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Personal Support Network of Ontario Volume 2, Issue 3 2008 PSW Conference: A Booming Success! With over 400 PSWs in attendance at the Sheraton Parkway North in Richmond Hill on October 20th, the 2nd annual PSW Conference was a huge success! From across On- tario, PSWs gathered for a full day of learning, meeting with old and new friends and a celebra-tion of the profession. After a networking Inside this issue: breakfast, delegates heard from Judith Fisher, her 91-year old mother, Aileen and two PSWs, Lynn Fitzpatrick and Patricia Parra. Judith's presentation described how two PSWs, Lynn and Patricia, helped Aileen regain her independence and return to her own home after being hospital-ized in January 2008. Judith expressed her fam- PSNO Congratu- 2 Judi Fisher, Aileen , Lynn
lates Scholarship ily's gratitude to Lynn and Patricia, and to all Fitzpatrick and Patricia Parra
PSWs, for the role they play in home care deliv- ery. Judith recalled how impressed she was with the knowledge and level of care pro- PSW Supervisor 3 vided by Lynn and Patricia and what it meant to her family. Since this experience, she has become an advocate for recognizing the role of the PSW in home care. Conference delegates then attended profes- sional development workshops presented by experts from across the province. Workshops included presentations on strategies to reduce the Year Finalists workplace injuries, communication strategies, infectious disease prevention, pain manage- Florence Dittmar: 5 ment and bullying in the workplace. Best Practices in 6 The conference concluded with the announce- MRSA / C.difficile: Trying to Take
Personal Support: ment of the PSW of the Year, Florence Ditmar, Over the World
from Huntsville and an employee of A Friend in Need (see page 4 for more details) and the Drum Café! Through Drum Cafe's interactive drumming program, all conference delegates were given a drum, taught and practiced different drumming techniques and learned more about how the drum help build tribal unity in Af-rica. The programs goals were to have fun, build teamwork and motivation. We have received very positive feedback from the Conference and are happy that so many were able to attend and participate throughout the day. Watch for details regarding a March PSW confer- ences in London and Ottawa.
Thanks to all who attended for making this year's Conference a success!
PSW Professional Development Scholarship: Winner Announced! In May of 2008, Saint Eliza- in health care services. use his degree to become a beth Health Care, the Per- Originally from Uganda, he Nurse Practitioner working sonal Support Network of studied Medicine, receiving in underserved communi- Ontario and the Ontario his Bachelors of Medicine Community Support Asso- and Surgery in 1987 and a ciation announced the launch Masters of Medicine of a new scholarship for Per- (General Surgery) in 1994 sonal Support Workers in from Makerer University in Ontario who wished to ad- Kampala, Uganda. In vance his/her education in Uganda he worked as a the area of Health Care, with Medical Officer, Senior to Andrew from
a focus on Home and Com- House Officer and General all of us at PSNO"
Surgeon. Andrew made a The Scholarship Committee decision to join his family in received many strong appli- Canada but was unable to Andrew Kidza
cations and had a difficult practice medicine because of Winner of the PSW
time selecting this year's regulatory requirements. He scholarship recipient because began working as a replace- Development Scholarship
of the high qualifications of ment service support worker and later started working for Congratulations to Andrew Bellwoods Centres in 2000. We are happy to announce on receiving the scholar- In 2003 he completed his the winner of the 2008 PSW ship and we wish him the Personal Support Worker Professional Development best of luck in pursuing his Scholarship is Andrew Kidza. academic and professional Currently, Andrew is pursu- goals. Special thanks to Andrew is currently a PSW ing a Bachelor of Science in Saint Elizabeth Health Care with Bellwoods Centres for Nursing degree at York Uni- for their sponsorship of the Community Living Inc. versity. Andrew plans to Andrew has had a long career PSNO Congratulates Scholarship Finalists PSNO would also like to Techniques in Gerontology It was Ashley's enthusiasm congratulate Ashley Stangler Certificate program at for her work, and Linda's and Linda Sea who were the Georgian College. journey towards working two finalists in the PSW Having worked as a PSW within the health care sector Professional Development with the Yee Hong Centre that captured the attention since 2003, Linda Sea is of the Selection Committee. Though only 25, Ashley has currently pursuing her PSNO would like to wish been working as a PSW for RPN with Georgian Col- the best of luck to both 7 years and is interested in Ashley and Linda. pursuing the Activation PSNO PSW Supervisor Conference PSNO is happy to an- • Attracting and Retaining nounce that we will be Your Personal Support • Launching A Redesigned holding the First Annual Personal Support Service PSW Supervisor Confer- • Performance Reviews, ence: Mentoring Leaders, • Hush—No Rush: The on November 25, 2008. • Recruiting the Best Team Approach to De- The Conference, to be held at The Westin Prince, in Developing