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Annual Management Report 2007-2008 An environment focused on caring for clients! TABLE OF CONTENTS

MESSAGE FROM THE PRESIDENT AND THE DIRECTOR GENERAL . 2
DECLARATION BY THE DIRECTOR GENERAL . 4

ORGANIZATIONAL STRUCTURE . 5
A PROFILE OF THE CSSS POPULATION AND TERRITORY. 8
BOARD AND COMMITTEE MEMBERS . 11
CSSS STAFF . 14
THE SERVICE OFFER . 15
BRANCH HIGHLIGHTS FOR 2007–2008 . 15
BRANCH OUTLOOKS FOR 2008–2009 . 15
INCOME STATEMENT . 36
ANNUAL REPORT BY THE LOCAL SERVICE QUALITY
AND COMPLAINTS COMMISSIONER . 37

ANNUAL REPORT BY THE USERS'COMMITTEE AND RESIDENTS'COMMITTEE . 39
ANNUAL REPORT BY THE EXECUTIVE COMMITTEE OF THE BOARD . 39
OF PHYSICIANS, DENTISTS AND PHARMACISTS
REPORT BY THE PHARMACOLOGY COMMITTEE . 39
REPORT BY THE MULTIDISCIPLIN REPORT BY THE BOARD OF NURSES ARY BOARD . 39
REPORT BY THE BOARD OF NURSES . 41
MESSAGE FROM THE PRESIDENT AND THE DIRECTOR GENERAL
The Centre de santé et de services sociaux (CSSS) de La Côte-de-Gaspé has yet again wrapped up a year filled with challenges and projects involving a single objective: improving the accessibility, continuity and quality of services for the population served by the CSSS. The CSSS de La Côte-de-Gaspé is pursuing the momentum set in motion three years ago. Although certain advances remain to be consolidated, the evolving organizational structure and a range of events have led to greater stability, which in turn facilitates our day-to-day actions. Henceforth, we have a better command of this new multi-clientele environment where needs and responses to them are often interrelated. Further, we are seeing the birth of a CSSS organizational culture among our teams, whose members are more aware of the work of others and the ties they can establish with them. The merger of missions four years ago has gradually led to a local network of internal services. The next major challenge of the CSSS is to coordinate with external partners, community organizations, municipalities and other bodies to create a true local services network that can meet all the needs of the Côte-de-Gaspé population. In the past year, the Board of Directors of the CSSS de La Côte-de-Gaspé began a strategic planning process for the 2008−2011 period with respect to national and regional orientations. The process involved public meetings in Grande-Vallée, Murdochville, Rivière-au-Renard, Wakeham and Gaspé to present and validate our view of the issues. Community organizations and internal stakeholders of the CSSS also participated in the consultation processes. Other public and internal meetings will be held in 2008, this time to present the intervention or improvement objectives identified by the CSSS. The strategic plan of the CSSS de La Côte-de-Gaspé should be presented for adoption at the Board of Directors meeting in the fall of 2008. The 2007−2008 fiscal year ended March 31, 2008, was marked by several major files that will have a medium-term impact on our organization and on services to the population. REVIEW OF THE SERVICE OFFER FOR FUNCTIONALLY DEPENDENT SENIORS
We are currently reviewing the entire range of services offered to our clientele for residential services, intermediate resources and home support services. The year 2008–2009 will continue with a review and consolidation of the introduction of an intermediate resource for physically and mentally disabled persons and the planning of a brand new 32-bed residential and long-term care centre in Rivière-au-Renard. NEW DIGITAL PATIENT RECORDS
The CSSS has adopted a computer system that gives professionals better access to clinical data. Among
other improvements, during the year professionals at institutions other than Hôpital Hôtel-Dieu began to access the data in hospital records. The implementation of an integrated care and services network depends mainly on professionals being able to access clinical information. Digital records will facilitate the work of our professionals.
FLOODING IN CORTE-RÉAL, GRANDE-VALLÉE AND RIVIÈRE-AU-RENARD


The tragic flooding in the summer of 2007 affected the local population as well as CSSS staff living in these towns. Our ability to maintain a full range of services to the population was significantly strained during the floods and in the months that followed. We wish to thank all our partners, our staff and the population⎯often including those struck by the disaster⎯who helped us and supported us in maintaining and even temporarily increasing services during that difficult time. The CSSS remains attentive to the special needs of individuals affected by the disaster, particularly the social distress they continue to experience to this day. CONTINUOUS QUALITY IMPROVEMENT PROCESS
For several years now, the CSSS de La Côte-de-Gaspé has been involved in a continuous process to
improve the quality of its services. As part of the process, the CSSS de La Côte-de-Gaspé conducted a public survey in the spring of 2008. The survey was distributed to 1,000 households in the Côte-de-Gaspé territory. The response rate was sizeable and statistically significant. Almost all survey results showed that the population is satisfied with the services delivered by the CSSS de La Côte-de-Gaspé. Below are a few specific points that stand out from the survey: SERVICES
RATE OF SATISFACTION
Quality of services Courtesy 88% Privacy regulation In terms of improvements, the survey identified the cleanliness of the Centre d'hébergement Mgr-Ross and of Hôpital Hôtel-Dieu as being an issue. There were many other achievements in 2007–2008. They are detailed in this report under the sections specific to each branch of the CSSS. An annual activity report cannot capture the full extent of our CSSS's achievements. Our achievements in developing, maintaining, consolidating and upgrading the entire service offer at our CSSS was made possible only by the phenomenal contribution of the CSSS working teams, volunteers team and management team. Thank you for your dedication, your action and your professionalism in delivering quality service to our population every day. Jean-Pierre Tremblay Director General Board of Directors DECLARATION BY THE DIRECTOR GENERAL


