Dilution of chemotherapy drugs
On March 20th a pharmacy technician at an Ontario hospital realizes an error in regards to the dilution of chemotherapy drugs. Shortly thereafter, The Ministry of Health and Long Term Care is notified of the dilution and the public is notified. The pre-mixed chemotherapy cocktails were being outsourced from Marchese Hospital Solutions.
In total, 1202 patients in Ontario and New Brunswick received diluted chemotherapy drugs, some for as long as a year. Extra saline in the bags of chemotherapy drugs watered down the prescribed concentrations by as much as 10 per cent. One hundred-thirty-seven patients have died since starting their treatment, though there is no indication what, if any, role the diluted medication played.
This error revealed a startling problem – health care companies such as Marchese are allowed to mix drugs for hospitals without any oversight – federally or provincially (as reported by Toronto Star).
Following an independent review led by prominent pharmacist, Dr. Jake Thiessen, it was concluded that the diluted therapy drugs “boiled down to gaps in communication,” between the private Marchese Solutions, the hospitals and the bulk drug supply company that brokered the sale of the drugs.
Dr. Thiessen said he found no evidence of any harmful intent and made 12 recommendations to improve the oversight of drugs purchased by hospitals. The Ontario government accepted all of the recommendations and introduced the Enhancing Patient Care and Pharmacy Safety Act, 2013 to strengthen the safety and oversight of Ontario’s cancer drug supply system. This new legislation, if passed, will allow the Ontario College of Pharmacists to accredit and inspect pharmacies within public and private hospitals, in the same manner it currently accredits and inspects community pharmacies. Health Canada put in place a new policy requiring drug facilities to be regulated under either: the federal Food and Drugs Act, the supervision of a provincially licensed pharmacist, or in a hospital.
On September 11th an Ontario hospital issued a public statement that they were in the process of reviewing 3500 CT scans and mammograms conducted between April 1, 2012 and March 31, 2013 to ensure the accuracy of results.
The review was being undertaken due to a performance issue with one radiologist who worked at two of the hospital’s three sites. The radiologist who worked at the hospital for 33 years is no longer working there. All patients whose scans were being reviewed were notified. Thus far, the hospital has confirmed that at least one patient one misdiagnosed.
The hospital has launched an external review of the scans – led by Dr. Brian Yemen of The Juravinski Hospital and Cancer Centre. In mid -November, Dr. Yemen provided an update: To date, more than 75 per cent of patients have received their results and he is confident he will be able provide his final findings in the coming weeks. The review will be made public.
Canada’s immunization rate falling – In April 2013 a UNICEF report revealed that the immunization rate for children in Canada is 28th among the world’s 29 richest industrial nations, and is one of only three of the 29 countries in which immunization rates fall below 90 per cent. Canada’s immunization rate has been falling for the last decade. Places in Africa, such as Tunisia and Eritrea, now have higher immunization rates than Canada’s. Vaccination rates are plummeting around the world. Once dormant diseases are reappearing – like measles, one of the most infectious.
In April 2013, Ottawa public health officials suspended nearly 1000 students because they did not have properly kept immunization records. They city said that 18,000 warning letters were sent out to parents about providing proof of immunization or applying for a special exemption.
In late October a measles outbreak was reported in Southern Alberta . At press time, 28 cases have been confirmed in the region – most of those infected were not immunized. The first case developed in a boy who travelled to the Netherlands where nearly 2000 people have been infected since May. Southern Alberta has some of the lowest immunization rates in the province -at less than 60 per cent. Alberta Health Services has established mobile immunization clinics in an effort to immunize those who are at risk. Cases of mumps and whooping cough – not common in most developed communities – have also been reported in the region. Seven cases of measles were reported in the Fraser Health Region (BC) since August – the source has not been found.
First public cord-blood bank launches in Canada
On September 30th, Canada’s first national public blood bank for umbilical cord blood accepted its first donation at the Ottawa Hospital. According to Canadian Blood Services, until then, Canada was the only G8 nation without a public cord blood bank. The Cord Blood Bank will benefit Canadian patients by providing an increased opportunity for transplant and will also reduce Canada’s 100 per cent reliance on internationally sourced cord blood stem cell donations.
The Public Cord Blood Bank will consist of five collection hospitals in four cities: Ottawa, Brampton, Edmonton, and Vancouver. In mid-2014 collections will begin at William Osler Health System in Brampton – the hospitals in Vancouver and Edmonton will also be announced. The goal is to bank 20,000 ethnically diverse cord blood units over eight years. To date, 192 cord blood donations have been collected at The Ottawa Hospital.
First Nations Health Authority
In October the historic transfer of all Health Canada health programs and services to B.C. First Nations was made via the first aboriginal health authority in Canada -The First Nations Health Authority (FNHA).
Statistically significant health disparities exist for First Nations people in BC and across Canada. FNHA, an organization that reflects First National culture and philosophy aims to reform the way healthcare is delivered to BC First Nations to close these gaps and improve health and wellbeing.
In 2012 approximately 21 per cent of Canadians were over the age of 60. By 2030 – it is estimated to rise to 28.5 per cent and by 2050 – 31 per cent. Some experts are warning that the health care system, already strapped for cash will not be able to sustain the increase in demands for healthcare.
The Canadian Medical Association’s 13th Annual National Report Card on Health focused on the future of senior’s health care and revealed that a majority of Canadians do not feel confident in the health system’s ability to meet the aging population’s needs. Ninety-three per cent of respondents believe that Canada needs a national strategy for senior’s healthcare at home, hospitals, hospices and long-term care facilities.
A Canadian Medical Association survey of almost 10,500 practising physicans indicates that Canada’s aging population is already having an impact on medical practice. A survey synopsis says that because of Canada’s aging population, it is no surprise that geriatricians (59 per cent) led the list of specialists reporting a major increase in the need for their services.
Mandatory flu vaccine for health care workers
In October, a British Columbia arbitrator upheld a provincial government policy requiring all health care workers in the province to get a flu shot or wear a mask while caring for patients during flu season (December to March). The Health Sciences Association, representing more than 16,000 health science professionals opposed the policy and launched a grievance, and were disappointed with the arbitrator’s ruling.
Many provinces were awaiting the decision in BC and are expected to follow suit in mandating flu vaccines or masks for workers during flu season. Recently, in Ontario, The Ministry of Health and Long Term Care launched the pilot project “Let’s get Fluless”. The campaign, (including posters and information sheets) aims to increase flu shot uptake among health care professionals. Government statistics indicate that Ontario’s provincial median rate for flu vaccinations among health care workers is between 50 and 50 per cent.
For what may be the first time in an Ontario hospital, Bluewater Health has implemented the same policy as British Columbia – all staff, doctors and volunteers are required to have the flu vaccine or wear a mask around patients during flu season. Many other hospitals in Ontario implement this policy, but only during active outbreaks of influenza at their facility.