Leadership Toronto, Ontario is the Qualities To Inspire and Put Your Strengths To first of its kind to focus on Engage Your Staff Work: How One Organi- PSW Supervisors and their • Cultural Competence for zation Is Harnessing The Clinical Leaders and Su- Strengths In Their Work- The Conference will give PSW Supervisors the op- • Promoting Within: PSW portunity to network and Mentoring Programs In For more information attend workshops. Supportive Housing please visit us at: • What PSW Supervisors www.psno.ca. There you Workshops include: Can Do To Enhance The will find Conference details, • I'm A Supervisor Now Work Experience of Per- schedules and registration What? Professional Care sonal Support Workers Boundaries for Supervis-ing Peers • Understanding the Health Support for Personal Support Workers Community of Practice The Support for Personal best practices in caring Practice Specialists and Edu- Support Workers Commu- The Support for nity of Practice (PSWCoP) • access to the services of a Personal Support Members receive notice of is a free knowledge ex- Knowledge Broker and all PSWCoP activities; op- Community of changed network for PSWs an Information Specialist tions to participate in dia- Practice is working with seniors in the to answer practice ques- logues and learning exchange funded and community or in long term tions and provide infor- events. There is no fee for supported by the care in Ontario. mation useful to them in Seniors Health Research The purpose of PSWCoP is To become a PSWCoP Transfer Network to provide PSWs working • training in the use of member, leave a message and sponsored by with seniors in dispersed web-based communica- with your name and contact the Personal work settings in the commu- information at 416-489-2500 Support Network nity with support through: The PSWCoP is currently of Ontario (PSNO) • access to the support and recruiting members. Cur- and VHA Home pswcop@vha.ca. Please
HealthCare. expertise of their col- rent members are PSWs note this membership is
working with seniors, Re- separate from membership
• access to research about searchers, Ethicists, Clinical in PSNO.
Volume 2, Issue 3
Profile: PSW of the Year Finalists This year's PSW Conference culminated with the announcement of the 1st annual PSW of the Year Award which was created to recognize and honour an outstanding PSW working in Ontario. Clearly, there are many exceptional PSWs delivering care in Ontario. PSNO began collecting nominations for the PSW of the Year Award in Au-gust and received a large number of nominations from supervisors, case managers, clients, family members and friends from all over Ontario. Nominees had to be outstanding in the following 6 categories: • Professional Knowledge • Patient Care • Advocacy • Team Support • Going Beyond the Call of Duty • Outstanding Work History Finalists Margo McLaughlin
Based upon her 38 years of commitment and out- and Kerry Conway (center) with Lori standing performance, Florence Dittmar from
Payne of PSNO and Susan Thorning Huntsville was selected as PSW of the Year. Kerry
Conway of Ottawa and Margo McLaughlin of Belleville were finalists along with Florence. Florence's story follows on the next page. We would also like to tell you about our two other finalists. Kerry Conway works with Carefor Community Services in Ottawa. She works with vulner-able clients including the homeless and individuals addicted to alcohol, tobacco and drugs. Despite a challenging environment, she ensures that her clients' hygiene, medicinal and nutri-tional needs are met. Three years ago, Kerry was instrumental in starting a lunch program for her clients, so as to remove their dependence on the Shelter for meals. Kerry encourages her clients to strive to reach their potential and this is what made her stand out to the Selection Committee. Kerry was nominated by Barb Campbell, her Supervisor at Carefor Health. Margo McLaughlin currently works at Belmont Long Term Care Facility in Belleville. Her nomination was submitted by Karen Mayer, who was her PSW teacher at Loyola Community Learning Centre. Often coming into work early and leaving late, Margo focuses on the qual-ity of care her patients receive. She is a volunteer with the Palliative Care team. Margo advo-cates for the PSW profession, and goes to speak to Karen's PSW students about the role and challenges of being a PSW. She is passionate about new students and often volunteers her time to ensure they get more one-on-one time. One student was unable to make one of her tuition payments, and Margo privately made the payment, unbeknownst to anyone. We salute Florence, Kerry and Margo and all our nominees. You are the heavy lifters of the health care sector and the work that you do does not go unnoticed. Florence Dittmar: PSW of the Year Florence was nominated by her employer, Catherine Hayhoe of A Friend in Need Home Health Care Services in Huntsville. In 500 words, Catherine was able to present a passion-ate story of Florence's work history and the contributions she has made to the profession of Personal Support. In a 38-year career in Long Term Care and Home Care, Florence has demonstrated leadership skills and advanced knowledge. She advocates for improve-ments and mandatory standards for the profes-sion, as well as for her clients and colleagues. Florence is passionate about her job, an expert at her agency and is involved in every in-service function. Florence has solid clinical judgement coupled with emotional intelligence which allows her to develop trusting therapeutic relationships with her clients. There have been situations when Florence on being