The information in this annual statistical report falls under my responsibility. This responsibility concerns the reliability of the data in the report and of related controls. The results and data in the annual report for the 2007–2008 fiscal year of the CSSS de La Côte-de-Gaspé: • faithfully describe the mission, mandates, values and strategic orientations currently being developed; • present indicators, targets and outcomes; • present accurate and reliable data. I declare that the data in this report and the controls related to these data are reliable and reflect the situation as it stood for the fiscal year ended March 31, 2008. Jean-Pierre Tremblay Director General Director: Gaétan Vézina Chair: Michel Roy Chair: Régine Bo Advisor, Budgeting Gérald O'connor Technical Services Risk / Mental Health ( Services Programs Branch Program Head, Children- Program Head, Mental Long-T Délenda Sam Out-Patient Clinic/ Specialized Services Jean-Fran Rehabilitation/ Clinical Diagnostic Services and ral Services and Intensive Care Luce Weekends Margot Adams Nancy Francoi Patient Services/ Integrated Health Evenings, Nights, Lovia Castilloux Dr. Céline Arcou Dr. Isabelle Plour Intensive Care U r. Jean- Medical Imaging Dr Dentists and Pharmacists Medical Biology Dr. Jocely MISSION OF THE CSSS DE LA CÔTE-DE-GASPÉ
The Centre de santé et de services sociaux (CSSS) de La Côte-de-Gaspé is one of the five local health and social services networks in the Gaspé Peninsula / Magdalen Islands region. The CSSS consists of seven facilities found in the towns of Gaspé (Gaspé and Rivière-au-Renard), Grande-Vallée, Murdochvil e and Percé (Barachois) offering all the services essential to prevention, maintenance and recovery of physical and mental health. • CLSC de Rivière-au-Renard • CLSC de Barachois • CLSC de Murdochville • CLSC de Grande-Vallée • CLSC de Gaspé • Hôpital Hôtel-Dieu • Centre d'hébergement Mgr-Ross The main objectives of the CSSS de La Côte-de-Gaspé are to: • foster internal consistency among all services intended for a given clientele; • favour continuity in service delivery for specific populations or pathologies; • encourage approaches tailored to the territory's characteristics; • improve the accessibility, continuity and smooth delivery of front-line, second-line and third-line services; • ensure that human rights and freedoms are respected; • foster support for the community in developing resources to meet its needs. Over the next year, the CSSS de La Côte-de-Gaspé, with the implementation of the local health and social services network of the MRC de La Côte-de-Gaspé and with its internal and external partners, such as the community organizations in our territory, will update the strategic plan for the next three years. THE CSSS DE LA CÔTE-DE-GASPÉ AND ITS TERRITORY
The CSSS offers a comprehensive range of health and social services in its territory, which extends some 175 kilometres along the coastline from Manche-d'Épée to Coin-du-Banc and includes the municipality of Murdochville, located almost 90 kilometres inland. The territory's population density is 13.2 inhabitants per square kilometre. Hôpital Hôtel-Dieu offers short-term care and has 56 beds. The Centre d'hébergement Mgr-Ross offers long-term care to 126 residents, acute psychiatric care to 9 clients, and child psychiatry services to 5 clients; 5 other clients reside in the mental disability/mental health ward. There is also a 20-bed intermediate resource for functionally dependent seniors at Foyer Notre-Dame. With an annual budget of $51,798,957, the CSSS offers users a wide range of medical specialties as well as general and specialized care in mental and physical health: • short-term care and hospitalization services; • out-patient care and services; • residential and long-term care services; • training activities for health professionals. There are 18,537 people living in the territory of the CSSS, most of whom are francophone. The population also includes a Mi'kmaq community. Anglophones represent 15% of the territory's residents. In terms of socioeconomic data, there is an unfavourable variance for the anglophone community versus the francophone community for all the data below: • 47% of residents age 25 and ove do not have their high school diploma (31.3% for Quebec); • 8.5% hold a university degree (16% for Quebec); • the median income of a household consisting of a couple with children is $67,139 ($76,339 for Quebec); • the median income of a household consisting of a couple without children is $46,975 ($55,438 for • the median income of a household consisting of a single person is $19,482 ($23,598 for Quebec); • 76.4% of residents own their home while 23.6% rent their housing; • the employment rate is 49.6% (60.4% for Quebec); • the unemployment rate is 13.8% (7% for Quebec); • 8.8% of residents receive employment assistance benefits (6.8% for Quebec); • 73% receive the Guaranteed Income Supplement (49% for Quebec). IGHLIGHTS OF THE POPULATION'S HEALTH PROFILE

Health of Children and Youth

Premature births
The percentage of premature births in the Côte-de-Gaspé region is roughly the same as for Quebec for the
2001−2003 period (9.8% versus 7.5%).
Breastfeeding in the Gaspé Peninsula and Magdalen Islands
71% of babies born to a mother in the region were breastfed during their first days of life in 2005−2006 (85% for Quebec).
Early pregnancy
For the 2001–2003 period, the rate for the Côte-de-Gaspé region was the same as that of Quebec.
Maltreatment of infants and children
In 2005–2006, 50 children in the Côte-de-Gaspé region were taken into care by the Centre jeunesse due to
maltreatment, that is, 15.2 children in 1,000 (16.2 for Quebec).
Youth exodus
45% of young people ages 10 to 19 in 1996 left the Côte-de-Gaspé region between 1996 and 2006 (1,559
young people).
Decline in birth rate
The number of births dropped from 282 to 127 between 1986 and 2003, a decline of 55% over 18 years
(13% for Quebec).
Adults

Spousal abuse in the Gaspé Peninsula and Magdalen Islands
In 2005, the rate of crime committed in a spousal context against women in the region was the same as for
Quebec.
Mental disorders
In 2003–2004 and 2004–2005, mental disorders accounted for 6.9% of hospitalizations and monopolized
16% of short-term beds.
Males between the ages of 15 and 49 seem particularly vulnerable to mental disorders.
Suicide
From 1999 to 2003, the suicide rates for women and men were the same as the rates for Quebec.
Changes in mortality
• As is the case at the provincial level, there have been fewer deaths from circulatory diseases in the past
• Deaths from cancer have risen due to the aging of the population; • The number of deaths from cancer now exceeds the number of deaths from circulatory diseases. Status with Regard to Cancers and Circulatory Diseases
Cancers:
• Leading cause of death (37% of deaths);
• Major cause of early death (29% of deaths before age 65). • Most frequent cancers: o breast cancer for women (26% of cases detected); o lung cancer for men (25%). • Deadliest cancers: o lung cancer (34% of deaths by cancer); o colorectal and pancreatic cancer (11% respectively). Circulatory diseases:
• Leading cause of hospitalizations (24% of admissions);
• Second leading cause of death (29% of deaths); • Hypertension and heart disease: declared by 23% of residents in the Gaspé Peninsula and Magdalen Tobacco use
• There has been a drop in tobacco use in the past 15 years. In 2003, the percentage of smokers in the
Gaspé Peninsula and Magdalen Islands was roughly the same as for Quebec (24.9% versus 21.6%). Sedentariness
• In 2003, 30% of adults and 28% of teens were not getting enough physical activity in their leisure time;
• Among adults, men are more sedentary than women (33% versus 27%); • There are more sedentary adults in the Gaspé Peninsula and Magdalen Islands than for Quebec in general (30% versus 26%). Nutrition
• In 2003, 50.4% of residents age 12 and over were not eating the recommended number of fruits and
vegetables (54.9% for Quebec); • More men than women neglect this healthy living habit (59% versus 42%).
Obesity and overweight
• The obesity rate has risen in the past 15 years (from 7.8% in 1987 to 16.5% in 2003);
• There is a similar upward trend for overweight (from 33% in 1987 to 38% in 2003); • In 2003, 54% of adults were overweight (47% for Quebec).
Transportation accidents
• From 2000 to 2003, compared with the provincial average, a higher percentage of men in the Côte-de-
Gaspé region died in transportation accidents. This was not the case for women; • Like everywhere in the Gaspé Peninsula and Magdalen Islands, there was excess mortality due to off- road vehicle accidents (3 deaths from 2000 to 2003).
Seniors

