695,"columnLeft":2454,"columnRight":2461},"22d6870f-4367-4d25-a46e-581cf92265e3","Risk Factors and Related Injuries",[],[],{"type":12,"content":2455},[2456],{"type":15,"attrs":2457,"content":2458},{"textAlign":53},[2459],{"text":2460,"type":299},"Factors predisposing the infant to birth injury and their related injuries include (Akangire, 2016):",{"type":12,"content":2462},[2463,2472,2481,2490,2499,2508,2517,2526,2535],{"type":15,"attrs":2464,"content":2465},{"textAlign":53},[2466,2470],{"text":2467,"type":299,"marks":2468},"Risk factors",[2469],{"type":716},{"text":2471,"type":299},": Related injuries",{"type":15,"attrs":2473,"content":2474},{"textAlign":53},[2475,2479],{"text":2476,"type":299,"marks":2477},"Forceps delivery",[2478],{"type":716},{"text":2480,"type":299},": Facial nerve injuries",{"type":15,"attrs":2482,"content":2483},{"textAlign":53},[2484,2488],{"text":2485,"type":299,"marks":2486},"Vacuum extraction",[2487],{"type":716},{"text":2489,"type":299},": Depressed skull fracture, subgaleal hemorrhage",{"type":15,"attrs":2491,"content":2492},{"textAlign":53},[2493,2497],{"text":2494,"type":299,"marks":2495},"Forceps/vacuum/forceps + vacuum",[2496],{"type":716},{"text":2498,"type":299},": Cephalohematoma, intracranial hemorrhage, shoulder dystocia, retinal hemorrhages",{"type":15,"attrs":2500,"content":2501},{"textAlign":53},[2502,2506],{"text":2503,"type":299,"marks":2504},"Breech presentation",[2505],{"type":716},{"text":2507,"type":299},": Brachial plexus palsy, intracranial hemorrhage, gluteal lacerations, long bone fractures",{"type":15,"attrs":2509,"content":2510},{"textAlign":53},[2511,2515],{"text":2512,"type":299,"marks":2513},"Macrosomia",[2514],{"type":716},{"text":2516,"type":299},": Shoulder dystocia, clavicle, and rib fractures, cephalohematoma, caput succedaneum",{"type":15,"attrs":2518,"content":2519},{"textAlign":53},[2520,2524],{"text":2521,"type":299,"marks":2522},"Abnormal presentation (face, brow, transverse, compound)",[2523],{"type":716},{"text":2525,"type":299},": Excessive bruising, retinal hemorrhage, lacerations",{"type":15,"attrs":2527,"content":2528},{"textAlign":53},[2529,2533],{"text":2530,"type":299,"marks":2531},"Prematurity",[2532],{"type":716},{"text":2534,"type":299},": Bruising, intracranial, and extracranial hemorrhage",{"type":15,"attrs":2536,"content":2537},{"textAlign":53},[2538,2542],{"text":2539,"type":299,"marks":2540},"Precipitous delivery",[2541],{"type":716},{"text":2543,"type":299},": Bruising, intracranial, and extracranial hemorrhage, retinal hemorrhage",{"type":12,"content":2545},[2546],{"type":15,"attrs":2547},{"textAlign":53},{"_uid":628,"content":2549,"component":626},[2550],{"_uid":631,"content":2551,"component":625},{"type":12,"content":2552},[2553,2557,2562,2567],{"type":544,"attrs":2554,"content":2555},{"level":546,"textAlign":53},[2556],{"text":638,"type":299},{"type":15,"attrs":2558,"content":2559},{"textAlign":53},[2560],{"text":2561,"type":299},"'I can't forget the horror of my son's birth'",{"type":15,"attrs":2563,"content":2564},{"textAlign":53},[2565],{"text":2566,"type":299},"Despite medical advancements, childbirth is a major cause of post-traumatic stress disorder – and yet nobody talks about it. Leah McLaren tells the harrowing story of the arrival of her second child – and her fight for treatment and support (McLaren, 2017).",{"type":15,"attrs":2568,"content":2569},{"textAlign":53},[2570],{"text":2571,"type":299,"marks":2572},"https://www.theguardian.com/lifeandstyle/2017/may/07/i-cant-forget-the-horror-of-my-sons-birth-post-traumatic-stress-disorder-childbirth",[2573],{"type":559,"attrs":2574},{"href":2571,"uuid":53,"anchor":53,"custom":2575,"target":1052,"linktype":747},{},{"_uid":688,"items":2577,"title":834,"component":835,"description":2981},[2578],{"_uid":691,"title":692,"ctaLeft":2579,"ctaRight":2580,"component":695,"columnLeft":2581,"columnRight":2603},[],[],{"type":12,"content":2582},[2583],{"type":15,"attrs":2584,"content":2585},{"textAlign":53},[2586,2592,2599],{"text":2587,"type":299,"marks":2588},"To develop a more in-depth understanding of the care delivered to patients, chart audits, incident analyses and prospective analyses can be helpful in identifying quality improvement opportunities. Links to key resources for conducting chart audits and analysis methods are included in the ",[2589],{"type":938,"attrs":2590},{"color":2591},"#000000",{"text":2593,"type":299,"marks":2594},"Hospital Harm Improvement Resource Introduction",[2595],{"type":559,"attrs":2596},{"href":561,"uuid":356,"anchor":53,"custom":2597,"target":563,"linktype":564,"story":2598},{},{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"text":711,"type":299,"marks":2600},[2601],{"type":938,"attrs":2602},{"color":2591},{"type":12,"content":2604},[2605,2610,2615],{"type":15,"attrs":2606,"content":2607},{"textAlign":53},[2608],{"text":2609,"type":299},"Chart audits are recommended as a means to develop a more in-depth understanding of the care delivered to patients identified by the HHI. Chart audits help identify quality improvement opportunities.",{"type":15,"attrs":2611,"content":2612},{"textAlign":53},[2613],{"text":2614,"type":299},"If your review reveals that your cases of birth trauma are linked to specific processes or procedures, you may find these resources helpful:",{"type":582,"content":2616},[2617,2651,2684,2717,2739,2768,2862,2889,2910,2924,2957,2970],{"type":585,"content":2618},[2619,2630],{"type":15,"attrs":2620,"content":2621},{"textAlign":53},[2622,2624],{"text":2623,"type":299},"Association of Ontario Midwives ",{"text":2625,"type":299,"marks":2626},"www.ontariomidwives.ca",[2627],{"type":559,"attrs":2628},{"href":2629,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},"http://www.ontariomidwives.ca/",{"type":582,"content":2631},[2632],{"type":585,"content":2633},[2634],{"type":15,"attrs":2635,"content":2636},{"textAlign":53},[2637,2639,2643,2645],{"text":2638,"type":299},"Corey J, MacDonald T. ",{"text":2640,"type":299,"marks":2641},"Management of the Uncomplicated Pregnancy Beyond 41+0 Weeks Gestation",[2642],{"type":622},{"text":2644,"type":299},". Association of Ontario Midwives; 2010. ",{"text":2646,"type":299,"marks":2647}," https://www.ontariomidwives.ca/sites/default/files/CPG%20full%20guidelines/CPG-Management-of-pregnancy-beyond-41-weeks-gestation-PUB.pdf",[2648],{"type":559,"attrs":2649},{"href":2650,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},"https://www.ontariomidwives.ca/sites/default/files/CPG%20full%20guidelines/CPG-Management-of-pregnancy-beyond-41-weeks-gestation-PUB.pdf",{"type":585,"content":2652},[2653,2663],{"type":15,"attrs":2654,"content":2655},{"textAlign":53},[2656,2658],{"text":2657,"type":299},"British Medical Journal Open ",{"text":2659,"type":299,"marks":2660},"https://bmjopen.bmj.com/",[2661],{"type":559,"attrs":2662},{"href":2659,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},{"type":582,"content":2664},[2665],{"type":585,"content":2666},[2667],{"type":15,"attrs":2668,"content":2669},{"textAlign":53},[2670,2672,2676,2678],{"text":2671,"type":299},"Coroneos CJ, Voineskos SH, Christakis MK, Thoma A, Bain JR, Brouwers MC. Obstetrical brachial plexus injury (OBPI): Canada's national clinical practice guideline. ",{"text":2673,"type":299,"marks":2674},"BMJ Open",[2675],{"type":622},{"text":2677,"type":299},". 2017;7(1):e014141. doi:",{"text":2679,"type":299,"marks":2680},"10.1136/bmjopen-2016-014141",[2681],{"type":559,"attrs":2682},{"href":2683,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":747},"https://doi.org/10.1136/bmjopen-2016-014141",{"type":585,"content":2685},[2686,2696],{"type":15,"attrs":2687,"content":2688},{"textAlign":53},[2689,2691],{"text":2690,"type":299},"Cureus Journal of Medical Science ",{"text":2692,"type":299,"marks":2693},"https://www.cureus.com/",[2694],{"type":559,"attrs":2695},{"href":2692,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":747},{"type":582,"content":2697},[2698],{"type":585,"content":2699},[2700],{"type":15,"attrs":2701,"content":2702},{"textAlign":53},[2703,2705,2709,2711],{"text":2704,"type":299},"Ojumah N, Ramdhan RC, Wilson C, Loukas M, Oskouian RJ, Tubbs RS. Neurological Neonatal Birth Injuries: A Literature Review. ",{"text":2706,"type":299,"marks":2707},"Cureus",[2708],{"type":622},{"text":2710,"type":299},". 2017;9(12):e1938. doi:",{"text":2712,"type":299,"marks":2713},"10.7759/cureus.1938",[2714],{"type":559,"attrs":2715},{"href":2716,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},"https://doi.org/10.7759/cureus.1938",{"type":585,"content":2718},[2719,2724],{"type":15,"attrs":2720,"content":2721},{"textAlign":53},[2722],{"text":2723,"type":299},"Fanaroff & Martin's Neonatal-Perinatal Medicine Eleventh Edition",{"type":582,"content":2725},[2726],{"type":585,"content":2727},[2728],{"type":15,"attrs":2729,"content":2730},{"textAlign":53},[2731,2733,2737],{"text":2732,"type":299},"Prazad PA, Rajpal MN, Mangurten HH, Puppala BL. Birth Injuries. In: ",{"text":2734,"type":299,"marks":2735},"Fanaroff and Martin's Neonatal-Perinatal Medicine",[2736],{"type":622},{"text":2738,"type":299},". 11th ed. Chapter 29. Elsevier; 2020:458-488",{"type":585,"content":2740},[2741,2752],{"type":15,"attrs":2742,"content":2743},{"textAlign":53},[2744,2746],{"text":2745,"type":299},"HIROC ",{"text":2747,"type":299,"marks":2748},"www.hiroc.com",[2749],{"type":559,"attrs":2750},{"href":2751,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},"http://www.hiroc.com/",{"type":582,"content":2753},[2754,2761],{"type":585,"content":2755},[2756],{"type":15,"attrs":2757,"content":2758},{"textAlign":53},[2759],{"text":2760,"type":299},"Healthcare Insurance Reciprocal of Canada. Assisted Vaginal Deliveries. HIROC Risk Reference Sheets. Published September 2020. https://www.hiroc.com/resources/risk-reference-sheets/assisted-vaginal-deliveries",{"type":585,"content":2762},[2763],{"type":15,"attrs":2764,"content":2765},{"textAlign":53},[2766],{"text":2767,"type":299},"Healthcare Insurance Reciprocal of Canada. Shoulder Dystocia. HIROC Risk Reference Sheets. Published 2020. https://www.hiroc.com/resources/risk-reference-sheets/shoulder-dystocia",{"type":585,"content":2769},[2770,2781],{"type":15,"attrs":2771,"content":2772},{"textAlign":53},[2773,2775],{"text":2774,"type":299},"Journal of Obstetrics and Gynecology of Canada ",{"text":2776,"type":299,"marks":2777},"www.jogc.ca",[2778],{"type":559,"attrs":2779},{"href":2780,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":747},"http://www.jogc.ca/",{"type":582,"content":2782},[2783,2795,2808,2826,2844],{"type":585,"content":2784},[2785],{"type":15,"attrs":2786,"content":2787},{"textAlign":53},[2788,2790,2793],{"text":2789,"type":299},"Hobson S, Cassell K, Windrim R, Cargill Y. No. 381-Assisted Vaginal Birth. ",{"text":1877,"type":299,"marks":2791},[2792],{"type":622},{"text":2794,"type":299},". 2019;41(6):870-882. doi:10.1016/j.jogc.2018.10.020",{"type":585,"content":2796},[2797],{"type":15,"attrs":2798,"content":2799},{"textAlign":53},[2800,2802,2806],{"text":2801,"type":299},"Kotaska A, Menticoglou S. No. 384-Management of breech presentation at term. ",{"text":2803,"type":299,"marks":2804},"J Obstet Gynaecol Can",[2805],{"type":622},{"text":2807,"type":299},". 2019;41(8):1193 1205. doi:10.1016/j.jogc.2018.12.018",{"type":585,"content":2809},[2810],{"type":15,"attrs":2811,"content":2812},{"textAlign":53},[2813,2815,2818,2820],{"text":2814,"type":299},"Lefebvre G, Calder LA, De Gorter R, Bowman CL, Bell D, Bow M. Recommendations from a national panel on quality improvement in obstetrics. ",{"text":1877,"type":299,"marks":2816},[2817],{"type":622},{"text":2819,"type":299},". 2019; 41(5):653-659. doi:",{"text":2821,"type":299,"marks":2822},"10.1016/j.jogc.2019.02.011",[2823],{"type":559,"attrs":2824},{"href":2825,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},"https://doi.org/10.1016/j.jogc.2019.02.011",{"type":585,"content":2827},[2828],{"type":15,"attrs":2829,"content":2830},{"textAlign":53},[2831,2833,2836,2838],{"text":2832,"type":299},"Bloch C, Dore S, Hobson S. Committee Opinion No. 415: Impacted fetal head, second-stage cesarean delivery. ",{"text":1877,"type":299,"marks":2834},[2835],{"type":622},{"text":2837,"type":299},". 