case managers, nursing supervisors and family PSNO's PSW of
members of clients have been unable to suggest the Year
or implement necessary care plan changes. Flor-ence is called on in these circumstances to dis-cuss the changes with the client and in most Florence Dittmar receives her award
and cheque for $500
situations the client will agree to the changes that "Flo suggested". As an indication of her knowledge and involvement in her career, Florence is often called upon for her opinion. One example of such was of a junior team member who was not viewed as a right fit for the organization she worked with. Florence disagreed and be-lieved that with more guidance and mentorship, this young staff member would succeed. She took this young PSW under her wing for one year and now because of her help the staff member has gained the clinical skill and judgement to follow in Florence's footsteps. Florence's professional knowledge, care for clients, advocacy, and dedication for her pro-fession and towards her colleagues is why she is the first recipient of the PSW of the Year award. We were all thrilled to have the opportunity to meet such an amazing woman at the Con-ference and to be able to present her with her award and a cheque for $500. Congratula-tions to Florence on being PSNO's PSW of the Year. Her experience and commitment is truly inspirational. The PSNO PSW of the Year Award will be presented annually at our Annual PSW Con-ference held in October. Applications for next year will become available July 2009 and PSNO members will be the first to receive the announcement and nomination forms. Volume 2, Issue 3
Best Practices in Personal Support—Myth Busting: Medications By: Mary-Lou van der Horst Myth 1: Not much kidney disease in LTC
Kidneys are critical for good health. Their main task is to remove waste products from the
body. We have two kidneys, the size of a clenched fist, one on either side of the spine un-
der the lower ribs. Kidney disease or renal impairment is more common in older adults. It
is especially common in long term care, up to 44% of men and 70% of women have renal impairment. The 3 leading causes of kidney failure are diabetes, high blood pressure Mary-Lou van der and glomerulonephritis. Kidney damage is diagnosed us- Horst is currently ing blood, urine or imaging tests. Glomerular filtration rate working with the (GFR) is used to classify the severity of kidney damage. Regional Geriatric Calculated creatinine clearance (CrCl) is used as an indirect Programs of Ontario-Central area as a a estimation of kidney function. Kidney function is catego- Geriatric Nursing / rized as stages by the level of CrCl, Stage 5 is the worst. Knowledge Chronic kidney disease is defined as either kidney damage Translation or CrCl <60 ml/ml for ≥ 3 months. However, renal impairment is still frequently not rec- Consultant and the ognized in older adults. For On- Ontario Osteoporosis Strategy for Long- tario's 75,000 LTC residents that Term care as Project means about 30,000 residents have Manager / LTC renal insufficiency. Nursing Consultant. Previously, she was Myth 2: No need to adjust med doses
the Regional Best Prescribing for LTC residents presents several challenges due to their various illnesses and Practice Coordinator age-related decline in kidney function. Many medications are cleared by renal excretion and in Lon Term Care for Central South the clearance of these and their metabolites from the body is lowered with reduced kidney Ontario with the function. Inappropriate prescribing along with reduced Ontario Ministry of kidney function increases the risk of adverse medication Health and Long- events in frail LTC residents such as falls, delirium, confu- Term care assisting sion and agitation. In studies, 1 in 3 prescriptions were the long-term care sector to implement considered inappropriate for the calcu- evidence-based / best lated CrCl of residents. The medications practices care most frequently prescribed inappropri- improvements. ately were allopurinol, glyburide, ranitidine, hydrochlorothiazide and met-formin. Significant predictors for receiving an inappropriate medication were advancing age, number of prescribed medications, and number of physicians prescribing the medications in the LTC home. Equations to predict creatinine clearance from serum creatinine such as the Cockcroft-Gault formula have been shown to give more valid and practical estimates of kidney functions since with aging, serum creatinine increases and muscle mass decreases. Unfortunately, renal function is often overlooked by physicians and nurses when medica-tion therapies are being considered or changed. Best Practices in Personal Support—Myth Busting: Medications—Continued Myth 3: Its safer to under dose Coumadin to avoid bleeding
Coumadin (Warfarin) is often prescribed to LTC residents. It is a "blood thinner" or anti-
coagulant that is used to prevent blood clots from forming or getting larger. Most often, it
is residents who have had a stroke, blood clot in their legs, TIA's (transcient ischemic at-
tacks) or have atrial fibrillation that are taking this medication.