Life expectancy at age 65 for 2001–2003
• Age 85.6 for women (age 85.5 for Quebec);
• Age 81.6 for men (age 81.8 for Quebec).
Disabilities
• In 2001, 40% of seniors reported that they suffer from a disability:
ο 33% of seniors age 65 to 74; ο 53% of seniors age 75 and over. How the region's seniors view their health
In 2003, three-quarters of seniors considered themselves in good health, very good health or excellent
health.
References: L'État de santé et de bien-être de la population, Direction de la santé publique; 2001 Census and 2005 Census, Statistics Canada; Community Health and
Social Services Network; Profiles of Selected English-speaking Communities by CLSC, baseline data report 2004–2005. BOARDS, COMMITTEES AND TEAMS OF THE CSSS DE LA CÔTE-DE-GASPÉ
Board of Directors
Administrative Committee of the Board of Directors
Solange Roy, Chair Executive Committee
and ex-officio member of all committees of the Board of Directors Yves Bernatchez, Vice-Chair Jean-Pierre Tremblay Pierre-Paul Côté Audit Committee
Jean-Raymond Châles Francine Chouinard General Manager's Evaluation Committee
Dr Jean-Pierre Pacuraru Marjolaine Pelletier Marie-Soleil Renaud May Rochefort Steeve Synnott Jean-Pierre Tremblay, Secretary et Director General Users' Committee
Residents' Committee
Pierre-Paul Côté, Chair Pierre-Paul Côté, Chair Cynthia Patterson, Vice-Chair Lionel Jalbert, Vice-Chair May Rochefort, Secretary, Germaine Noël, Secretary Rémi Dion, Advisor May Rochefort, Advisor Ronald Langlais, Advisor Bibiane Côté, Advisor Executive Committee of the Board of Physicians,
Executive Committee of the Foundation
Dentists and Pharmacists
Dr. Michel Roy, Chair Jean-François Tapp, Secretary Dr. Nathalie Guilbeault, Vice-Chair Dr. Céline Arcouet, Treasurer Dr. Sylvain Trudel, Secretary Dr. Antoine Groulx, Administrator Marlène Lacasse Dr. Martin Lamarre, Director, Professional Marketha Letemplier and Out-Patient Services Jean-Pierre Tremblay, Director General Glen Patterson Gervais Pigeon, Vice-Chair Louis-Philippe Ste-Croix, Treasurer Denis Lévesque, Chair Jean-Pierre Tremblay, Director General Steeve Roy, Vice-Chair Board of Nurses
Multidisciplinary Board
Célyne Coulombe, Chair Roseline Adams, Chair Marie-France Minville, CLSC de Grande-Vallée Marie-Josée Dion, Vice-Chair Brigitte Lejeune, CLSC de Rivière-au-Renard Manon Adams, Secretary Lisette Whitty, CLSC de Gaspé Pierre-André Germain, Administrator Monique Coulombe, General, Medical and Surgical Care Marie-Josée Grenier, Administrator Henriette Morin, General Medical and Surgical Care Renée Savage, Administrator Maryse Savage, Mental Health Jean-Pierre Tremblay, Director General, Michelle Dunn, Extended Care Gilles Loubert, member appointed by CSSS executive Lucia Grenier, Secretary Frederick Ross, Director Risk Management Committee
Restraint Reduction Working Committee
Dr. Michel Roy, Chair, Board of Physicians, Dentists and Diane Henry, Program Head, Physical Rehabilitation, Clinical Nutrition and Electrophysiology Céline Coulombe, Chair, Board of Nurses Nicole Gailliard, Nurse, Acute Care May Rochefort, Users' Committee Nadia Gérard, Occupational Therapist Jean-François Sénéchal, Assistant Director, Specialized Renée Jalbert-Cloutier, Chronic Care Occupational Marc Lemieux, Multidisciplinary Board Representative Marina O'Connor, Nurse, Mental Health Anne Langlois, Nurse, Infection Prevention Marie-France Ouellet, Program Head, Emergency Guy Ferland, Director, Administrative Services Elise Fournier, Nursing Assistant, Family Practice Bernard Lemieux, Department Head, Pharmacy Lovia Castilloux, Assistant Director, Physical Health Hermance Plante, Program Head, Diagnostic Services and Serge Côté, Physician
Archives
Solange Roy, ex-officio member
Jean-Pierre Tremblay, ex-officio member
Hélène Grenier, Advisor, Risk Management
Frederick Ross, Director, Nursing
Interdisciplinary Oncology Committee
Infection Prevention Committee
Dr. Michèle Lavoie Jacques De Bie, Surgeon Nathalie Coulombe, Nurse, Home Support Nancy Richard, Pharmacist Solange Coulombe, Assistant Head Nurse, Operating Magella Poirier, Dietitian Room Patrick Dolce, Microbiologist, CSSS Rimouski- Brenda Bertrand, Social Worker - to be replaced by Stéphanie Martin Marina Fournier, Microbiology Technologist Sophie Dupuis, Nurse Navigator Cathy Howell, Assistant Head Nurse, CHSLD Marlène Pipon, Nurse, Chemotherapy Gilles Gauthier, Physician Adélina Cloutier, Nurse, Palliative Care Hélène Grenier, Advisor, Risk Management Lisette Whitty, Acting Program Head, Home Care Anne Langlois, Nurse, Infection Prevention Lovia Castilloux, Assistant Director, Physical Health Lyse Le Blanc, Advisor, Work Attendance and Quality of Marie-France Ouellet, Program Head Life Bernard Lemieux, Department Head, Pharmacy Dr. Denis Loiselle, Medical Examiner, Public Health Branch Claudia Plourde, Physician Frederick Ross, Director, Nursing Gaétan Vézina, Director, Technical Services Seniors' Integrated Services Network Committee
Traumatology Committee
Lucie Dufresne, Human Relations Officer Dr. Christian Mainville Hélène Babin, Liaison Nurse, Geriatrics Délenda Samson, Program Head, Long-Term Care Lucette Parent, Program Head, Medicine/Surgery/ Nicole Bilodeau, Program Head, Intermediate Resources/ Family Resources /Geriatrics/ Day Centre/ Food Services Diane Henry, Program Head, Physical Rehabilitation Lucette Samuel, Program Head, Home Support Dr. Jean-René Hamel, Department Head, Surgery Paulette Cummings, Centre d'action bénévole Le Hauban Dr. Martin Lamarre, Director, General Services and Maryse Francoeur, Corporation d'aide à domicile/ Pascale Lamarre, Archivist Marie-Berthe Bélanger, Centre d'action bénévole de Hermance Plante, Program Head, Diagnostic Services and Suzanne Leclerc, Centre d'action bénévole des Hauts- Dr. Sylvain Trudel, Regional Physician in Charge, Pre- Frederick Ross, Director, Nursing Jocelyn Marin, Representative, Out-Patient Services Diane Henry, Program Head, Physical Rehabilitation, Marie-France Ouellet, Program Head, Emergency Clinical Nutrition and Electrophysiology Mireille Dion, Assistant Head Nurse, Emergency Cynthia Patterson, Groupe Vision Gaspé-Percé Now Henriette Morin, Liaison Nurse, Physical Health Chronic Obstructive Pulmonary Disease
Organ and Tissue Donation Committee
Pierrette Cormier, Nurse Chantal Ouellet, Nurse Educator Caroline Dion, Respiratory Therapist Paul Blanchette, Physiotherapist Diane Henry, Program Head, Physical Rehabilitation Annie Cloutier, Respiratory Therapist Dr. Michèle Leblanc Marjolaine Pelletier, Nurse Clinician Henriette Morin, Liaison Nurse Nancy Richard, Pharmacist Lovia Castilloux, Assistant Director, Physical Health Heart Failure Committee
Diabetes Committee
Claudia Belletête, Pharmacist Marie Aucoeur, Nurse Arnaud Bocquier, Physician Lovia Castilloux, Assistant Director, Physical Health Lovia Castilloux, Assistant Director, Physical Health Adélina Cloutier, Nurse O'neil Côté, Nurse Sophie Cyr, Nurse Sophie Cyr, Nurse Marie-Noëlle Dupuis, Pharmacist Annie Denis, Nurse Annie Gosselin, Dietitian Louise Joncas, Nurse Michèle Leblanc, Physician Marjolaine Pelletier, Nurse Julie Poirier, Dietitian Mario Roméro, Physician, Internist Stéphanie Smith, Pharmacist Strategic Planning Committee
Management Team at the CSSS
de La Côte-de-Gaspé
Monique Coulombe Margot Adams,Carole Aspirault, Alban Béland, Julie Pierre-André Germain Bernier, Nicole Bilodeau, Sylvain Bouchard, Christine Frederick Ross, Director Boulay, Lovia Castilloux, François Cyr, Nancy Drolet, Lucie Martin Lamarre, Director Dufresne,Guy Ferland, Jacinthe Gratton, Hélène Grenier, Sylvain Bouchard, Director Diane Henry, Martin Lamarre, Robert Lapointe, Lyse Le Blanc, Renée Lelievre, Gilles Loubert, Jovette Minville, Solange Roy, Chair, Board of Directors Gérald O'Connor, Marie-France Ouellet, Lucette Parent, Michelle Sinnett, Counsellor, Communications and Quality Hermance Plante, Robert Richard, Frédérick Ross, Mireille Rehel, Jean-Luc Roussel, Délenda Samson, Jean-François Sénéchal, Michelle Sinnett Pharmacology Committee
Pharmaco-Nursing Committee
Lynnette McGregor, Pharmacist Henriette Morin, Nurse, Immediate Supervisor Assistant Bernard Lemieux, Pharmacist Monique Coulombe, Nurse, Immediate Supervisor Marie- Noëlle Dupuis, Pharmacist Nancy Richard, Pharmacist Rachelle Béland, Nurse, Immediate Supervisor Assistant Patsy Skene, Physician Mireille Dion, Nurse, Immediate Supervisor Assistant Michel Poulin, Physician Délenda Samson, Program Head, PAPAL (Functionally Stéphane Rousseau, Physician dependent seniors) Mario Roméro, Physician Frederick Ross, Nurse and Director, Nursing Danielle Reeves, Assistant Technical Head, Pharmacy Bernard Lemieux, Head Pharmacist Medical Supplies Assessment Committee
Breastfeeding Committee
Nathalie Coulombe, Nurse Dr. Marie-Yanouk Blain Chantale Reeves, Nurse Dr. Michelle Héroux Marie-France Minville, Nurse Colombe Chicoine, Nurse, CLSC de Grande-Vallée Nicole Tremblay, Nurse Manon Labbé, Nurse, CLSC de Gaspé Émilienne Arsenault, Physiotherapist Gina Minville, Nurse, Hôpital Hôtel-Dieu Jean-Luc Roussel, Department Head, Supply Christine Paquet, Nurse, Hôpital Hôtel-Dieu Frederick Ross, Director, Nursing Sophie Côté, Nurse Educator, Cégep de la Gaspésie et Karine Packwood, Respiratory Therapist des Îles de la Madeleine Jocelyn Martel, Pharmacist Caroline Pelletier, Resource Person, Halte-Parents de la Rose-Marie Denis, Nurse Lovia Castilloux, Assistant Director, Physical Health Jovette Minville, Program Head, Children-Family-Youth at Micheline Proulx, Clinical Advisor Risk and Family Planning Code of Ethics for Members of the Board of Directors