2021;43(3):406-413. doi:",{"text":2839,"type":299,"marks":2840},"10.1016/j.jogc.2021.01.005",[2841],{"type":559,"attrs":2842},{"href":2843,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},"https://doi.org/10.1016/j.jogc.2021.01.005",{"type":585,"content":2845},[2846],{"type":15,"attrs":2847,"content":2848},{"textAlign":53},[2849,2851,2854,2856],{"text":2850,"type":299},"Berger H, Gagnon R, Sermer M. Guideline No. 393-Diabetes in pregnancy. ",{"text":1877,"type":299,"marks":2852},[2853],{"type":622},{"text":2855,"type":299},". 2019;41(12):1814-1825.e1. doi:",{"text":2857,"type":299,"marks":2858},"10.1016/j.jogc.2019.03.008",[2859],{"type":559,"attrs":2860},{"href":2861,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},"https://doi.org/10.1016/j.jogc.2019.03.008",{"type":585,"content":2863},[2864,2869],{"type":15,"attrs":2865,"content":2866},{"textAlign":53},[2867],{"text":2868,"type":299},"Journal of Perinatal and Neonatal Nursing",{"type":582,"content":2870},[2871],{"type":585,"content":2872},[2873],{"type":15,"attrs":2874,"content":2875},{"textAlign":53},[2876,2878,2882,2884],{"text":2877,"type":299},"Pressler JL. Classification of Major Newborn Birth Injuries. ",{"text":2879,"type":299,"marks":2880},"The Journal of Perinatal & Neonatal Nursing",[2881],{"type":622},{"text":2883,"type":299},". 2008;22(1). ",{"text":2885,"type":299,"marks":2886},"https://journals.lww.com/jpnnjournal/Fulltext/2008/01000/Classification_of_Major_Newborn_Birth_Injuries.13.aspx",[2887],{"type":559,"attrs":2888},{"href":2885,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},{"type":585,"content":2890},[2891,2896],{"type":15,"attrs":2892,"content":2893},{"textAlign":53},[2894],{"text":2895,"type":299},"Merck Manual",{"type":582,"content":2897},[2898],{"type":585,"content":2899},[2900],{"type":15,"attrs":2901,"content":2902},{"textAlign":53},[2903,2905],{"text":2904,"type":299},"Stavis RL. Birth Injuries. Merck Manuals Professional Edition. Published July 2019. Accessed March 2021. ",{"text":2906,"type":299,"marks":2907},"https://www.merckmanuals.com/en-ca/professional/pediatrics/perinatal-problems/birth-injuries",[2908],{"type":559,"attrs":2909},{"href":2906,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},{"type":585,"content":2911},[2912],{"type":15,"attrs":2913,"content":2914},{"textAlign":53},[2915,2917,2922],{"text":2916,"type":299},"MORE",{"text":2918,"type":299,"marks":2919},"OB  ",[2920],{"type":2921},"superscript",{"text":2923,"type":299},"www.moreob.com",{"type":585,"content":2925},[2926,2936],{"type":15,"attrs":2927,"content":2928},{"textAlign":53},[2929,2931],{"text":2930,"type":299},"Pediatrics in Review ",{"text":2932,"type":299,"marks":2933},"https://pedsinreview.aappublications.org/",[2934],{"type":559,"attrs":2935},{"href":2932,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":747},{"type":582,"content":2937},[2938],{"type":585,"content":2939},[2940],{"type":15,"attrs":2941,"content":2942},{"textAlign":53},[2943,2945,2949,2951],{"text":2944,"type":299},"Akangire G, Carter B. Birth Injuries in Neonates. ",{"text":2946,"type":299,"marks":2947},"Pediatr Rev",[2948],{"type":622},{"text":2950,"type":299}," 2016;37(11):451. doi:",{"text":2952,"type":299,"marks":2953},"10.1542/pir.2015-0125",[2954],{"type":559,"attrs":2955},{"href":2956,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},"https://doi.org/10.1542/pir.2015-0125",{"type":585,"content":2958},[2959],{"type":15,"attrs":2960,"content":2961},{"textAlign":53},[2962,2964],{"text":2963,"type":299},"Salus Global ",{"text":2965,"type":299,"marks":2966},"www.salusglobal.com",[2967],{"type":559,"attrs":2968},{"href":2969,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},"http://www.salusglobal.com/",{"type":585,"content":2971},[2972],{"type":15,"attrs":2973,"content":2974},{"textAlign":53},[2975,2977],{"text":2976,"type":299},"Society of Obstetricians and Gynecologists of Canada ",{"text":1862,"type":299,"marks":2978},[2979],{"type":559,"attrs":2980},{"href":1866,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},{"type":12,"content":2982},[2983,2994,2998],{"type":15,"attrs":2984,"content":2985},{"textAlign":53},[2986,2988,2992],{"text":2987,"type":299},"Given the broad range of potential causes of ",{"text":2989,"type":299,"marks":2990},"birth trauma",[2991],{"type":622},{"text":2993,"type":299},", in addition to recommendations listed above, we recommend conducting clinical and system reviews to identify latent causes and determine appropriate recommendations.",{"type":15,"attrs":2995,"content":2996},{"textAlign":722},[2997],{"text":847,"type":299},{"type":849,"attrs":2999,"content":3000},{"order":851},[3001,3007,3013,3019],{"type":585,"content":3002},[3003],{"type":15,"attrs":3004,"content":3005},{"textAlign":53},[3006],{"text":859,"type":299},{"type":585,"content":3008},[3009],{"type":15,"attrs":3010,"content":3011},{"textAlign":53},[3012],{"text":866,"type":299},{"type":585,"content":3014},[3015],{"type":15,"attrs":3016,"content":3017},{"textAlign":53},[3018],{"text":873,"type":299},{"type":585,"content":3020},[3021],{"type":15,"attrs":3022,"content":3023},{"textAlign":53},[3024],{"text":880,"type":299},{"_uid":882,"items":3026,"title":927,"component":928,"description":3051},[3027,3033,3039,3045],{"_uid":885,"image":3028,"title":915,"component":891,"description":3030},{"id":887,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":888,"copyright":16,"fieldtype":288,"meta_data":3029,"is_external_url":290},{},{"type":12,"content":3031},[3032],{"type":15},{"_uid":896,"image":3034,"title":899,"component":891,"description":3036},{"id":887,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":888,"copyright":16,"fieldtype":288,"meta_data":3035,"is_external_url":290},{},{"type":12,"content":3037},[3038],{"type":15},{"_uid":904,"image":3040,"title":890,"component":891,"description":3042},{"id":887,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":888,"copyright":16,"fieldtype":288,"meta_data":3041,"is_external_url":290},{},{"type":12,"content":3043},[3044],{"type":15},{"_uid":912,"image":3046,"title":907,"component":891,"description":3048},{"id":887,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":888,"copyright":16,"fieldtype":288,"meta_data":3047,"is_external_url":290},{},{"type":12,"content":3049},[3050],{"type":15},{"type":12,"content":3052},[3053],{"type":15,"attrs":3054,"content":3055},{"textAlign":53},[3056],{"text":935,"type":299},{"_uid":942,"items":3058,"title":976,"component":835,"description":3431},[3059,3122,3193],{"_uid":945,"title":946,"ctaLeft":3060,"ctaRight":3061,"component":695,"columnLeft":3062,"columnRight":3078},[],[],{"type":12,"content":3063},[3064,3073],{"type":15,"attrs":3065,"content":3066},{"textAlign":53},[3067,3071],{"text":3068,"type":299,"marks":3069},"Code",[3070],{"type":716},{"text":3072,"type":299},": Code descriptions ",{"type":15,"attrs":3074,"content":3075},{"textAlign":53},[3076],{"text":3077,"type":299},"P10–P15: Identified as diagnosis type (M), (1), (2), (W), (X) or (Y) AND Entry Code N*",{"type":12,"content":3079},[3080,3084],{"type":15,"attrs":3081,"content":3082},{"textAlign":53},[3083],{"text":2092,"type":299},{"type":849,"attrs":3085,"content":3086},{"order":851},[3087,3094,3101,3108,3115],{"type":585,"content":3088},[3089],{"type":15,"attrs":3090,"content":3091},{"textAlign":53},[3092],{"text":3093,"type":299},"Newborns whose mother’s abstract has intervention codes for instrument-assisted or Caesarean section delivery,† (5.MD.53.^^, 5.MD.54.^^, 5.MD.55.^^, 5.MD.56.NN, 5.MD.56.PC, 5.MD.56.NR, 5.MD.56.PF, 5.MD.56.NW, 5MD.56.PJ or 5.MD.60.^^)‡ OR",{"type":585,"content":3095},[3096],{"type":15,"attrs":3097,"content":3098},{"textAlign":53},[3099],{"text":3100,"type":299},"Newborn abstracts with brain damage due to birth injury (P10.–, P11.1 or P11.2) as diagnosis type (M) or (1) AND preterm and low birth weight (P07.– ) as diagnosis type (M), (1) or (2) OR",{"type":585,"content":3102},[3103],{"type":15,"attrs":3104,"content":3105},{"textAlign":53},[3106],{"text":3107,"type":299},"Newborn abstracts with termination of pregnancy affecting fetuses and newborns (P96.4) OR",{"type":585,"content":3109},[3110],{"type":15,"attrs":3111,"content":3112},{"textAlign":53},[3113],{"text":3114,"type":299},"Newborn abstracts with congenital malformations of the central nervous system (Q00–Q07) as diagnosis type (M) or (1) OR",{"type":585,"content":3116},[3117],{"type":15,"attrs":3118,"content":3119},{"textAlign":53},[3120],{"text":3121,"type":299},"Newborn abstracts with congenital malformations and deformations of the musculoskeletal system (Q65–Q79) as diagnosis type (M) or (1)",{"_uid":961,"title":962,"ctaLeft":3123,"ctaRight":3124,"component":695,"columnLeft":3125,"columnRight":3129},[],[],{"type":12,"content":3126},[3127],{"type":15,"attrs":3128},{"textAlign":53},{"type":12,"content":3130},[3131,3139,3148,3157,3166,3175,3184],{"type":15,"attrs":3132,"content":3133},{"textAlign":53},[3134,3137],{"text":3068,"type":299,"marks":3135},[3136],{"type":716},{"text":3138,"type":299},": Code Description",{"type":15,"attrs":3140,"content":3141},{"textAlign":53},[3142,3146],{"text":3143,"type":299,"marks":3144},"P10.-",[3145],{"type":716},{"text":3147,"type":299},": Intracranial laceration and hemorrhage due to birth injury",{"type":15,"attrs":3149,"content":3150},{"textAlign":53},[3151,3155],{"text":3152,"type":299,"marks":3153},"P11.-",[3154],{"type":716},{"text":3156,"type":299},": Other birth injuries to central nervous system",{"type":15,"attrs":3158,"content":3159},{"textAlign":53},[3160,3164],{"text":3161,"type":299,"marks":3162},"P12.-",[3163],{"type":716},{"text":3165,"type":299},": Birth injury to scalp",{"type":15,"attrs":3167,"content":3168},{"textAlign":53},[3169,3173],{"text":3170,"type":299,"marks":3171},"P13.-",[3172],{"type":716},{"text":3174,"type":299},": Birth injury to skeleton",{"type":15,"attrs":3176,"content":3177},{"textAlign":53},[3178,3182],{"text":3179,"type":299,"marks":3180},"P14.-",[3181],{"type":716},{"text":3183,"type":299},": Birth injury to peripheral nervous system",{"type":15,"attrs":3185,"content":3186},{"textAlign":53},[3187,3191],{"text":3188,"type":299,"marks":3189},"P15.-",[3190],{"type":716},{"text":3192,"type":299},": Other birth injuries",{"_uid":2091,"title":3194,"ctaLeft":3195,"ctaRight":3196,"component":695,"columnLeft":3197,"columnRight":3219},"Additional codes & Exclusions",[],[],{"type":12,"content":3198},[3199,3204,3209,3214],{"type":15,"attrs":3200,"content":3201},{"textAlign":53},[3202],{"text":3203,"type":299},"*Entry Code N indicates an infant was born alive in the reporting facility.",{"type":15,"attrs":3205,"content":3206},{"textAlign":53},[3207],{"text":3208,"type":299},"† Due to the unavailability of chart numbers for Prince Edward Island, birth trauma with and without the assistance of instruments cannot be differentiated; therefore, all birth trauma in P.E.I. is included in this group regardless of the use of instruments or method of delivery.",{"type":15,"attrs":3210,"content":3211},{"textAlign":53},[3212],{"text":3213,"type":299},"‡ Newborns whose mothers are discharged from acute care facilities in a different fiscal year cannot be linked to the mothers' records; therefore, a few birth trauma cases that belong to D04 could be misclassified to A04 as the linkage is done within a fiscal year. A fiscal year is defined based on discharged date from April 1 of the current year to March 31 of the subsequent year.",{"type":15,"attrs":3215,"content":3216},{"textAlign":53},[3217],{"text":3218,"type":299},"§ These codes are part of the selection criteria, except when preterm and low birth weight is also coded. See the exclusion terms in the selection criteria section above.",{"type":12,"content":3220},[3221,3228,3237,3246,3255,3264,3273,3287,3296,3305,3314,3323,3332,3341,3350,3359,3368,3377,3386,3395,3404,3413,3422],{"type":15,"attrs":3222,"content":3223},{"textAlign":53},[3224,3227],{"text":3068,"type":299,"marks":3225},[3226],{"type":716},{"text":3138,"type":299},{"type":15,"attrs":3229,"content":3230},{"textAlign":53},[3231,3235],{"text":3232,"type":299,"marks":3233},"P07.