Maintaining a therapeutic level of Coumadin is critical to en-
For more information sure it's effective. This is a balancing act between taking on this and other best enough Coumadin to prevent a clot from forming while at the practices same time making sure you don't take too much so that you • Contact your spontaneously bleed. To measure if a resident is within thera- Regional Best peutic range, their blood INR Practices (international normalized ratio) is measured. Ideal range Coordinator for INR is 2.0 to 3.0. Studies have found that residents' www.rgpc.ca INR were within, below and above INR therapeutic range: • Seniors Health 54%, 35% and 11% of the time. They also found that 20% Research Network of the time, the INR was not measured within 7 days after www.shrtn.on.ca starting or a change in medication dose. In addition, many • Hamilton Long physicians tend to use a careful approach and run INRs Term Care Resource lower than 2 to minimize the risk of bleeding. Centre www.rgpc.ca Myth 4: Don't use Coumadin if they fall
The risk of falling and hitting the head with the potential to develop an internal head bleed is often considered a reason why not to start anticoagulation in residents. High risk resi-dents with a history of falling usually have multiple medical conditions along with physical and function issues. Studies have shown that residents do re-spond favourably to Coumadin. For residents who fall, physi-cians may use a careful approach. Studies confirm that the risk of having an internal head bleed from a fall is so small that a resi-dent with the average risk of a stroke from atrial fibrillation (5%) and no major illnesses must fall 300x a year for the risk of antico-agulation to outweigh its benefits. In fact, falling is usually not a reason to avoid starting medication. Research supports the stroke protection benefits of the anticoagulation therapy in older adults especially those with a history of hypertension, left ven- tricular dysfunction, dia-betes and/or TIAs or stroke. For the full issue or other issues of the BP Blogger, please visit www.rgpc.ca. Or e-mail marylou1harold@xplornet.com Volume 2, Issue 3
Upcoming Conferences Mark your calendar and watch for more information about the following upcoming PSW Conferences: November 25, 2008
Mentoring Leaders: PSW Supervisor Conference The Westin Prince, Toronto, ON March 11, 2009
Best Western Lamplighter Inn, London, ON March 2009
Personal Support Network of Ontario 104 - 970 Lawrence Avenue West The Personal Support Network Toronto, ON M6A 3B6 of Ontario was established to Phone: 416-256-3010/1-800-267-6272 help personal support service Ext. 0 Fax: 416-256-3021 professionals carry out their E-mail: sarah.blakely@psno.ca work more effectively by offer- We're on the Web ing access to information, re- sources and tools as well as providing opportunities to con-nect with a network of profes-sionals in their field. Helping PSWs carry out their work more effectively

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Observatoire des Médicaments, des Dispositifs médicaux et des Innovations Thérapeutiques Prescription médicamenteuse chez la personne âgée Liste ATC des médicaments proposés par la Commission Gériatrie de la région Centre Préambule Ce livret thérapeutique regroupe la liste des médicaments pouvant être prescrits chez le sujet âgé, proposés par la Commission Gériatrie de la région Centre pilotée par l'OMéDIT. Il a pour objectif d'aider les médecins généralistes, principaux prescripteurs chez les personnes âgées1, dans l'élaboration de leur prescription, la thérapeutique gériatrique n'étant pas une priorité de la formation médicale initiale et continue. Sous le terme de « personnes âgées » sont concernés les sujets de 75 ans et plus, ainsi que ceux de plus de 65 ans polypathologiques. Ils représentent 16 millions de personnes au 1er Janvier 2011 (données INSEE)2. L'âge en soi ne contre-indique aucune thérapeutique, mais le vieillissement et les situations physiopathologiques associées peuvent modifier l'objectif des traitements et leur rapport bénéfice-risque.

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THE FAULT IN OUR STARS Scott Neustadter & Michael H. Weber Based on the novel by John Green FOX 2000 PICTURES FINAL SHOOTING SCRIPT 10201 W. Pico Blvd. Los Angeles, CA 90035 Revisions Green – August 27, 2013 Yellow – August 30, 2013 Goldenrod – September 13, 2013 Salmon – September 18, 2013 2nd Blue – September 23, 2013