In the coming year the CSSS will develop a code of ethics for members of the Board of Directors. During the
current fiscal year, there were no ethical matters or conflicts of interest involving members of the Board of
Directors.
CSSS STAFF
Job Group
Nursing and cardio staff Paratechnical staff and trades Clerical and administrative staff Health technicians and professionals Dentists, physicians and pharmacists QUALITY OF SERVICES

HIGHLIGHTS

• Development of the strategic plan; • Creation of the Users' Committee; • Implementation of the accreditation process; • Creation of the Infection Prevention program; • Consolidation of risk management/safety of care; • Implementation of permanent quality assurance teams; • Conduct of a quality survey targeting a thousand households in the Côte-de-Gaspé region; • Intensive promotion of the new complaint system involving the Local Service Quality and Complaints • Introduction of digital patient records; • Creation of the Advisory and Quality Board. OUTLOOK FOR 2008–2009
• Development and update of action plans by quality assurance teams related to the Agrement Canada recommendations; • Development of terms of reference for quality assurance; • Implementation of a quality assessment system for client services by sector; • Beginning of the protocol and policy review process for the entire institution. THE SERVICE OFFER

GENERAL SERVICES AND PHYSICAL HEALTH PROGRAMS BRANCH

The CSSS de La Côte-de-Gaspé offers medical services to clients of all ages. These services include health assessments, diagnosis and treatment of acute and chronic health conditions, as well as the case management and follow-up appropriate to each client's health. The services also include prenatal and postnatal care and home care for persons with a severe functional dependence. The CSSS integrates disease prevention by offering health promotion, information and education services to help individuals prevent, detect and reduce the risks associated with illness or life habits and to treat themselves through CSSS programs, whether offered at its institutions, in the workplace, at school or through other avenues. To improve the accessibility, coordination, integration and continuity of health services, physicians work closely with nurses and other health professionals as part of an interprofessional approach.
CURRENT HEALTH SERVICES - HIGHLIGHTS