-",[3234],{"type":716},{"text":3236,"type":299},": Disorders related to short gestation and low birth weight, not elsewhere classified",{"type":15,"attrs":3238,"content":3239},{"textAlign":53},[3240,3244],{"text":3241,"type":299,"marks":3242},"P10.–§",[3243],{"type":716},{"text":3245,"type":299},": \tIntracranial laceration and hemorrhage due to birth injury",{"type":15,"attrs":3247,"content":3248},{"textAlign":53},[3249,3253],{"text":3250,"type":299,"marks":3251},"P11.1§",[3252],{"type":716},{"text":3254,"type":299},": Other specified brain damage due to birth injury",{"type":15,"attrs":3256,"content":3257},{"textAlign":53},[3258,3262],{"text":3259,"type":299,"marks":3260},"P11.2§",[3261],{"type":716},{"text":3263,"type":299},": Unspecified brain damage due to birth injury",{"type":15,"attrs":3265,"content":3266},{"textAlign":53},[3267,3271],{"text":3268,"type":299,"marks":3269},"P96.4",[3270],{"type":716},{"text":3272,"type":299},": Termination of pregnancy, affecting fetus and newborn",{"type":15,"attrs":3274,"content":3275},{"textAlign":53},[3276,3280,3282],{"text":3277,"type":299,"marks":3278},"Q00–Q07",[3279],{"type":716},{"text":3281,"type":299},": ",{"text":3283,"type":299,"marks":3284},"Congenital malformations of the nervous system (refer to Appendix A)",[3285],{"type":938,"attrs":3286},{"color":940},{"type":15,"attrs":3288,"content":3289},{"textAlign":53},[3290,3294],{"text":3291,"type":299,"marks":3292},"Q65–Q79",[3293],{"type":716},{"text":3295,"type":299},": Congenital malformations and deformations of the musculoskeletal system (refer to Appendix A)",{"type":15,"attrs":3297,"content":3298},{"textAlign":53},[3299,3303],{"text":3300,"type":299,"marks":3301},"5.CA.20.^^",[3302],{"type":716},{"text":3304,"type":299},": Pharmacotherapy (in preparation for), termination of pregnancy",{"type":15,"attrs":3306,"content":3307},{"textAlign":53},[3308,3312],{"text":3309,"type":299,"marks":3310},"5.CA.24.^^",[3311],{"type":716},{"text":3313,"type":299},": Preparation by dilating cervix (for), termination of pregnancy",{"type":15,"attrs":3315,"content":3316},{"textAlign":53},[3317,3321],{"text":3318,"type":299,"marks":3319},"5.CA.88.^^",[3320],{"type":716},{"text":3322,"type":299},": Pharmacological termination of pregnancy",{"type":15,"attrs":3324,"content":3325},{"textAlign":53},[3326,3330],{"text":3327,"type":299,"marks":3328},"5.CA.89.^^",[3329],{"type":716},{"text":3331,"type":299},": Surgical termination of pregnancy",{"type":15,"attrs":3333,"content":3334},{"textAlign":53},[3335,3339],{"text":3336,"type":299,"marks":3337},"5.CA.93.^^",[3338],{"type":716},{"text":3340,"type":299},": Surgical removal of extrauterine pregnancy",{"type":15,"attrs":3342,"content":3343},{"textAlign":53},[3344,3348],{"text":3345,"type":299,"marks":3346},"5.MD.53.^^",[3347],{"type":716},{"text":3349,"type":299},": Forceps traction and rotation delivery",{"type":15,"attrs":3351,"content":3352},{"textAlign":53},[3353,3357],{"text":3354,"type":299,"marks":3355},"5.MD.54.^^",[3356],{"type":716},{"text":3358,"type":299},": Vacuum traction delivery",{"type":15,"attrs":3360,"content":3361},{"textAlign":53},[3362,3366],{"text":3363,"type":299,"marks":3364},"5.MD.55.^^",[3365],{"type":716},{"text":3367,"type":299},": Combination of vacuum and forceps 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It is designed to help leaders self-reflect and better understand how to support creating environments for safety, ensure improvement efforts are part of learning from harm, and that everyone has an opportunity to contribute to safer care.",{"type":544,"attrs":4115,"content":4116},{"level":546,"textAlign":722},[4117],{"text":4118,"type":299},"Why it matters",{"type":15,"attrs":4120,"content":4121},{"textAlign":722},[4122,4128],{"text":4053,"type":299,"marks":4123},[4124],{"type":559,"attrs":4125},{"href":4057,"uuid":414,"anchor":53,"custom":4126,"target":563,"linktype":564,"story":4127},{},{"name":4053,"id":4060,"uuid":414,"slug":4061,"url":4062,"full_slug":4062,"_stopResolving":461},{"text":4129,"type":299}," encourages us to recognize that everyone contributes to patient safety. Participating in this activity is an important starting point to creating safer care. It also provides an opportunity for your own continuing development. 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It does happen.",[4205,4208],{"type":559,"attrs":4206},{"href":4207,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},"https://www.cihi.ca/en/patient-harm-in-canadian-hospitals-it-does-happen",{"type":622},{"type":15,"attrs":4210},{"textAlign":53},{"type":544,"attrs":4212,"content":4213},{"level":546,"textAlign":53},[4214],{"text":4215,"type":299},"Hospital Harm Measure",{"type":15,"attrs":4217,"content":4218},{"textAlign":53},[4219,4221,4226],{"text":4220,"type":299},"The collaboration between the ",{"text":4222,"type":299,"marks":4223},"Canadian Institute for Health Information (CIHI) ",[4224],{"type":559,"attrs":4225},{"href":4182,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},{"text":4227,"type":299},"and Healthcare Excellence Canada on hospital harm is aimed at answering the question, \"How often do patients experience harm in hospital?\"",{"type":15,"attrs":4229,"content":4230},{"textAlign":53},[4231],{"text":4232,"type":299},"This initiative uses administrative data to develop a patient safety measure for inpatient care.",{"type":15,"attrs":4234,"content":4235},{"textAlign":53},[4236],{"text":4237,"type":299},"There are three outputs from this collaboration.",{"type":849,"attrs":4239,"content":4240},{"order":851},[4241,4250,4261],{"type":585,"content":4242},[4243],{"type":15,"attrs":4244,"content":4245},{"textAlign":53},[4246],{"text":4215,"type":299,"marks":4247},[4248],{"type":559,"attrs":4249},{"href":4182,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},{"type":585,"content":4251},[4252],{"type":15,"attrs":4253,"content":4254},{"textAlign":53},[4255],{"text":556,"type":299,"marks":4256},[4257],{"type":559,"attrs":4258},{"href":561,"uuid":356,"anchor":53,"custom":4259,"target":563,"linktype":564,"story":4260},{},{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"type":585,"content":4262},[4263],{"type":15,"attrs":4264,"content":4265},{"textAlign":53},[4266],{"text":4267,"type":299,"marks":4268},"Analytical Report (PDF)",[4269],{"type":559,"attrs":4270},{"href":4271,"uuid":53,"anchor":53,"custom":4272,"target":1052,"linktype":747},"https://www.cihi.ca/sites/default/files/document/measuring-patient-harm-in-canadian-hospitals-report-en.pdf?locale=en&pf=PFC3312",{},{"type":544,"attrs":4274,"content":4275},{"level":546,"textAlign":53},[4276],{"text":4277,"type":299,"marks":4278},"What is the Hospital Harm Measure?",[4279],{"type":716},{"type":15,"attrs":4281,"content":4282},{"textAlign":53},[4283],{"text":4284,"type":299},"Hospital harm captured by this indicator is defined as the rate of acute care hospitalizations with at least one occurrence of unintended harm during a hospital stay that could have been potentially prevented by implementing known evidence-informed practices. While not all instances of harm captured by this indicator can be prevented, adoption of evidence-informed practices can help to reduce the rate of harm.",{"type":15,"attrs":4286,"content":4287},{"textAlign":53},[4288],{"text":4289,"type":299},"Harm is captured only when it:",{"type":582,"content":4291},[4292,4299,4306],{"type":585,"content":4293},[4294],{"type":15,"attrs":4295,"content":4296},{"textAlign":53},[4297],{"text":4298,"type":299},"Is identified as having occurred after admission and within the same hospital stay;",{"type":585,"content":4300},[4301],{"type":15,"attrs":4302,"content":4303},{"textAlign":53},[4304],{"text":4305,"type":299},"Requires treatment, alters treatment or prolongs the hospital stay; and",{"type":585,"content":4307},[4308],{"type":15,"attrs":4309,"content":4310},{"textAlign":53},[4311],{"text":4312,"type":299},"Is one of the conditions from the 31 clinical groups in the Hospital Harm Framework",{"type":15,"attrs":4314,"content":4315},{"textAlign":53},[4316],{"text":4317,"type":299},"The Hospital Harm Measure is intended to monitor variations in patient safety in inpatient acute care settings at the national level across facilities over time. It is designed to help identify patient safety improvement opportunities in hospitals.",{"type":15,"attrs":4319,"content":4320},{"textAlign":53},[4321,4323,4330],{"text":4322,"type":299},"Results for categories and types of harm, aggregated at the national level (outside of Quebec), can be found in ",{"text":4324,"type":299,"marks":4325},"the data tables on CIHI’s website",[4326],{"type":559,"attrs":4327},{"href":4328,"uuid":53,"anchor":53,"custom":4329,"target":1052,"linktype":747},"https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww.cihi.ca%2Fsites%2Fdefault%2Ffiles%2Fdocument%2Fhospital-harm-results-2014-2024-data-tables-en.xlsx&wdOrigin=BROWSELINK?src=https%3A%2F%2Fwww.cihi.ca%2Fsites%2Fdefault%2Ffiles%2Fdocument%2Fhospital-harm-results-2014-2022-data-tables-en.xlsx&wdOrigin=BROWSELINK?src=https%3A%2F%2Fwww.cihi.ca%2Fsites%2Fdefault%2Ffiles%2Fdocument%2Fhospital-harm-results-2014-2022-data-tables-en.xlsx&wdOrigin=BROWSELINK",{},{"text":711,"type":299},{"type":544,"attrs":4332,"content":4333},{"level":546,"textAlign":53},[4334],{"text":556,"type":299},{"type":15,"attrs":4336,"content":4337},{"textAlign":53},[4338],{"text":4339,"type":299},"Healthcare Excellence Canada has developed the Hospital Harm Improvement Resource – a compilation of resources to support patient safety and improvement efforts.",{"type":15,"attrs":4341,"content":4342},{"textAlign":53},[4343],{"text":4344,"type":299,"marks":4345},"Access Now",[4346],{"type":559,"attrs":4347},{"href":561,"uuid":356,"anchor":53,"custom":4348,"target":563,"linktype":564,"story":4349},{},{"name":556,"id":566,"uuid":356,"slug":567,"url":568,"full_slug":568,"_stopResolving":461},{"type":544,"attrs":4351,"content":4352},{"level":546,"textAlign":53},[4353],{"text":4354,"type":299},"Analytical Report",{"type":15,"attrs":4356,"content":4357},{"textAlign":53},[4358,4360,4367],{"text":4359,"type":299},"This analytical report, ",{"text":4361,"type":299,"marks":4362},"Measuring Patient Harm in Canadian Hospitals (PDF)",[4363,4366],{"type":559,"attrs":4364},{"href":4271,"uuid":53,"anchor":53,"custom":4365,"target":1052,"linktype":747},{},{"type":622},{"text":4368,"type":299},", shares the approach to measuring hospital harm, provides an overview of the status of these patient safety events in Canada (outside of Quebec ¹) and identifies how the data and associated improvement resource can be used for ongoing improvement.",{"type":15,"attrs":4370,"content":4371},{"textAlign":53},[4372],{"text":4373,"type":299},"The report includes:",{"type":582,"content":4375},[4376,4383,4390,4397],{"type":585,"content":4377},[4378],{"type":15,"attrs":4379,"content":4380},{"textAlign":53},[4381],{"text":4382,"type":299},"An overview of the status of patient safety in Canada",{"type":585,"content":4384},[4385],{"type":15,"attrs":4386,"content":4387},{"textAlign":53},[4388],{"text":4389,"type":299},"The number and types of harmful events",{"type":585,"content":4391},[4392],{"type":15,"attrs":4393,"content":4394},{"textAlign":53},[4395],{"text":4396,"type":299},"The types of patients and their outcomes",{"type":585,"content":4398},[4399],{"type":15,"attrs":4400,"content":4401},{"textAlign":53},[4402],{"text":4403,"type":299},"Information on how measurement can be used for improvement",{"type":15,"attrs":4405,"content":4406},{"textAlign":53},[4407],{"text":4408,"type":299},"¹ Data from Quebec as well as data for patients with selected mental health diagnoses has been excluded due to differences in data collection.",{"type":15,"attrs":4410,"content":4411},{"textAlign":53},[4412,4414,4421],{"text":4413,"type":299},"CIHI has also worked with stakeholders to further refine the methodology used to calculate hospital harm. The most current methodology can be found in ",{"text":4415,"type":299,"marks":4416},"CIHI's Indicator Library",[4417],{"type":559,"attrs":4418},{"href":4419,"uuid":53,"anchor":53,"custom":4420,"target":1052,"linktype":747},"https://www.cihi.ca/en/indicators/hospital-harm",{},{"text":711,"type":299},{"id":16,"_uid":4423,"items":4424,"component":1173},"b97a538b-604c-46b1-80cf-a9584d104fba",[4425],{"_uid":4426,"link":4427,"image":4432,"title":1164,"component":1165,"description":4434},"3899a935-c1ff-402c-85c0-9e1ac9062526",[4428],{"_uid":4429,"link":4430,"label":1158,"component":1159},"2016395e-5568-4d6f-86ab-f84f6bb254a8",{"id":1153,"url":16,"linktype":564,"fieldtype":1031,"cached_url":1154,"story":4431},{"name":1156,"id":1157,"uuid":1153,"slug":9,"url":1154,"full_slug":1154,"_stopResolving":461},{"id":1161,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1162,"copyright":16,"fieldtype":288,"meta_data":4433,"is_external_url":290},{},{"type":12,"content":4435},[4436],{"type":15,"attrs":4437,"content":4438},{"textAlign":53},[4439],{"text":1172,"type":299},[143,115,122,129,136,150,157],[185,192,200],"hospital-harm-is-everyones-concern","resources/hospital-harm-is-everyones-concern",-18410,[],{"parent_slug":457,"umbraco_path":4447,"umbraco_uuid":4448},"/HealthcareExcellenceCanada/Resources/HospitalHarmIsEveryonesConcern","f01ab755-8ca5-4f82-bc9e-5d6e8c27c67b","ad223968-2a8a-4790-b25b-a1333d083161","2025-11-26T23:54:23.658Z",[],[4453],{"path":4454,"name":4455,"lang":469,"published":461},"ressources/les-prejudices-a-l-hopital-c-est-l-affaire-de-tout-le-monde","Les préjudices à l’hôpital, c’est l’affaire de tout le monde",{"name":4457,"created_at":4458,"published_at":4459,"updated_at":4460,"id":4461,"uuid":307,"content":4462,"slug":6372,"full_slug":6373,"sort_by_date":53,"position":6374,"tag_list":6375,"is_startpage":290,"parent_id":462,"meta_data":6376,"group_id":6379,"first_published_at":6380,"release_id":53,"lang":300,"path":53,"alternates":6381,"default_full_slug":6373,"translated_slugs":6382},"A Framework for Establishing a Patient Safety Culture","2025-11-26T23:54:01.836Z","2026-02-27T17:41:04.817Z","2026-02-27T17:41:04.943Z",116783685107956,{"new":290,"seo":4463,"_uid":4466,"hero":4467,"type":174,"topics":4483,"Noindex":290,"content":4484,"audience":6370,"duration":16,"regional":6371,"component":1176},{"title":4464,"plugin":279,"description":4465},"Patient Safety Culture Bundle","The Framework is based on a set of evidence-based practices that must all be applied in order to deliver good, safe care.","49df0bce-fd9d-46d2-8dc6-0ff0774021c5",[4468],{"_uid":4469,"file":4470,"image":4471,"title":4457,"format":16,"component":505,"description":4474,"key_learning":16,"prerequisite":16},"79e09932-73e6-42b2-9a8d-e64a6f111b31",[],{"id":4472,"filename":4473,"fieldtype":288},108534901744414,"https://a-ca.storyblok.com/f/850807391887861/670x450/0df79330c2/header-2-visual.png",{"type":12,"content":4475},[4476],{"type":15,"attrs":4477,"content":4478},{"textAlign":53},[4479],{"text":4465,"type":299,"marks":4480},[4481],{"type":938,"attrs":4482},{"color":2591},[84,76,39],[4485,4886,5287],{"_uid":4486,"content":4487,"component":626},"99f5eb80-72f4-4d41-a1e4-3e90cccf2d8e",[4488,4525,4534,4738],{"_uid":4489,"content":4490,"component":625},"5cebfb0b-2763-49f2-8765-c93c4b22ba83",{"type":12,"content":4491},[4492,4499,4504,4515],{"type":544,"attrs":4493,"content":4494},{"level":546,"textAlign":53},[4495],{"text":4496,"type":299,"marks":4497},"Patient Safety Culture \"Bundle\" for CEOs/Senior Leaders",[4498],{"type":716},{"type":544,"attrs":4500,"content":4501},{"level":652,"textAlign":53},[4502],{"text":4503,"type":299},"What is the Patient Safety Culture \"Bundle\"?",{"type":15,"attrs":4505,"content":4506},{"textAlign":53},[4507,4509,4513],{"text":4508,"type":299},"Strengthening a safety culture necessitates sequential, iterative and simultaneous interventions that",{"text":4510,"type":299,"marks":4511}," enable, enact and learn ",[4512],{"type":716},{"text":4514,"type":299},"in a way that is attuned to the existing culture. Through a literature review of more than 60 resources, we created a Patient Safety Culture “Bundle” that has been validated through interviews with Canadian thought leaders. The Bundle is based on a set of evidence-based practices that must all be applied in order to deliver good care. All components are required to improve the patient safety culture.",{"type":15,"attrs":4516,"content":4517},{"textAlign":53},[4518,4519,4523],{"text":4189,"type":299},{"text":4520,"type":299,"marks":4521},"Patient Safety Culture \"Bundle\" for CEOs and Senior Leaders ",[4522],{"type":716},{"text":4524,"type":299},"encompasses key concepts of safety science, implementation science, just culture, psychological safety, staff safety/health, patient and family engagement, disruptive behaviour, high reliability/resilience, patient safety measurement, frontline leadership, physician leadership, staff engagement, teamwork/communication and industry-wide standardization/alignment.",{"_uid":4526,"file":4527,"link":4532,"label":4533,"linkType":4082,"component":4083,"linkLabel":16},"4fa0996b-9c01-4306-9c98-2f469b22b816",{"id":4528,"alt":4529,"name":16,"focus":16,"title":4529,"source":16,"filename":4530,"copyright":16,"fieldtype":288,"meta_data":4531,"is_external_url":290},114293328894289,"Patient Safety Culture Bundle For Leaders EN FINAL Ua","https://a-ca.storyblok.com/f/850807391887861/7677ee3692/patient-safety-culture-bundle-for-leaders-en-final-ua.pdf",{},{"id":16,"url":16,"linktype":564,"fieldtype":1031,"cached_url":16},"One-Pager of the Patient Safety Culture “Bundle” for CEOs/Senior Leaders",{"_uid":4535,"content":4536,"component":625},"7bdfc769-9073-4c00-ab3b-8bbad7e07ce0",{"type":12,"content":4537},[4538,4543,4548,4553,4558,4563,4572,4579,4598,4603,4615,4622,4634,4641,4653,4660,4678,4685,4694,4701,4716,4723],{"type":544,"attrs":4539,"content":4540},{"level":546,"textAlign":53},[4541],{"text":4542,"type":299},"Why was this Bundle created?",{"type":15,"attrs":4544,"content":4545},{"textAlign":53},[4546],{"text":4547,"type":299},"A patient safety culture is difficult to operationalize. Improving safety requires an organizational culture that enables and prioritizes patient safety. The importance of culture change needs to be brought to the forefront, rather than taking a back seat to other safety activities.",{"type":15,"attrs":4549,"content":4550},{"textAlign":53},[4551],{"text":4552,"type":299},"The National Patient Safety Consortium Education Working Group verified the critical role senior leadership plays in ensuring patient safety is an organizational priority. A working group of partners, led by the Canadian Patient Safety Institute (now Healthcare Excellence Canada), Canadian College of Health Leaders (CCHL), HealthCareCAN and the Healthcare Insurance Reciprocal of Canada (HIROC), joined together to establish a framework and advance this work.",{"type":544,"attrs":4554,"content":4555},{"level":546,"textAlign":53},[4556],{"text":4557,"type":299},"Testimonials",{"type":15,"attrs":4559,"content":4560},{"textAlign":53},[4561],{"text":4562,"type":299},"\"Patient safety and healthcare quality are advanced when boards and senior leaders are committed to it and are able to show evidence of that commitment. Missing until now is a concise \"how to\" guide. The Patient Safety bundle for Leaders fills that gap.\"",{"type":15,"attrs":4564,"content":4565},{"textAlign":53},[4566,4570],{"text":4567,"type":299,"marks":4568},"Catherine Gaulton",[4569],{"type":716},{"text":4571,"type":299},", CEO, HIROC",{"type":15,"attrs":4573,"content":4574},{"textAlign":53},[4575],{"text":4576,"type":299,"marks":4577},"\"Leadership is critical to developing a patient safety culture and building leadership capacity requires a vision of the knowledge, skills and behaviours necessary to achieve this. The Patient Safety Leadership Bundle provides this and will be a practical tool for health leaders across the healthcare continuum to assess their personal capabilities. It will also provide both organizations and the system, as a whole, a checklist for what's missing from our collective leadership education toolkits so that we can strategically respond to these needs. HealthCareCAN is committed to the spread of this tool across the country as part of a cultural shift to safety and a drive towards high-reliability culture.\"",[4578],{"type":622},{"type":15,"attrs":4580,"content":4581},{"textAlign":53},[4582,4586,4588,4592,4594],{"text":4583,"type":299,"marks":4584},"Dale Schierbeck",[4585],{"type":716},{"text":4587,"type":299},", Vice-President, Learning & Development, HealthCare",{"text":4589,"type":299,"marks":4590},"CAN",[4591],{"type":622},{"type":4593},"hard_break",{"text":4595,"type":299,"marks":4596},"and Co-Chair, Patient Safety Education for Leaders Working",[4597],{"type":622},{"type":15,"attrs":4599,"content":4600},{"textAlign":53},[4601],{"text":4602,"type":299},"\"The drive to quality and patient safety must start at the top with the board of directors – they are a critical enabler of culture change. It has been well-recognized that taking a passive role in this fundamental responsibility is not an option. Governors need insight into best practice principles and a corresponding framework to help guide them in this important task – this bundle delivers that.\"",{"type":15,"attrs":4604,"content":4605},{"textAlign":53},[4606,4610,4612,4613],{"text":4607,"type":299,"marks":4608},"Elizabeth Martin",[4609],{"type":716},{"text":4611,"type":299},", Board Chair, HIROC;",{"type":4593},{"text":4614,"type":299},"former Board member, Sunnybrook Health Sciences Centre",{"type":15,"attrs":4616,"content":4617},{"textAlign":53},[4618],{"text":4619,"type":299,"marks":4620},"\"Preventable harm must remain a focus for all Boards as they consider their organization's commitment to the people they care for. The depth of information and insight contained within the Patient Safety Culture Bundle will assist all leaders, boards and organizations to fully appreciate the importance culture plays in achieving these goals. Armed with this knowledge, the dedicated people within healthcare organizations can be supported to deliver consistently safe care.\"",[4621],{"type":622},{"type":15,"attrs":4623,"content":4624},{"textAlign":53},[4625,4629,4631,4632],{"text":4626,"type":299,"marks":4627},"Ruthe Anne Conyngham",[4628],{"type":716},{"text":4630,"type":299},", Faculty, Canadian Patient Safety Institute;",{"type":4593},{"text":4633,"type":299},"Member, Cancer Quality Council of Ontario",{"type":15,"attrs":4635,"content":4636},{"textAlign":53},[4637],{"text":4638,"type":299,"marks":4639},"\"For years, senior leaders have promoted the use of checklists to support evidence-informed clinical practice. Now leaders have their own checklist to support a safety culture. The Patient Safety Leadership Bundle will be an invaluable resource to help leaders walk the talk and lead by example\"",[4640],{"type":622},{"type":15,"attrs":4642,"content":4643},{"textAlign":53},[4644,4648,4650,4651],{"text":4645,"type":299,"marks":4646},"Maura Davies",[4647],{"type":716},{"text":4649,"type":299},", Former President and CEO, Saskatoon Health Region;",{"type":4593},{"text":4652,"type":299},"President, Maura Davies Healthcare Consulting Inc.",{"type":15,"attrs":4654,"content":4655},{"textAlign":53},[4656],{"text":4657,"type":299,"marks":4658},"\"The patient safety and quality culture bundle is a key resource that provides useful guidance for senior leaders on the critical knowledge and actions needed to support improvements in safety culture and outcomes.\"",[4659],{"type":622},{"type":15,"attrs":4661,"content":4662},{"textAlign":53},[4663,4667,4669,4670,4672,4673,4675,4676],{"text":4664,"type":299,"marks":4665},"Ross Baker",[4666],{"type":716},{"text":4668,"type":299},", Ph.D., Professor and Program Lead, Quality Improvement and Patient Safety,",{"type":4593},{"text":4671,"type":299},"Institute of Health Policy, Management and Evaluation,",{"type":4593},{"text":4674,"type":299},"Dalla Lana School of Public Health,",{"type":4593},{"text":4677,"type":299},"University of Toronto",{"type":15,"attrs":4679,"content":4680},{"textAlign":53},[4681],{"text":4682,"type":299,"marks":4683},"\"One of many actions resulting from the work of National Patient Safety Consortium is the Safety Bundle for Leaders/CEOs, which demonstrates the critical role senior leadership plays in ensuring patient safety is an organizational priority. The Safety Bundle will help identify the best practices, skills, tools and resources healthcare leaders can deploy to advance patient safety and facilitate the spread of this knowledge within their organizations.\"",[4684],{"type":622},{"type":15,"attrs":4686,"content":4687},{"textAlign":53},[4688,4692],{"text":4689,"type":299,"marks":4690},"Chris Power",[4691],{"type":716},{"text":4693,"type":299},", Chief Executive Officer, Canadian Patient Safety Institute",{"type":15,"attrs":4695,"content":4696},{"textAlign":53},[4697],{"text":4698,"type":299,"marks":4699},"\"The Board is ultimately accountable for the performance of the organization. The \"Patient Safety Culture Bundle\" is an excellent resource to assist the Board in improving organizational culture and advancing its patient safety agenda.\"",[4700],{"type":622},{"type":15,"attrs":4702,"content":4703},{"textAlign":53},[4704,4708,4710,4711,4713,4714],{"text":4705,"type":299,"marks":4706},"Joan Dawe",[4707],{"type":716},{"text":4709,"type":299},", Peer facilitator Effective Governance for Quality and Patient Safety",{"type":4593},{"text":4712,"type":299},"Education Program; Past Chair, Eastern Health Regional Authority;",{"type":4593},{"text":4715,"type":299},"Past Chair, Health and Community Services, St. John's Region",{"type":15,"attrs":4717,"content":4718},{"textAlign":53},[4719],{"text":4720,"type":299,"marks":4721},"\"The Board, CEO and Senior Leaders all play critical roles in setting the tone and championing the importance of a safety culture in their organizations. Engaging staff in this effort starts at the top and demands attention and concerted ongoing effort. It requires support for and engagement with front line staff and respect for what they do, and equally important, engaging those being served and the shared knowledge this experience generates for improving care processes. This work is complex and the Bundle will serve as a useful guide for the scope of effort required to improve safety and eliminate harm.\"",[4722],{"type":622},{"type":15,"attrs":4724,"content":4725},{"textAlign":53},[4726,4730,4732,4736],{"text":4727,"type":299,"marks":4728},"Ray Racette",[4729],{"type":716},{"text":4731,"type":299},", former ",{"text":4733,"type":299,"marks":4734},"CEO",[4735],{"type":716},{"text":4737,"type":299}," Canadian College of Health 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",{"type":12,"content":5276},[5277,5282],{"type":15,"attrs":5278,"content":5279},{"textAlign":53},[5280],{"text":5281,"type":299},"The key components required for a Patient Safety Culture are identified under three pillars.",{"type":15,"attrs":5283,"content":5284},{"textAlign":53},[5285],{"text":5286,"type":299},"Adapted from: Singer & Vogus (2013). Reducing hospital errors: Interventions that build safety culture. ARPH 34:373-96 JANUARY 2018",{"_uid":5288,"items":5289,"title":270,"component":835,"description":6367},"ebd2f041-18f8-48f8-b84b-5efd37257a29",[5290],{"_uid":5291,"title":5292,"ctaLeft":5293,"ctaRight":5294,"component":695,"columnLeft":5295,"columnRight":5298},"3ac89885-aee2-4328-addf-62c5a787340f","Expand to see the full list of resources",[],[],{"type":12,"content":5296},[5297],{"type":15},{"type":12,"content":5299},[5300,5312,5321,5357,5369,5378,5390,5399,5408,5420,5429,5441,5450,5462,5471,5483,5492,5504,5513,5525,5534,5546,5555,5567,5637,5724,5811,5823,5844,5866,5875,5898,5920,5942,5951,5974,5996,6018,6027,6054,6077,6099,6122,6131,6140,6149,6172,6193,6215,6237,6246,6269,6291,6314,6336,6358],{"type":544,"attrs":5301,"content":5302},{"level":546,"textAlign":722},[5303,5309],{"text":5304,"type":299,"marks":5305},"Singer and Vogus – Interventions That Build Safety Culture (2013)",[5306,5308],{"type":938,"attrs":5307},{"color":16},{"type":716},{"text":713,"type":299,"marks":5310},[5311],{"type":716},{"type":15,"attrs":5313,"content":5314},{"textAlign":722},[5315,5320],{"text":5316,"type":299,"marks":5317},"Piecemeal initiatives to improve a patient safety culture are inadequate; improving a patient safety culture requires sequential, iterative and simultaneous interventions that:",[5318],{"type":938,"attrs":5319},{"color":16},{"text":713,"type":299},{"type":849,"attrs":5322,"content":5323},{"order":851},[5324,5335,5346],{"type":585,"content":5325},[5326],{"type":15,"attrs":5327,"content":5328},{"textAlign":53},[5329,5334],{"text":5330,"type":299,"marks":5331},"Enable: e.g., \"transformational\" leadership; critical role of senior leaders; leadership characteristics; human resources; information technology (IT); external regulators",[5332],{"type":938,"attrs":5333},{"color":16},{"text":713,"type":299},{"type":585,"content":5336},[5337],{"type":15,"attrs":5338,"content":5339},{"textAlign":53},[5340,5345],{"text":5341,"type":299,"marks":5342},"Enact: e.g., teamwork; communication; mindfulness; patient involvement; reporting; coordination between areas /at transitions",[5343],{"type":938,"attrs":5344},{"color":16},{"text":713,"type":299},{"type":585,"content":5347},[5348],{"type":15,"attrs":5349,"content":5350},{"textAlign":53},[5351,5356],{"text":5352,"type":299,"marks":5353},"Elaborate: e.g., learning (e.g., reports, complaints, morbidity and mortality rounds); 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safety climate; psychological safety; organizational fairness; just culture; stress recognition; working conditions; leadership; learning and improvement; patients as partners; transparency.",[5426],{"type":938,"attrs":5427},{"color":16},{"text":713,"type":299},{"type":544,"attrs":5430,"content":5431},{"level":546,"textAlign":722},[5432,5438],{"text":5433,"type":299,"marks":5434},"American College of Healthcare Executives (ACHE) / Institute for Healthcare Improvement (IHI) / National Patient Safety Foundation (NPSF) – Leadership Blueprint for Culture of Safety (2017)",[5435,5437],{"type":938,"attrs":5436},{"color":16},{"type":716},{"text":713,"type":299,"marks":5439},[5440],{"type":716},{"type":15,"attrs":5442,"content":5443},{"textAlign":722},[5444,5449],{"text":5445,"type":299,"marks":5446},"Six leadership domains: vision; trust, respect and inclusion; board engagement; leadership development; just culture; behaviour expectations.",[5447],{"type":938,"attrs":5448},{"color":16},{"text":713,"type":299},{"type":544,"attrs":5451,"content":5452},{"level":546,"textAlign":722},[5453,5459],{"text":5454,"type":299,"marks":5455},"IHI Whitepaper – Patient Safety (2006)",[5456,5458],{"type":938,"attrs":5457},{"color":16},{"type":716},{"text":713,"type":299,"marks":5460},[5461],{"type":716},{"type":15,"attrs":5463,"content":5464},{"textAlign":722},[5465,5470],{"text":5466,"type":299,"marks":5467},"Patient safety strategy/aims; senior leader communication and awareness building (e.g., walk-rounds); engage stakeholders (board, leaders, physicians, staff, patients/families) in patient safety; implement \"just\" culture; focus on process redesign/improved reliability (e.g., evidence-based standardization, human factors); leader/ manager/staff accountability  (e.g., for safety reporting, reliable processes/\"daily work\") and aligned incentives for patient safety; patient safety infrastructure (staff and committees); assess patient safety  culture; measure/track patient safety (e.g. mortality, trigger tool); support patients/families impacted by errors.",[5468],{"type":938,"attrs":5469},{"color":16},{"text":713,"type":299},{"type":544,"attrs":5472,"content":5473},{"level":546,"textAlign":722},[5474,5480],{"text":5475,"type":299,"marks":5476},"IHI Whitepaper – 7 Leadership Leverage Points (2008)",[5477,5479],{"type":938,"attrs":5478},{"color":16},{"type":716},{"text":713,"type":299,"marks":5481},[5482],{"type":716},{"type":15,"attrs":5484,"content":5485},{"textAlign":722},[5486,5491],{"text":5487,"type":299,"marks":5488},"System-level aims; executable strategy; leadership attention; patients /families; Chief Financial Officer (CFO) as quality champion; engage physicians; improvement capability.",[5489],{"type":938,"attrs":5490},{"color":16},{"text":713,"type":299},{"type":544,"attrs":5493,"content":5494},{"level":546,"textAlign":722},[5495,5501],{"text":5496,"type":299,"marks":5497},"IHI Whitepaper – High-Impact Leadership (2013)",[5498,5500],{"type":938,"attrs":5499},{"color":16},{"type":716},{"text":713,"type":299,"marks":5502},[5503],{"type":716},{"type":15,"attrs":5505,"content":5506},{"textAlign":722},[5507,5512],{"text":5508,"type":299,"marks":5509},"Person-centredness (e.g., patient involvement/stories); front-line engagement (e.g., regular presence at frontlines, visible champion, lead projects); relentless focus (e.g., talk about vision every day, align schedule with high-priority initiatives; designate resources); transparency; build will to improve (e.g., communicate and model desired behaviours, openness, swift action against undesired behaviour); boundary-lessness (e.g., systems thinking, harvest ideas from and partner with other organizations).",[5510],{"type":938,"attrs":5511},{"color":16},{"text":713,"type":299},{"type":544,"attrs":5514,"content":5515},{"level":546,"textAlign":722},[5516,5522],{"text":5517,"type":299,"marks":5518},"IHI Whitepaper – Sustaining Improvement (2016)",[5519,5521],{"type":938,"attrs":5520},{"color":16},{"type":716},{"text":713,"type":299,"marks":5523},[5524],{"type":716},{"type":15,"attrs":5526,"content":5527},{"textAlign":722},[5528,5533],{"text":5529,"type":299,"marks":5530},"Quality control, improvement, culture; standardization; accountability (standard work); visual management; problem solving; escalation; integration; prioritization; daily work; policy; transparency; trust.",[5531],{"type":938,"attrs":5532},{"color":16},{"text":713,"type":299},{"type":544,"attrs":5535,"content":5536},{"level":546,"textAlign":722},[5537,5543],{"text":5538,"type":299,"marks":5539},"IHI Whitepaper – Safe, Reliable and Effective Care (2017)",[5540,5542],{"type":938,"attrs":5541},{"color":16},{"type":716},{"text":713,"type":299,"marks":5544},[5545],{"type":716},{"type":15,"attrs":5547,"content":5548},{"textAlign":722},[5549,5554],{"text":5550,"type":299,"marks":5551},"Leadership; psychological safety; accountability (act in safe and respectful manner); teamwork and communication; negotiation; continuous learning; improvement and measurement; reliability; transparency.",[5552],{"type":938,"attrs":5553},{"color":16},{"text":713,"type":299},{"type":544,"attrs":5556,"content":5557},{"level":546,"textAlign":722},[5558,5564],{"text":5559,"type":299,"marks":5560},"Key Concepts",[5561,5563],{"type":938,"attrs":5562},{"color":16},{"type":716},{"text":713,"type":299,"marks":5565},[5566],{"type":716},{"type":582,"content":5568},[5569,5586,5603,5620],{"type":585,"content":5570},[5571],{"type":15,"attrs":5572,"content":5573},{"textAlign":53},[5574,5580,5585],{"text":5575,"type":299,"marks":5576},"Safety science ",[5577,5579],{"type":938,"attrs":5578},{"color":16},{"type":716},{"text":5581,"type":299,"marks":5582},"– focusses on contributing factors and underlying causes of risk and harm, including errors and human factors. It includes many disciplines not typically