• Increase in walk-in clinic services at the CLSC de Rivière-au-Renard from one half-day per week to three half-days per week. OUTLOOK FOR 2008–2009
• Implementation of local service networks for chronic obstructive pulmonary disease (COPD), diabetes and • Consolidation of the Family Practice Group; • Introduction of blood pressure monitoring; • Arrival of three new physicians at Rivière-au-Renard in the fall of 2008. Statistics for Current Health Services – CLSC's in Grande-Vallée, Murdochville, Rivière-au-Renard
2006–2007
2007–2008
Number of visits Number of different users Statistics for Hospitalization
Short-term hospitalization
2006–2007
2007–2008
Average occupancy rate SHORT-TERM HOSPITAL UNITS - HIGHLIGHTS
• End of refitting work for units 300, 500 and 700 (infection prevention, higher potential number of private • Creation of a nursing position responsible for bed management; • Rooming-in approach for clients in obstetrics and neonatology; • Implementation of quality assurance teams; • Beginning of working team consolidation. OUTLOOK FOR 2008–2009
• Completion of working team consolidation; • Consolidation of links with community resources and home services; • Implementation of the continuous quality improvement plan. HÔTEL-DIEU EMERGENCY DEPARTMENT - HIGHLIGHTS
• For the third consecutive year, the emergency department earned an A on Quebec's list of top emergency • Part of the staff from all emergency departments of the CSSS received training on how to deal with aggressive clients; • The traumatology training in cooperation with the Agence was repeated this year, and most of our staff was able to participate; • Beginning of work by the Emergency quality assurance team; • Nurses from every institution were given training in wound care and code practices. OUTLOOK FOR 2008–2009
• This year we will work on reviewing several internal processes in cooperation with staff from every institution and on standardizing the operation of all emergency departments in our territory; • Provide all teams with training on how to deal with aggressive clients; • Implementation of the action plan for continuous quality improvement; • The team stabilization process is well under way: job postings will resume in the fall in order to fill the last empty positions; • Team stabilization. Emergency - Hôtel-Dieu
2006–2007
2007–2008
Patients registered Patients on gurneys 32,846 22,877
Clients on gurneys >24 hours Clients on gurneys < 48 hours Average length of emergency room visit (hours) * Visits to the emergency departments in Grande-Vallée and Murdochville were not taken into account for 2007–2008. Statistics for Emergency Services at the CLSC de Grande-Vallée and the CLSC de Murdochville
Emergencies - Grande-Vallée and Murdochville
2006–2007
2007–2008
Number of different users Number of interventions The data for 2007–2008 account only for registered users with an Emergency (193) intervention profile and for consultations from 4 p.m. to 8 a.m. at the CLSC de Grande-Vallée and the CLSC de Murdochville. 2006–2007
2007–2008
Out-patient clinics - Hôpital Hôtel-Dieu
Number of
Number of
Gastroenterology Otorhinolaryngology 3,254 28,196 28,194
INFECTION PREVENTION - HIGHLIGHTS
With the emergence of new multiple resistant bacteria and more virulent strains of C. difficile in recent years, the Ministère de la Santé et des Services sociaux (MSSS) has made infection prevention a top priority. Many protocols and procedures listed below were designed to potentially reduce nosocomial infections and to ensure the public receives safe care. • The Nosocomial Infection Prevention and Control Program (NIPCP) covers the six following components: o monitoring; o policies, procedures and support measures for nosocomial infection prevention and control; o education and training; o program evaluation; o communication and information. • Protocol for prevention and control of infections related to C. difficile; • Epidemiological surveillance program for surgical site infections at the CSSS de La Côte-de-Gaspé; • Intervention tools to prevent and control viral gastroenteritis; • MRSA/VRE policy and synthesis tools adapted to our institution; • Development of a 2007–2009 action plan based on key sections of the Nosocomial Infection Prevention and Control Program; • Development of the local plan to counter an influenza pandemic for the infection prevention component; • Beginning of work by the Infection Management quality assurance team; • Integration of the proper software at all CSSS institutions, including the "high touch" and "low touch" concepts in relation to health and hygiene guidelines.
RECOMMENDATIONS BY THE INFECTION PREVENTION AND CONTROL COMMITTEE IN RELATION TO

THE INSTITUTION'S INFECTION PREVENTION PRIORITIES
• Recommendations on aspects of capital assets and equipment that support the application of basic practices and additional precautions; • Recommendations on the project to refit patient care units at Hôpital Hôtel-Dieu in Gaspé; • Recommendations on the project to refit the emergency department and out-patient clinics at Hôpital Hôtel-Dieu in Gaspé; • Recommendations for follow-up to the report by the Stérile Conseil firm concerning the operating room; • Recommendations for the Grande-Vallée, Murdochville and Rivière-au-Renard institutions in relation to infection prevention and control measures; • Recommendations on various patient care techniques, for example: Aquapak, replacing conventional connectors with CLAVE connectors, etc.; • Recommendations to conduct VRE screening tests locally. FOLLOW-UP TO THESE RECOMMENDATIONS
• Set-up of displays at the entrance to all the institutions of our CSSS; • Installation of additional sinks in patient care units; • Addition of partitions to prevent splashes on medical supplies located near the sinks; • Installation of hooks outside rooms; • Increase in the number of private rooms with private bathrooms in patient care units. OUTLOOK FOR 2008–2009
• Creation of a respiratory isolation room in the emergency department of Hôpital Hôtel-Dieu and two in Department 700. Another will also be set up at CLSC institutions that are open 24 hours a day, 7 days a week (Grande-Vallée and Murdochville); • Application of the recommendations by the Stérile Conseil firm and the Infection Prevention Committee for the "operating room" file; • Follow-up for the ventilation/air quality file at Hôpital Hôtel-Dieu in Gaspé; • Airtightness tests with staff using N-95 respirators from Cardinal, in the event of an influenza pandemic; • Training and professional development for employees in various activity sectors on infection prevention and control and on the new guidelines; • Development of a policy on biomedical waste management; • Implementation of the action plan for continuous quality improvement; • Follow-up on the report by Accreditation Canada. Statistics for Nosocomial Clostridium Difficile-Associated Diarrhea (CDAD)
2006–2007
Number of cases
Number of cases
Statistics for Nosocomial MRSA and Staphylococcus Aureus Bacteremia
Staph aureus bacteremia
(non methicilin-resistant)
MRSA bacteremia
Rate of incidence for diarrhea associated with nosocomial Clostridium difficile per 10,000 patients / day by
administrative period at our institution
2006–2007 (Periods 1 to 13)
2007–2008 (Periods 1 to 13)
Rate per 10,000 patient-days In 2006–2007, Hôpital Hôtel-Dieu had an average rate of 12.6 cases per 10,000 days/presences. The situation improved in 2007–2008: the average rate was 4 cases per 10,000 days/presences. New cases of nosocomial MRSA
related to Hôpital Hôtel-Dieu de Gaspé
from April 1, 2007, to March 31, 2008
er of pa 1,5
From April 1, 2007, to March 31, 2008
No outbreak of gastroenteritis occurred at our institution. No outbreak of influenza in medical care settings was declared for our CSSS. INFO-SANTÉ - HIGHLIGHTS
• Standardize training for the Info-Santé service using virtual telephone interventions; • Directory of Web resources; • Implementation of 811.
OUTLOOK FOR 2008–2009

• Registration of the home support clientele; • Define a regional Info-Social model. Statistics for the Info-Santé Service
2006 –2007
Calls handled
Response time
2007–2008
Calls handled
Response time
CANCER PREVENTION AND TREATMENT - HIGHLIGHTS
• Development of a file for follow-up of patients in home-based palliative care that would follow the patient in the event of hospitalization. This file would prevent the patient from receiving services or interventions twice and give health care staff universal and standard access to the patients' wishes or decisions regarding their health; • The Oncology Department has worked hard this year. Members of the Interdisciplinary Committee meet regularly to work on improving services for clients with cancer and their loved ones; • Presentation of the work being done to fight cancer at the "Portrait de santé" health education day for the population in our territory; • Beginning of work by the Oncology quality assurance team. OUTLOOK FOR 2008–2009
• Implementation of the oncological file; • The team will receive interdisciplinarity training in cooperation with the health agency; • Development of ties to the community network; • Development of ties with health care workers to ensure follow-up for recurrence prevention; • Implementation of the action plan for continuous quality improvement. Statistics for Oncology
Oncology
2006–2007
2007–2008
Number of treatments
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) - HIGHLIGHTS
• Implementation of the Systematic COPD Monitoring Program; • A first for the program set up at the CLSC de Grande-Vallée: group meetings for patients; • Staff given training on the Systematic COPD Monitoring Program; • Presentation of COPD projects at the "Portrait de santé" health education day for the population in our • Identification of the COPD clientele in Murdochville and Grande Vallée; • Development of group learning for nurses and nursing assistants at the various institutions; • Implementation of a multidisciplinary team for evaluation of client problems; • Beginning of group meetings for patients at CLSC de Grande-Vallée and CLSC de Murdochville; • Information sessions at CLSC de Rivière-au-Renard; • Respiratory function tests to be offered by the respiratory therapist as part of the meetings; • Consolidation and introduction of the program.
OUTLOOK FOR 2008–2009

• Implementation of a process for respiratory function tests administered to patients at their first information session for group learning; • Development of group learning for nurses and nursing assistants at the various institutions; • Implementation of a multidisciplinary team for evaluation of client problems; • Beginning of group meetings for patients at the CLSC de Grande-Vallée and CLSC de Murdochville; • Information sessions at CLSC de Rivière-au-Renard; • Respiratory function tests to be offered by the respiratory therapist as part of the meetings; • Consolidation and introduction of the program.
DIABETES AND HEART FAILURE - HIGHLIGHTS

• Implementation of the Diabetes Committee and Heart Failure Committee, whose members are nurse clinicians (CSSS, Family Practice Unit and Family Practice Group) as well as bedside nurses, physicians, dietitians and pharmacists with the CSSS or from the community.
OUTLOOK FOR 2008–2009

• Preparation of the document on priority learning at the hospital centre; • Staff training and educational tools. PROFESSIONAL AND OUT-PATIENT SERVICES - HIGHLIGHTS
• Stabilization of the medical team; • Creation of a Family Practice Group (Gaspé, Family Practice Unit, Rivière-au-Renard); • Development of walk-in clinic services at Rivière-au-Renard; • Development of the mobile MRI service; • Stabilization of the medical team in radiology; • Introduction of digital patient records at Hôpital Hôtel-Dieu and the Family Practice Unit; • Stabilization of the internal medicine team (end of unfilled positions); • Recruitment in pharmacy; • Introduction of dual programs in cataract surgery to reduce wait times in ophthalmology; • Beginning of work by quality assurance teams. OUTLOOK FOR 2008–2009
• Development of the bone mineral density testing service; • Implementation of the local health services network; • Introduction of digital patient records at the Centre d'hébergement Mgr-Ross and at CLSC; • Upgrade of pharmacy facilities to meet standards for the preparation of sterile products; • Implementation of the action plan for continuous quality improvement; • Continuation of cataract surgery work in order to achieve the targeted wait times. Medical Staff Turnover
Arrivals
Departures
One internal medicine and two family practice Two family practice Table - Status of Medical Staff vs. Authorized Medical staff under PREM1
Specialties
As at March 31, 2008
Authorized by
Variance
Anatomopathology 1.4 Anesthesiology 2 Gastroenterology 1 Internal medicine Obstetrics-gynecology 2 Otorhinolaryngology 1 Psychiatry and child psychiatry Community health Total staff
Thus, as a March 31, 2008, the CSSS employed 69% of the medical staff authorized by the Ministère de la Santé et des Services sociaux for service to its population. Statistics for Laboratory
Grande-Vallée laboratory
2006–2007
2007–2008
Number of procedures Hôtel-Dieu laboratory
Number of procedures Murdochville laboratory
Number of procedures Statistics for Radiology
Radiology - Hôtel-Dieu
2006–2007
2007–2008
Number of technical units Number of examinations 1 PREM stands for Plan régional d'effectifs médicaux [regional medical staff plan]. Statistics Specific to Radiology at the CLSC's in Grande-Vallée and Murdochville
2006–2007
2007–2008
Number of clients Number of examinations Number of technical units Statistics Specific to Professional Services
Services
2006–2007
2007–2008
Physiotherapy 1,191 Occupational therapy Special education Clinical nutrition Clinical nutrition CLSC Occupational therapy home support Physiotherapy home support Speech therapy CLCS Electrophysiology 141,457 173,585 technical units PHYSICAL REHABILITATION/CLINICAL NUTRITION/ELECTROPHYSIOLOGY - HIGHLIGHTS
• Addition of a 0.4 position for a dietitian in long-term care; • 22.7% increase in activity for the electrophysiology service; • 50% deficit in staff for occupational therapy home support service (unsuccessful recruiting).
OUTLOOK FOR 2008-2009
• Recruiting in occupational therapy; • Support for implementation of the application protocol for restraint and isolation measures; • Purchase of non-restraint equipment; • Reception of interns; • Creation of a continuous quality improvement plan.
Use of Services

Number of persons
Activity centre
Average length of
Average length of
waiting for
Number of persons
wait for 2006
waiting for 2007–2008 wait for 2007
Nutrition services Occupational therapy Ophthalmology (surgery) Orthopedics (surgery) Electrophysiology Speech therapy, CLSC from 2 to 9 months Special education FAMILY PRACTICE UNIT (GASPÉ)- HIGHLIGHTS

• Setting up the Family Practice Group (FPG) with over 1,600 patients registered to date at the Family Practice Unit facility (a total of 4,400 for the FPG), a walk-in clinic (5 half-days per week) and participation in the walk-in clinic in Rivière-au-Renard; • Multidisciplinary follow-up for vulnerable clienteles (hypertension, COPD, heart failure and diabetes); • Although the new digital patient records required some adjustment and the system is not yet fully functional, overall the initiative has been well received by users; • In a context where family medicine is unpopular with students, we were able to fill 100% of our residency positions, whereas the provincial average is 70%. Much effort was expended to achieve this outcome; • Departure of one psychologist (we are actively recruiting); • Two new physicians were recruited for the Family Practice Unit; • Initiation of the process, in conjunction with the nursing department, to offer internships for specialized front-line nurses. The first two interns will join us in 2009, helping to train and recruit this new class of professionals for the entire Gaspé Peninsula; • Development of plans and estimates for a minor surgery room at the Family Practice Unit to be functional in the fall of 2008; • All our physicians were given university recognition of their contribution to teaching. They each have a title, whether clinical lecturer, clinical professor, or associate clinical professor. OUTLOOK FOR 2008–2009
• Consolidation of the Family Practice Group; • Increase in client registration; • Creation of a surgical room. 2006–2007
2007–2008
Number of visits to the Family Practice Unit