considered part of healthcare. Recognizes the fundamental importance of system design in driving workforce behaviour. In other industries, such as aviation, safety experts accept that human error must be expected, anticipated, and its effects mitigated. Safety science and human factors engineering is used to design systems to prevent errors, and to mitigate harm when errors occur. (Berwick et al., 2015).",[5583],{"type":938,"attrs":5584},{"color":16},{"text":713,"type":299},{"type":585,"content":5587},[5588],{"type":15,"attrs":5589,"content":5590},{"textAlign":53},[5591,5597,5602],{"text":5592,"type":299,"marks":5593},"Implementation science ",[5594,5596],{"type":938,"attrs":5595},{"color":16},{"type":716},{"text":5598,"type":299,"marks":5599},"– supplements patient safety science; focusses on identifying and implementing valuable practices and lessons learned, and scaling up/translation across the organization and system. (Berwick et al., 2015).",[5600],{"type":938,"attrs":5601},{"color":16},{"text":713,"type":299},{"type":585,"content":5604},[5605],{"type":15,"attrs":5606,"content":5607},{"textAlign":53},[5608,5614,5619],{"text":5609,"type":299,"marks":5610},"Just culture ",[5611,5613],{"type":938,"attrs":5612},{"color":16},{"type":716},{"text":5615,"type":299,"marks":5616},"– a culture that recognizes that individual practitioners should not be held accountable for system failings over which they have no control. A just culture recognizes many individual or \"active\" errors represent predictable interactions between humans and the systems in which they work. A just culture also does not tolerate conscious disregard of clear risks to patients or gross misconduct. (Berwick et al., 2015).",[5617],{"type":938,"attrs":5618},{"color":16},{"text":713,"type":299},{"type":585,"content":5621},[5622],{"type":15,"attrs":5623,"content":5624},{"textAlign":53},[5625,5631,5636],{"text":5626,"type":299,"marks":5627},"Psychological safety ",[5628,5630],{"type":938,"attrs":5629},{"color":16},{"type":716},{"text":5632,"type":299,"marks":5633},"– an environment where: anyone can ask questions without looking stupid; anyone can ask for feedback without looking incompetent; anyone can be respectfully critical without appearing negative; anyone can suggest innovative ideas without being perceived as disruptive. (Frankel, 2017).",[5634],{"type":938,"attrs":5635},{"color":16},{"text":713,"type":299},{"type":582,"content":5638},[5639,5656,5673,5690,5707],{"type":585,"content":5640},[5641],{"type":15,"attrs":5642,"content":5643},{"textAlign":53},[5644,5650,5655],{"text":5645,"type":299,"marks":5646},"Staff safety/health",[5647,5649],{"type":938,"attrs":5648},{"color":16},{"type":716},{"text":5651,"type":299,"marks":5652}," – A precursor to providing high quality care are staff that are free from physical harm during daily work. (Perlo, 2017)",[5653],{"type":938,"attrs":5654},{"color":16},{"text":713,"type":299},{"type":585,"content":5657},[5658],{"type":15,"attrs":5659,"content":5660},{"textAlign":53},[5661,5667,5672],{"text":5662,"type":299,"marks":5663},"Patient and family engagement ",[5664,5666],{"type":938,"attrs":5665},{"color":16},{"type":716},{"text":5668,"type":299,"marks":5669},"– recognized as a primary area of focus in patient safety and quality; includes engagement at three levels: direct care (diagnosis, treatment decisions, monitoring), organizational design and governance (planning, patient advisory councils, quality improvement projects), policy making (public health, research priorities, resource allocation). (Carman, 2013).",[5670],{"type":938,"attrs":5671},{"color":16},{"text":713,"type":299},{"type":585,"content":5674},[5675],{"type":15,"attrs":5676,"content":5677},{"textAlign":53},[5678,5684,5689],{"text":5679,"type":299,"marks":5680},"Disruptive behaviour ",[5681,5683],{"type":938,"attrs":5682},{"color":16},{"type":716},{"text":5685,"type":299,"marks":5686},"– any behaviour that shows disrespect for others or any interpersonal interactions that impede the delivery of patient care; this behaviour poses a threat to patient safety. (AHRQ PS Net, 2017).",[5687],{"type":938,"attrs":5688},{"color":16},{"text":713,"type":299},{"type":585,"content":5691},[5692],{"type":15,"attrs":5693,"content":5694},{"textAlign":53},[5695,5701,5706],{"text":5696,"type":299,"marks":5697},"High reliability/resilience ",[5698,5700],{"type":938,"attrs":5699},{"color":16},{"type":716},{"text":5702,"type":299,"marks":5703},"– reliable/mindful organizations are:  preoccupied with failure (look for small signals of failure vs. preoccupation with success); reluctant to simplify interpretations (acknowledge complexity); sensitive to operations (aware of what is happening at frontlines); committed to resilience (acting quickly when things go wrong, e.g., patient deterioration); and defer to experts (vs. authority). (Weick & Sutcliffe, 2015).",[5704],{"type":938,"attrs":5705},{"color":16},{"text":713,"type":299},{"type":585,"content":5708},[5709],{"type":15,"attrs":5710,"content":5711},{"textAlign":53},[5712,5718,5723],{"text":5713,"type":299,"marks":5714},"Patient safety measurement ",[5715,5717],{"type":938,"attrs":5716},{"color":16},{"type":716},{"text":5719,"type":299,"marks":5720},"– five dimensions: past harm (incidents, mortality); reliability (compliance); sensitivity to operations (walk-rounds, staffing levels, escalation); anticipation and preparedness (risk registers, safety culture scores, absenteeism); integration and learning (automated alerts, board dashboards). (Vincent, 2016).",[5721],{"type":938,"attrs":5722},{"color":16},{"text":713,"type":299},{"type":582,"content":5725},[5726,5743,5760,5777,5794],{"type":585,"content":5727},[5728],{"type":15,"attrs":5729,"content":5730},{"textAlign":53},[5731,5737,5742],{"text":5732,"type":299,"marks":5733},"Frontline leadership/distributed leadership",[5734,5736],{"type":938,"attrs":5735},{"color":16},{"type":716},{"text":5738,"type":299,"marks":5739}," – recognized as a key driver for change in healthcare; local leaders translate senior leader priorities/values into action at the microsystem level; they have great impact on unit cultures and learning processes. (IHI, 2016).",[5740],{"type":938,"attrs":5741},{"color":16},{"text":713,"type":299},{"type":585,"content":5744},[5745],{"type":15,"attrs":5746,"content":5747},{"textAlign":53},[5748,5754,5759],{"text":5749,"type":299,"marks":5750},"Physician leadership",[5751,5753],{"type":938,"attrs":5752},{"color":16},{"type":716},{"text":5755,"type":299,"marks":5756}," – recognized as a key driver for change in healthcare; six strategies for engaging physicians: discover common purpose; reframe values and beliefs; segment the engagement plan; use engaging improvement methods; show courage; adopt an engaging style. (Reinertsen, 2007).",[5757],{"type":938,"attrs":5758},{"color":16},{"text":713,"type":299},{"type":585,"content":5761},[5762],{"type":15,"attrs":5763,"content":5764},{"textAlign":53},[5765,5771,5776],{"text":5766,"type":299,"marks":5767},"Staff engagement",[5768,5770],{"type":938,"attrs":5769},{"color":16},{"type":716},{"text":5772,"type":299,"marks":5773}," – A joyful, engaged workforce will have: physical and psychological safety; meaning and purpose; choice and autonomy; recognition and rewards; participative management; camaraderie and teamwork; daily improvement; wellness and resilience; real-time measurement. (Perlo, 2017)",[5774],{"type":938,"attrs":5775},{"color":16},{"text":713,"type":299},{"type":585,"content":5778},[5779],{"type":15,"attrs":5780,"content":5781},{"textAlign":53},[5782,5788,5793],{"text":5783,"type":299,"marks":5784},"Teamwork/communication ",[5785,5787],{"type":938,"attrs":5786},{"color":16},{"type":716},{"text":5789,"type":299,"marks":5790},"– gaps in communication and/or poor teamwork are frequently noted as contributing factors to many patient safety events. Strong teams which train together and have established and reliable communication practices will have superior patient safety performance. (Baker, 2015).",[5791],{"type":938,"attrs":5792},{"color":16},{"text":713,"type":299},{"type":585,"content":5795},[5796],{"type":15,"attrs":5797,"content":5798},{"textAlign":53},[5799,5805,5810],{"text":5800,"type":299,"marks":5801},"Industry-wide standardization/alignment ",[5802,5804],{"type":938,"attrs":5803},{"color":16},{"type":716},{"text":5806,"type":299,"marks":5807},"– A key feature in other high-risk industries is alignment across the sector related to key priorities, national/international standards and regulation of safety-critical practices and technologies. (Dixon-Woods, 2016, Berwick et al., 2015).",[5808],{"type":938,"attrs":5809},{"color":16},{"text":713,"type":299},{"type":544,"attrs":5812,"content":5813},{"level":546,"textAlign":722},[5814,5820],{"text":5815,"type":299,"marks":5816},"Environmental Scan",[5817,5819],{"type":938,"attrs":5818},{"color":16},{"type":716},{"text":713,"type":299,"marks":5821},[5822],{"type":716},{"type":15,"attrs":5824,"content":5825},{"textAlign":722},[5826,5831,5839,5843],{"text":5827,"type":299,"marks":5828},"ACHE, NPSF Lucian Leape Institute. (2017). ",[5829],{"type":938,"attrs":5830},{"color":16},{"text":5832,"type":299,"marks":5833},"Leading a culture of safety: a blueprint for success",[5834,5837],{"type":559,"attrs":5835},{"href":5836,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},"https://www.ihi.org/resources/Pages/Publications/Leading-a-Culture-of-Safety-A-Blueprint-for-Success.aspx",{"type":938,"attrs":5838},{"color":16},{"text":711,"type":299,"marks":5840},[5841],{"type":938,"attrs":5842},{"color":16},{"text":713,"type":299},{"type":15,"attrs":5845,"content":5846},{"textAlign":722},[5847,5852,5861,5865],{"text":5848,"type":299,"marks":5849},"AHRQ PS Net. (2017). ",[5850],{"type":938,"attrs":5851},{"color":16},{"text":5853,"type":299,"marks":5854},"Disruptive and unprofessional behavior",[5855,5859],{"type":559,"attrs":5856},{"href":5857,"uuid":53,"anchor":53,"custom":5858,"target":1052,"linktype":747},"https://psnet.ahrq.gov/primers/primer/15/disruptive-and-unprofessional-behavior",{},{"type":938,"attrs":5860},{"color":16},{"text":711,"type":299,"marks":5862},[5863],{"type":938,"attrs":5864},{"color":16},{"text":713,"type":299},{"type":15,"attrs":5867,"content":5868},{"textAlign":722},[5869,5874],{"text":5870,"type":299,"marks":5871},"Baker R.  (2015). Beyond the quick fix – strategies for improving patient safety. Institute of Health Policy, Management and Evaluation at the University of Toronto.",[5872],{"type":938,"attrs":5873},{"color":16},{"text":713,"type":299},{"type":15,"attrs":5876,"content":5877},{"textAlign":722},[5878,5883,5892,5897],{"text":5879,"type":299,"marks":5880},"Baker R, Norton P, et al. (2004). ",[5881],{"type":938,"attrs":5882},{"color":16},{"text":5884,"type":299,"marks":5885},"The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada",[5886,5890],{"type":559,"attrs":5887},{"href":5888,"uuid":53,"anchor":53,"custom":5889,"target":1052,"linktype":747},"http://www.cmaj.ca/content/170/11/1678.full",{},{"type":938,"attrs":5891},{"color":16},{"text":5893,"type":299,"marks":5894},". CMAJ. 170(11):1678-86.",[5895],{"type":938,"attrs":5896},{"color":16},{"text":713,"type":299},{"type":15,"attrs":5899,"content":5900},{"textAlign":722},[5901,5906,5915,5919],{"text":5902,"type":299,"marks":5903},"BC Patient Safety and Quality Council. (2013). ",[5904],{"type":938,"attrs":5905},{"color":16},{"text":5907,"type":299,"marks":5908},"Culture change toolbox",[5909,5913],{"type":559,"attrs":5910},{"href":5911,"uuid":53,"anchor":53,"custom":5912,"target":1052,"linktype":747},"https://bcpsqc.ca/wp-content/uploads/2018/03/culture-toolkit_web.pdf",{},{"type":938,"attrs":5914},{"color":16},{"text":711,"type":299,"marks":5916},[5917],{"type":938,"attrs":5918},{"color":16},{"text":713,"type":299},{"type":15,"attrs":5921,"content":5922},{"textAlign":722},[5923,5928,5936,5941],{"text":5924,"type":299,"marks":5925},"Berwick D, Shojania K, et al. (2015). ",[5926],{"type":938,"attrs":5927},{"color":16},{"text":5929,"type":299,"marks":5930},"Free from harm: accelerating patient safety improvement fifteen years after To Err Is Human",[5931,5934],{"type":559,"attrs":5932},{"href":5933,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},"https://www.ihi.org/resources/Pages/Publications/Free-from-Harm-Accelerating-Patient-Safety-Improvement.aspx",{"type":938,"attrs":5935},{"color":16},{"text":5937,"type":299,"marks":5938},". National Patient Safety Foundation.",[5939],{"type":938,"attrs":5940},{"color":16},{"text":713,"type":299},{"type":15,"attrs":5943,"content":5944},{"textAlign":722},[5945,5950],{"text":5946,"type":299,"marks":5947},"Berwick D, Feely D. (2017). WIHI: the next wave of patient safety. Institute for Healthcare Improvement (IHI) webinar.",[5948],{"type":938,"attrs":5949},{"color":16},{"text":713,"type":299},{"type":15,"attrs":5952,"content":5953},{"textAlign":722},[5954,5959,5968,5973],{"text":5955,"type":299,"marks":5956},"Botwinick L, Bisognano M, Haraden C. (2006). ",[5957],{"type":938,"attrs":5958},{"color":16},{"text":5960,"type":299,"marks":5961},"Leadership guide to patient safety",[5962,5966],{"type":559,"attrs":5963},{"href":5964,"uuid":53,"anchor":53,"custom":5965,"target":1052,"linktype":747},"http://www.ihi.org/resources/Pages/IHIWhitePapers/LeadershipGuidetoPatientSafetyWhitePaper.aspx",{},{"type":938,"attrs":5967},{"color":16},{"text":5969,"type":299,"marks":5970},". IHI White Paper.",[5971],{"type":938,"attrs":5972},{"color":16},{"text":713,"type":299},{"type":15,"attrs":5975,"content":5976},{"textAlign":722},[5977,5982,5991,5995],{"text":5978,"type":299,"marks":5979},"Canadian Institute for Health Information, Canadian Patient Safety Institute (2016). ",[5980],{"type":938,"attrs":5981},{"color":16},{"text":5983,"type":299,"marks":5984},"Measuring patient harm in Canadian hospitals",[5985,5989],{"type":559,"attrs":5986},{"href":5987,"uuid":53,"anchor":53,"custom":5988,"target":1052,"linktype":747},"https://www.cihi.ca/sites/default/files/document/hospital_harm_technical_notes_en.pdf",{},{"type":938,"attrs":5990},{"color":16},{"text":711,"type":299,"marks":5992},[5993],{"type":938,"attrs":5994},{"color":16},{"text":713,"type":299},{"type":15,"attrs":5997,"content":5998},{"textAlign":722},[5999,6004,6013,6017],{"text":6000,"type":299,"marks":6001},"Canadian Patient Safety Institute (CPSI). (Date unknown). ",[6002],{"type":938,"attrs":6003},{"color":16},{"text":6005,"type":299,"marks":6006},"Patient safety culture",[6007,6011],{"type":559,"attrs":6008},{"href":4057,"uuid":414,"anchor":53,"custom":6009,"target":563,"linktype":564,"story":6010},{},{"name":4053,"id":4060,"uuid":414,"slug":4061,"url":4062,"full_slug":4062,"_stopResolving":461},{"type":938,"attrs":6012},{"color":16},{"text":711,"type":299,"marks":6014},[6015],{"type":938,"attrs":6016},{"color":16},{"text":713,"type":299},{"type":15,"attrs":6019,"content":6020},{"textAlign":722},[6021,6026],{"text":6022,"type":299,"marks":6023},"Carman L, Dardess P, Maurer M, et al. (2013). Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health Affairs. 32(2):223-231.",[6024],{"type":938,"attrs":6025},{"color":16},{"text":713,"type":299},{"type":15,"attrs":6028,"content":6029},{"textAlign":722},[6030,6035,6049,6053],{"text":6031,"type":299,"marks":6032},"CPSI, AHQPSC, HQO, PFPSC. (2017). ",[6033],{"type":938,"attrs":6034},{"color":16},{"text":6036,"type":299,"marks":6037},"Engaging patients in patient safety: a Canadian guide",[6038,6047],{"type":559,"attrs":6039},{"href":6040,"uuid":342,"anchor":53,"custom":6041,"target":563,"linktype":564,"story":6042},"/resources/engaging-patients-in-patient-safety-a-canadian-guide",{},{"name":6043,"id":6044,"uuid":342,"slug":6045,"url":6046,"full_slug":6046,"_stopResolving":461},"Engaging Patients in Patient Safety – a Canadian Guide",113881420570413,"engaging-patients-in-patient-safety-a-canadian-guide","resources/engaging-patients-in-patient-safety-a-canadian-guide",{"type":938,"attrs":6048},{"color":16},{"text":711,"type":299,"marks":6050},[6051],{"type":938,"attrs":6052},{"color":16},{"text":713,"type":299},{"type":15,"attrs":6055,"content":6056},{"textAlign":722},[6057,6062,6071,6076],{"text":6058,"type":299,"marks":6059},"Dixon-Woods M, Pronovost P. (2016). ",[6060],{"type":938,"attrs":6061},{"color":16},{"text":6063,"type":299,"marks":6064},"Patient safety and the problem of many hands",[6065,6069],{"type":559,"attrs":6066},{"href":6067,"uuid":53,"anchor":53,"custom":6068,"target":1052,"linktype":747},"http://qualitysafety.bmj.com/content/early/2016/02/24/bmjqs-2016-005232.extract",{},{"type":938,"attrs":6070},{"color":16},{"text":6072,"type":299,"marks":6073},". BMJ Qual Saf. 25(7):485-488.",[6074],{"type":938,"attrs":6075},{"color":16},{"text":713,"type":299},{"type":15,"attrs":6078,"content":6079},{"textAlign":722},[6080,6085,6094,6098],{"text":6081,"type":299,"marks":6082},"Frankel A, et al. (2017). ",[6083],{"type":938,"attrs":6084},{"color":16},{"text":6086,"type":299,"marks":6087},"A framework for safe, reliable, and effective care",[6088,6092],{"type":559,"attrs":6089},{"href":6090,"uuid":53,"anchor":53,"custom":6091,"target":1052,"linktype":747},"http://www.ihi.org/resources/Pages/IHIWhitePapers/Framework-Safe-Reliable-Effective-Care.aspx",{},{"type":938,"attrs":6093},{"color":16},{"text":5969,"type":299,"marks":6095},[6096],{"type":938,"attrs":6097},{"color":16},{"text":713,"type":299},{"type":15,"attrs":6100,"content":6101},{"textAlign":722},[6102,6107,6116,6121],{"text":6103,"type":299,"marks":6104},"IHI. (Date unknown). 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",[6320],{"type":938,"attrs":6321},{"color":16},{"text":6323,"type":299,"marks":6324},"High-impact leadership: improve care, improve the health of populations, and reduce costs",[6325,6329],{"type":559,"attrs":6326},{"href":6327,"uuid":53,"anchor":53,"custom":6328,"target":1052,"linktype":747},"http://www.ihi.org/resources/Pages/IHIWhitePapers/HighImpactLeadership.aspx",{},{"type":938,"attrs":6330},{"color":16},{"text":5969,"type":299,"marks":6332},[6333],{"type":938,"attrs":6334},{"color":16},{"text":713,"type":299},{"type":15,"attrs":6337,"content":6338},{"textAlign":722},[6339,6344,6352,6357],{"text":6340,"type":299,"marks":6341},"Vincent C, et al. (2016). ",[6342],{"type":938,"attrs":6343},{"color":16},{"text":6345,"type":299,"marks":6346},"A framework for measuring and monitoring safety: a practical guide to using a new framework for measuring and monitoring safety in the NHS",[6347,6350],{"type":559,"attrs":6348},{"href":6349,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},"https://www.health.org.uk/sites/default/files/AFrameworkForMeasuringAndMonitoringSafetyPracticalGuide.pdf",{"type":938,"attrs":6351},{"color":16},{"text":6353,"type":299,"marks":6354},". The Health Foundation Quick Guide.",[6355],{"type":938,"attrs":6356},{"color":16},{"text":713,"type":299},{"type":15,"attrs":6359,"content":6360},{"textAlign":722},[6361,6366],{"text":6362,"type":299,"marks":6363},"Weick, K, Sutcliffe, K. (2015). Managing the unexpected: sustained performance in a complex world. Hoboken, NJ: John Wiley & Sons.",[6364],{"type":938,"attrs":6365},{"color":16},{"text":713,"type":299},{"type":12,"content":6368},[6369],{"type":15},[143,150],[200,192,185],"a-framework-for-establishing-a-patient-safety-culture","resources/a-framework-for-establishing-a-patient-safety-culture",-18310,[],{"parent_slug":457,"umbraco_path":6377,"umbraco_uuid":6378},"/HealthcareExcellenceCanada/Resources/PatientSafetyCultureBundle","d332da54-27f7-4057-b2ed-46b84f69c4cb","d59c688e-d9d0-4543-8f02-d500e817c641","2025-11-26T23:54:01.978Z",[],[6383],{"path":6384,"name":6385,"lang":469,"published":461},"ressources/ensemble-de-culture-de-la-securite-des-patients","Ensemble de culture de la sécurité des patients",{"name":6387,"created_at":6388,"published_at":6389,"updated_at":6390,"id":6391,"uuid":329,"content":6392,"slug":6487,"full_slug":6488,"sort_by_date":53,"position":6489,"tag_list":6490,"is_startpage":290,"parent_id":462,"meta_data":6491,"group_id":6494,"first_published_at":6495,"release_id":53,"lang":300,"path":53,"alternates":6496,"default_full_slug":6488,"translated_slugs":6497},"Community Action and Resources Empowering Seniors (CARES)","2025-11-26T23:54:00.195Z","2025-12-22T14:43:56.211Z","2025-12-22T14:43:56.225Z",116783678267635,{"new":290,"seo":6393,"_uid":6396,"hero":6397,"type":179,"topics":6403,"content":6404,"audience":6485,"duration":16,"regional":6486,"component":1176},{"title":6394,"plugin":279,"description":6395},"Community Action and Resources Empowering Seniors","The Community Action and Resources Empowering Seniors (CARES) program supports seniors to age well and live a higher quality of life within their community for longer.","abcaf38d-01f9-4757-a28d-e8a9c5603d39",[6398],{"_uid":6399,"file":6400,"image":6401,"title":6387,"format":16,"component":505,"description":6395,"key_learning":16,"prerequisite":16},"0b66fa22-774f-4ab9-ba3f-2380b3056a5a",[],{"id":498,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":499,"copyright":16,"fieldtype":288,"meta_data":6402,"is_external_url":290},{"alt":16,"title":16,"source":16,"copyright":16},[69,98],[6405],{"_uid":6406,"content":6407,"component":626},"25fec3bc-7ec3-49e5-a8f4-313aa2b02bdd",[6408,6476],{"_uid":6409,"content":6410,"component":625},"46c62f1b-e5e4-479f-8096-9770074aa47e",{"type":12,"content":6411},[6412,6417,6422,6442,6447,6452,6457],{"type":15,"attrs":6413,"content":6414},{"textAlign":53},[6415],{"text":6416,"type":299},"The Community Action and Resources Empowering Seniors (CARES) program supports seniors to age well and live a higher quality of life within their community for longer. 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Community partners can help enhance the physical health of seniors at risk of frailty through active coaching to improve their access to exercise, nutrition and social engagement resources.",{"type":15,"attrs":6453,"content":6454},{"textAlign":53},[6455],{"text":6456,"type":299},"Other benefits of the CARES program include reduced acute care and emergency department use by seniors, as well as healthcare providers’ improved sensitivity to the measurement of frailty through their use of the evidence-informed frailty assessment tool.",{"type":15,"attrs":6458,"content":6459},{"textAlign":53},[6460,6462,6474],{"text":6461,"type":299},"This is one of the innovations being implemented as part of our ",{"text":6463,"type":299,"marks":6464},"Advancing Frailty Care in the Community ",[6465],{"type":559,"attrs":6466},{"href":6467,"uuid":6468,"anchor":53,"custom":6469,"target":563,"linktype":564,"story":6470},"/programs/advancing-community-frailty-care","23a32a2d-928f-4e3f-acc8-9e56903354e5",{},{"name":6463,"id":6471,"uuid":6468,"slug":6472,"url":6473,"full_slug":6473,"_stopResolving":461},124534046147856,"advancing-community-frailty-care","programs/advancing-community-frailty-care",{"text":6475,"type":299},"Collaborative.",{"_uid":6477,"file":6478,"link":6483,"label":6484,"linkType":4082,"component":4083,"linkLabel":16},"267f1a14-f1b4-475e-82af-db42656cdbeb",{"id":6479,"alt":6480,"name":16,"focus":16,"title":6480,"source":16,"filename":6481,"copyright":16,"fieldtype":288,"meta_data":6482,"is_external_url":290},114291120695119,"Cares Innovationprofile E FINAL Ua","https://a-ca.storyblok.com/f/850807391887861/c75da7690f/cares-innovationprofile-e-final-ua.pdf",{},{"id":16,"url":16,"linktype":564,"fieldtype":1031,"cached_url":16},"CARES Innovation Profile",[122,129],[200,192],"community-action-and-resources-empowering-seniors-cares","resources/community-action-and-resources-empowering-seniors-cares",-18290,[],{"parent_slug":457,"umbraco_path":6492,"umbraco_uuid":6493},"/HealthcareExcellenceCanada/Resources/CommunityActionAndResourcesEmpoweringSeniors","d0e92990-f696-441b-8d7f-d9a8b4bd90ac","a7cd0405-8f0c-4ccb-8ee2-af0fb5c04de3","2025-11-26T23:54:00.233Z",[],[6498],{"path":6499,"name":6500,"lang":469,"published":461},"ressources/programme-d-intervention-communautaire-et-de-ressources-pour-l-autonomie-des-aines-cares","Programme