FUNCTIONALLY DEPENDENT SENIORS/ MENTALLY AND PHYSICALLY DISABLED PERSONS PROGRAMS
BRANCH AND NURSING BRANCH


LONG-TERM CARE - HIGHLIGHTS

• Reorganization of patient care teams to meet the provincial standard, i.e., 46% professionals and 54% non-professionals; • Parity process with an advisor of the Association paritaire pour la santé et la sécurité du travail - Affaires sociales2 for implementation of the living environment approach at residential centres; • Introduction of a new medication distribution system – Manrex; • Refitting of the entrance hall stairs to improve safety; • Participation in the accreditation process with Accreditation Canada; • More hours in clinical nutrition (another two half-days per week); • Availability of two respite beds on a permanent basis; • Preparatory process for the provincial training program for orderlies at residential and long-term care centres under Bill 142; • Consolidation of the working teams; • Beginning of work by quality assurance teams. OUTLOOK FOR 2008–2009
• Implementation of the bed closure plan; • Exercise for certification of working teams in relation to local bargaining; • Update of the action plan further to the accreditation report; • Provincial training for orderlies in residential and long-term care centres; • Training on the living environment approach. Statistics for Long-Term Care
Long-term hospitalization
2006–2007
2007–2008
Average occupancy rate
HOME SUPPORT SERVICES - HIGHLIGHTS

• Assessment of the residents of Manoir St-Augustin in order to adjust the service offer required by home • Request for funding from the Agence in order to upgrade the service offer at Les Habitations Val-Rosiers to ensure the presence of a night attendant: a non-recurrent budget of $28,666 was granted for 2007–2008; • Implementation of the I-CLSC application at all CLSC institutions; • Implementation of the one-window approach; • Consolidation of the home support team in Rivière-au-Renard (the one-window Liaison Nurse; the person responsible for home aids and the Employment Service Cheque Processing Centre; the Coordinator, Residential Services; the Program Head; and the Secretary, Home Support); • Evaluation of the clinico-administrative processes for nursing, rehabilitation, social work involving case management of functionally dependent seniors under the home support program by an external consultant; • Upgrade of positions in nursing, social work and home aids for home support in order to shift to a front-line approach rather than institutionalization; • Participation in the accreditation process with the Canadian Council on Health Services Accreditation; • Participation of three social workers and the Program Head, Home Support, in a regional symposium on geriatrics, held in Rimouski; • Reassessment of all home support clients under way; • Grant awarded in 2007–2008 for La Maison des aînés de Grande-Vallée; • Beginning of work by the quality assurance team. 2 joint labour/management association for occupational health and safety – social affairs OUTLOOK FOR 2008–2009
• Certification of positions for nurses who work 7 out of 14 days at all points of service; • Work organization project submitted to the Agence in order to carry out the recommendations in the report by the external consultant; • Development of assessment tools for the home support clientele; • Development of eligibility criteria for home support; • Implementation of the night respite project for informal caregivers of functionally dependent seniors in cooperation with Corporation Multi-services; • Training in case management; • Introduction of case managers for the home support clientele; • Implementation of the respite/support project for informal caregivers of the Alzheimer clientele in cooperation with Corporation Multi-services; • Presence of a night attendant at Les Habitations Val-Rosiers subject to funding by the Agence; • Evaluation of the relevance of adding nursing assistants to the organization and service offer for home • Implementation of the action plan for continuous quality improvement; • Implementation of the tool for ISO-SMAF (system for measuring functional independence); • Development of a single file with a protocol and work tools for home care and hospital care to ensure standardization at all institutions. Statistics for Home Support Services
2006–2007
2007–2008
Number of
Number of
Number of
Number of
Postoperative care or services care or services Physical health care or services (short- 620 3,016 680 3,889 Physical health care or services (other) Care or services for the physically 344 5,235 262 4,014 Care or services for the mentally disabled Care or services for functionally 70 210 563 13,735 dependent seniors
INTERMEDIATE RESOURCE FOR FUNCTIONALLY DEPENDENT SENIORS - HIGHLIGHTS

• Project to implement the 12-bed cognitive intermediate resource: still under way; • Maintenance of one respite bed at the intermediate resource for functionally dependent seniors; • Evaluation of residents of the intermediate resource in order to estimate their daily cost.
OUTLOOK FOR 2008–2009

• Implementation of the 12-bed cognitive intermediate resource for the CSSS de La Côte-de-Gaspé; • Addition of one or two places at the intermediate resource for functionally dependent seniors. Residential resource
2006–2007
2007–2008
Number of
Average wait
Number of
wait time
Centre d'hébergement Mgr-Ross - wait in hospital Intermediate resource – Foyer Notre-Dame - wait in hospital * Management by the Centre de la réadaptation de la Gaspésie.
FOOD SERVICES - HIGHLIGHTS

• Participation in a study on junk food conducted by Université Laval (results pending); • Broader range of products available in vending machines at the two main institutions of the CSSS de La Côte-de-Gaspé in order to offer more healthful choices; • Purchase of two new meal distribution carts for the Centre d'hébergement Mgr-Ross. OUTLOOK FOR 2008–2009
• Assessment of residential client satisfaction with respect to food temperature.
NURSING - HIGHLIGHTS

• Creation and dissemination of the protocol for pressure ulcer prevention, treatment and follow-up; • Delivery of training: o Eight resource nurses for wound care; o For nurses and nursing assistants on how to write progress notes in records and on pharmacotherapy; o On changing practices in order to reduce the use of restraint and isolation; o Annual vaccination against influenza; o On therapeutic nursing plans, by the OIIQ. • Day program for nursing in short-term care; • Reception and integration program in active medicine/surgery/geriatrics for nurses with permanent employee status; • Creation of the Medical Supplies Assessment Committee; • Development of the local workforce plan for nursing; • Visit to institutions by the advisors: the four CSLCs and Foyer Notre-Dame; • Creation of the Nursing Branch−Public Health Branch Working Committee and advisory positions in risk management, infection prevention and nursing; • Coordination of job interviews for nurses, nursing graduates pending license, nursing assistants and • Implementation of computerized nursing methods at all institutions; • Organization of "Nurses' and Nursing Assistants' Day" with recognition awards; • Support for the organization of the "Perspectives pédopsychiatriques" [child psychiatry perspectives] day; • Creation of the Medical Supplies Assessment Committee.
OUTLOOK FOR 2008–2009

• Introduction of the therapeutic nursing plan; • Implementation of Bill 90 throughout the institutions of the CSSS; • Cooperation in implementing the program to reduce restraint and isolation measures; • Involvement in follow-up on the recommendations for accreditation; • Close cooperation on various files with the Board of Nurses; • On-going work on priority issues identified by the Nursing Branch in 2007–2008; • Fall prevention program throughout the institutions of the CSSS; • Continuation of projects on risk management, infection prevention and nursing for the CSSS.
RISK MANAGEMENT - HIGHLIGHTS