d’intervention communautaire et de ressources pour l’autonomie des aînés (CARES)",{"name":6502,"created_at":6503,"published_at":6504,"updated_at":6505,"id":6506,"uuid":322,"content":6507,"slug":6581,"full_slug":6582,"sort_by_date":53,"position":6583,"tag_list":6584,"is_startpage":290,"parent_id":462,"meta_data":6585,"group_id":6588,"first_published_at":6589,"release_id":53,"lang":300,"path":53,"alternates":6590,"default_full_slug":6582,"translated_slugs":6591},"Case-Finding for Complex Chronic Conditions in Persons 75+ (C5-75)","2025-11-26T23:53:35.600Z","2026-02-24T15:27:46.684Z","2026-02-24T15:27:46.711Z",116783577559281,{"new":290,"seo":6508,"_uid":6511,"hero":6512,"type":174,"topics":6519,"Noindex":290,"content":6520,"audience":6579,"duration":16,"regional":6580,"component":1176},{"title":6509,"plugin":279,"description":6510},"Case-Finding for Complex Chronic Conditions in Persons 75 plus","Case-Finding for Complex Chronic Conditions in Persons 75+ enables family practices to rapidly screen patients 75 years of age and older for frailty and its associated conditions, with minimum training and equipment.","ddb1fcc4-0350-48f9-944c-d665c2680f0c",[6513],{"_uid":6514,"file":6515,"image":6516,"title":6502,"format":16,"component":505,"description":6518,"key_learning":16,"prerequisite":16},"133f0e31-e00e-454f-ba8f-f9738373c46e",[],{"id":286,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":287,"copyright":16,"fieldtype":288,"meta_data":6517,"is_external_url":290},{},"Case-Finding for Complex Chronic Conditions in Persons 75+ (C5-75) enables family practices to rapidly screen patients 75 years of age and older for frailty and its associated conditions, with minimum training and equipment.",[69,76,98],[6521],{"_uid":6522,"content":6523,"component":626},"9346565f-40cf-42c0-a24c-38430b4c3616",[6524,6570],{"_uid":6525,"content":6526,"component":625},"13953ab3-cd01-4ddc-8186-a2a102409122",{"type":12,"content":6527},[6528,6533,6538,6543,6548,6553,6558],{"type":15,"attrs":6529,"content":6530},{"textAlign":53},[6531],{"text":6532,"type":299},"The C5-75 program supports patients to maintain their health, quality of life and community living for as long as possible.",{"type":15,"attrs":6534,"content":6535},{"textAlign":53},[6536],{"text":6537,"type":299},"C5-75 was developed by the family health team at the Centre for Family Medicine in Kitchener, Ontario in 2012 and tested in 19 local family practices. The target group is patients aged 75 and older who are in a family practice group with shared electronic health records and who have been screened as frail.",{"type":15,"attrs":6539,"content":6540},{"textAlign":53},[6541],{"text":6542,"type":299},"Based on the Fried frailty phenotype criteria, C5-75 examines gait speed and hand grip strength to identify frail older adults who may be at higher risk of health destabilization. Together, these two tests were found to be a sensitive and specific proxy for the full Fried frailty phenotype for identifying those who are frail, while being faster to administer and resource-light in primary care.",{"type":15,"attrs":6544,"content":6545},{"textAlign":53},[6546],{"text":6547,"type":299},"The six-month community pilot project engaged 14 health service providers and 11,819 patients within an urban family practice setting in Kitchener, Ontario. Community staff, such as pharmacists, were trained to complete C5-75 Level 1 screening in addition to their prerequisite medication review duties.",{"type":15,"attrs":6549,"content":6550},{"textAlign":53},[6551],{"text":6552,"type":299},"The project team measured patients’ satisfaction levels and found that the mean score was 4.5 out of 5 (“very satisfied”). Pharmacy staff perceived the screening process to be feasible and acceptable, identifying screening time-related concerns in only two cases (4%). Eighteen family healthcare providers highlighted the usefulness of C5-75 in their frailty assessments of patients.",{"type":15,"attrs":6554,"content":6555},{"textAlign":53},[6556],{"text":6557,"type":299},"C5-75 is designed to proactively identify unrecognized or sub-optimally treated co-existing conditions. The program includes appropriate interventions with the goal of averting medical crises for patients that result in emergency department visits, hospitalization and early transition into long-term care.",{"type":15,"attrs":6559,"content":6560},{"textAlign":53},[6561,6562,6569],{"text":6461,"type":299},{"text":6563,"type":299,"marks":6564},"Advancing Frailty Care in the Community Collaborative",[6565],{"type":559,"attrs":6566},{"href":6467,"uuid":6468,"anchor":53,"custom":6567,"target":563,"linktype":564,"story":6568},{},{"name":6463,"id":6471,"uuid":6468,"slug":6472,"url":6473,"full_slug":6473,"_stopResolving":461},{"text":711,"type":299},{"_uid":6571,"file":6572,"link":6577,"label":6578,"linkType":4082,"component":4083,"linkLabel":16},"c4643013-19a0-472e-a8cc-3f15c54d226c",{"id":6573,"alt":6574,"name":16,"focus":16,"title":6574,"source":16,"filename":6575,"copyright":16,"fieldtype":288,"meta_data":6576,"is_external_url":290},114291128063827,"C575 Innovationprofile E FINAL Ua","https://a-ca.storyblok.com/f/850807391887861/62cdf83d19/c575-innovationprofile-e-final-ua.pdf",{},{"id":16,"url":16,"linktype":564,"fieldtype":1031,"cached_url":16},"Download the C5-75 innovation profile",[129,136,150],[185,192,200],"case-finding-for-complex-chronic-conditions-in-persons-75-plus","resources/case-finding-for-complex-chronic-conditions-in-persons-75-plus",-18250,[],{"parent_slug":457,"umbraco_path":6586,"umbraco_uuid":6587},"/HealthcareExcellenceCanada/Resources/CaseFindingForComplexChronicConditionsInPersons75Plus","b3b37cd8-7069-404e-b473-e2555ecc4a76","3e76ab0f-7513-4378-b171-6d06cce3c32e","2025-11-26T23:53:35.663Z",[],[6592],{"path":6593,"name":6594,"lang":469,"published":461},"ressources/depistage-d-affections-chroniques-complexes-chez-les-personnes-de-75-ans-et-plus","Dépistage d’affections chroniques complexes chez les personnes de 75 ans et plus (C5-75)",{"name":6596,"created_at":6597,"published_at":6598,"updated_at":6599,"id":6600,"uuid":407,"content":6601,"slug":6673,"full_slug":6674,"sort_by_date":53,"position":6675,"tag_list":6676,"is_startpage":290,"parent_id":462,"meta_data":6677,"group_id":6680,"first_published_at":6681,"release_id":53,"lang":300,"path":53,"alternates":6682,"default_full_slug":6674,"translated_slugs":6683},"Rapid review: Delivering primary care services in non-traditional healthcare settings to people experiencing homelessness","2025-11-26T23:53:26.269Z","2026-02-25T19:52:32.416Z","2026-02-25T19:52:32.432Z",116783539310832,{"new":290,"seo":6602,"_uid":6605,"hero":6606,"type":170,"topics":6614,"Noindex":290,"content":6615,"audience":6671,"duration":16,"regional":6672,"component":1176},{"title":6603,"plugin":279,"description":6604},"Rapid review Delivering primary care services","An overview of promising models of care and key findings that support equitable access to primary care for people experiencing homelessness.","214a0ce8-27c0-4419-9cdf-c99ef8cfdb59",[6607],{"_uid":6608,"file":6609,"image":6610,"title":6596,"format":16,"component":505,"description":6604,"key_learning":16,"prerequisite":16},"4a114fd0-9cd6-4a92-92a1-9074a816351f",[],{"id":6611,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":6612,"copyright":16,"fieldtype":288,"meta_data":6613,"is_external_url":290},138976226047341,"https://a-ca.storyblok.com/f/850807391887861/1500x1000/b44bb247e6/shapes-6.webp",{},[91,98,46],[6616,6650,6661],{"_uid":6617,"content":6618,"component":626},"f4dcdbc4-debc-417c-996d-2f1c285a23e3",[6619],{"_uid":6620,"content":6621,"component":625},"f0a90e1a-e6d3-4f86-b805-7114c55849ea",{"type":12,"content":6622},[6623,6635,6640,6645],{"type":15,"attrs":6624,"content":6625},{"textAlign":53},[6626,6627,6633],{"text":4189,"type":299},{"text":6628,"type":299,"marks":6629},"Rapid Review: Delivering Primary Care in Non-Traditional Healthcare Settings to Individuals Experiencing Homelessness",[6630],{"type":559,"attrs":6631},{"href":6632,"uuid":53,"anchor":53,"custom":53,"target":1052,"linktype":747},"https://ihpme.utoronto.ca/research/research-centres-initiatives/nao/rapid-reviews/rapid-review-34/",{"text":6634,"type":299}," identifies promising models of care that support equitable access to primary care for people experiencing homelessness.",{"type":15,"attrs":6636,"content":6637},{"textAlign":53},[6638],{"text":6639,"type":299},"People experiencing homelessness often face barriers, including stigma or exclusion, when accessing primary care. This results in higher rates of unmet needs and trips to the emergency room. One approach to better meet the needs of people experiencing homelessness is to provide primary care outside of traditional primary care clinics.",{"type":15,"attrs":6641,"content":6642},{"textAlign":53},[6643],{"text":6644,"type":299},"This report was completed by the North American Observatory on Health Systems and Policies with support from Healthcare Excellence Canada.",{"type":15,"attrs":6646,"content":6647},{"textAlign":53},[6648],{"text":6649,"type":299},"The report identified the following six key considerations for providing primary care services to people experiencing homelessness in non-traditional settings.",{"id":16,"_uid":6651,"content":6652,"component":626},"09dc8b38-b592-4d42-aa61-71e784c73163",[6653],{"_uid":6654,"image":6655,"component":6660},"dd954eb5-7181-4eba-be20-3c68185bf4c3",{"id":6656,"alt":6657,"name":16,"focus":16,"title":16,"source":16,"filename":6658,"copyright":16,"fieldtype":288,"meta_data":6659,"is_external_url":290},114298617466516,"Key considerations for delivering primary care services to people experiencing homelessness: Foster positive interpersonal relationships between people experiencing homelessness and healthcare providers, include peer support workers and interprofessional team members to address the complex needs of people experiencing homelessness, establish a welcoming and inclusive environment to encourage access to primary care and social connectedness, support system navigation and build connections to mainstream care to help reduce barriers, enable collection and sharing of health information to improve care continuity and support evaluation of primary care programs, and adopt sustainable and adaptive funding models.","https://a-ca.storyblok.com/f/850807391887861/1c25f585f0/infographic-key-considerations-for-delivering-primary-care.png",{"alt":6657,"title":16,"source":16,"copyright":16},"simple-image",{"_uid":6662,"content":6663,"component":626},"ed77ebed-56c8-4b63-a559-91987617e33a",[6664],{"_uid":6665,"file":6666,"link":6668,"label":6628,"linkType":559,"component":4083,"linkLabel":6670},"e30b0566-f682-4390-8eeb-87f19e30ac96",{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":288,"meta_data":6667},{},{"id":16,"url":6669,"target":1052,"linktype":747,"fieldtype":1031,"cached_url":6669},"https://naohealthobservatory.ca/research/rapid-review-34/","Download",[150,143,136],[200,192,185],"rapid-review-delivering-primary-care-services-in-non-traditional-healthcare-settings-to-people-experiencing-homelessness","resources/rapid-review-delivering-primary-care-services-in-non-traditional-healthcare-settings-to-people-experiencing-homelessness",-18230,[],{"parent_slug":457,"umbraco_path":6678,"umbraco_uuid":6679},"/HealthcareExcellenceCanada/Resources/RapidReviewDeliveringPrimaryCareServices","aa34c24d-b74b-4f7c-8812-692ba43286df","a82c07cf-86b9-45a5-8acf-f0dd04cbfee9","2025-11-26T23:53:26.305Z",[],[6684],{"path":6685,"name":6686,"lang":469,"published":461},"ressources/revue-rapide-prestation-de-soins-de-sante-primaires-en-milieu-non-traditionnel-chez-les-personnes-en-situation-d-itinerance","Revue rapide : Prestation de soins de santé primaires en milieu non traditionnel chez les personnes en situation d’itinérance",156,1776087582152]