• Implementation and dissemination of policies and regulations including mandatory disclosure of incidents/accidents and the information users require further to an accident; • Delivery of training in risk management and application of the new AH-223 form for various professionals and health care workers, assistants, team leaders and managers working in a range of areas; o Follow-up by the Risk Management Committee: o Monitoring of sentinel events and in many cases, improvements were made with respect to the resulting recommendations, whether to the environment (physical premises) or to professional and/or organizational practices, etc. However, there should be an improvement in turnaround times. Among sentinel events, some require special attention and a more rigorous follow-up by the Risk Management Committee, in conjunction with other bodies such as the Board of Physicians, Dentists and Pharmacists, the Infection Prevention Committee, the Users' Committee, the Board of Nurses, and the Nursing Branch−Public Health Branch Working Committee, as well as advisors; o Follow-up on the specialized report by Stérile Conseil 2000 on the operating room in June 2006. Members of the Risk Management Committee subsequently developed an assessment grid for monitoring the necessary results. In May 2008, executive management ordered an internal audit. o The Risk Management Committee was also informed through a report of the work conducted to assess the quality and safety of care and services at various CSSS institutions in 2007 by the Risk Management Advisors, the Clinical Care Advisors, and the Infection Prevention Nurse. Improvements were subsequently made at these institutions. • The Risk Manager documents all declared events and handles the files in close cooperation with the Clinical Care Advisor, the Infection Prevention Nurse, the Local Service Quality and Complaints Commissioner, and the Department Heads. OUTLOOK FOR 2008–2009
In an effort to continue activities that ensure the safe delivery of care and services, the Risk Management Committee has determined it priorities: • Management of medication errors and falls: analysis and measures to be implemented to prevent and reduce incidents related to medication errors and falls; • Disclosure of accidents; • Implementation of recommendations resulting from sentinel events within an acceptable time period; • Implementation of the recommendations for the continuous quality improvement process related to the report by Accreditation Canada. Incident/Accident Table
2006–2007
2007–2008
Total number
Total number
Care/clinical services Medication errors Equipment/material 18 Miscellaneous 86 Grand total


The data in AH-223 reports are captured using the risk management software. Among the accidents
declared, 112 involved injury. These users required either specific or specialized treatment (sutures, short-
term hospitalization for intensive care or surgery, close monitoring, etc.). Changes in administrative
processes and professional practices at the organizations were also necessary as the result of these
undesirable events.

However, it is clear that medication errors and falls are the preponderant events. In fact, dealing with these
events will be among the priorities in 2008–2009. A working team was created at the Centre d'hébergement
Mgr-Ross to analyze medication errors. That process is planned for the fall and will be implemented at the
other institutions
Please note that a detailed report on these incidents/accidents is available from the Risk Management
Department.
CHILDREN-FAMILIES-YOUTH AT RISK, MENTAL HEALTH AND COMMUNITY SERVICES PROGRAMS
BRANCH

CHILDREN-FAMILIES-YOUTH AT RISK AND FAMILY PLANNING - HIGHLIGHTS

• Organization of a major gathering entitled "Défi allaitement maternel" [breastfeeding challenge]
simultaneously with similar gatherings in other cities across Quebec. No less than 28 mothers brought child to breast at 11 a.m. that morning. In the meantime, at Hôpital Hôtel-Dieu, two new mothers participated in the event, one of whom had given birth at 9:55 a.m. under the care of Dr. Nathalie Guilbault.; • In cooperation with the Public Health Branch: o "Wellness-Oriented School" approach; o Awareness campaign for the approach and analysis of the profile for al schools in the Côte-de-Gaspé o The "Wellness-Oriented School" approach appears to be taking off. It is crucial to work on health education in schools, especially with the arrival of such files as the policy framework, the violence plan, sex education, etc. • Creation of quality assurance teams; • Development of a 2008−2011 action plan for continuous quality improvement. OUTLOOK FOR 2008-2009
• Implementation of the action plan for continuous quality improvement; • Health in schools: o Gardasil vaccine for girls in Grade 4 of primary school and Secondary III, as well as any girls under age 18 in Secondary IV or Secondary V, Adult Education or Cégep who did not receive the vaccine; o Implementation of a youth clinic at Cégep de Gaspé; o Regional sex education program for the 3rd cycle of primary. • Psychosocial services: o Implementation of a youth intervention team for at-risk youth in partnership with public health o Partnership between front- and second-line workers in youth mental health. • Customized breastfeeding training for all health care workers at CLSCs and hospital centres who work with the target clientele; • Closer partnership between the CSSS and the Centre jeunesse since application of the new youth protection legislation. Family planning: regional mandate with 1st line activities for prevention, training and psycho-social services,
as well as 2nd line services.
2006-2007
2007-2008
Number of voluntary pregnancy interruptions Number of artificial inseminations with donors Prenatal information sessions
2006–2007
2007–2008
Number of participants 2006–2007
2007–2008
(% of mothers who breastfed)
at the time of hospital discharge 2 days after discharge from CH Postnatal at home (short-term)
2006–2007
2007–2008
Number of interventions (nurses) 2006–2007
Postnatal follow-up ages 05
Perinatality (Prevention, promotion, screening)
2006–2007
2007–2008
Pregnancy follow-up
Number of pregnant women Number of interventions Maternity
2006–2007
2007–2008
Number of deliveries at l'Hôpital Hôtel-Dieu de Gaspé Follow-up at age 2: Evaluation of the child's development and language as part of 2006–2007 2007–2008
structured activities and pediatric consultations
Number of participants "3 ans… c'est amusant" activities
2007–2008
Number of participants Vaccination
2006–2007
2007–2008
Ages 0-5 - Number of interventions Speech therapy service, ages 0-5
2006–2007
2007–2008
Number of children Number of interventions Psychosocial interventions – At-risk children, ages 0-5
2006–2007
2007–2008
Number of children Number of interventions School health
2006–2007
2007–2008
Number of children Number of interventions Dental services at school
2006–2007
2007–2008
Number of children Number of interventions Social services at school
2006–2007
2007–2008
Number of children Number of interventions Vaccination
2006–2007
2007–2008
Ages 6−18 - Number of interventions Mental health – Children/Youth (under age 18)
2006–2007
2007–2008
Number of children Number of interventions Psychological services (under age 18)
2006–2007
2007–2008
Number of children Number of interventions
COMMUNITY SERVICES - HIGHLIGHTS

• Development of the action plan for the accreditation process by the quality assurance team (community • Psychosocial intervention for the residents affected by the Rivière-au-Renard disaster; • Beginning of the intervention and follow-up for the dismantling of Xstrata facilities in Murdochville for occupational health; • Implementation of the front-line addiction program. OUTLOOK FOR 2008–2009
• Review of internal processes for community services; • Implementation of the action plan put forward by the quality assurance team; • Introduction of the integrated network of mental health services; • Consolidation of the preventive health service; • Intervention and follow-up for the dismantling of Xstrata facilities in Gaspé; • Review of the service identification and residential services referral team; • Presentation of home support program orientations and its proposed changes to the Board of Directors; • Review of how multidisciplinary home support teams allocate services; • Recruiting of a psychologist at the CLSC de Grande-Vallée. 2006–2007
2007–2008
Flu Vaccine
Statistics for Adult and Community Services
Programs
2006–2007
2007–2008
Number of
Number of
Number of
Number of interv.
24/7 social emergencies Psychosocial services Psychological services Nutritional services Travellers' clinic *The drop in 2006−2007 is attributable to the Rivière-au-Renard disaster interventions. Interventions by the Service régional santé et sécurité au travail
2006–2007
2007–2008
Company visits for worker health-risk assessment, with follow-up on the required corrective measures; Evaluations of CRT display screen positions were conducted; Evaluations of CRT display screen positions.
MENTAL HEALTH - HIGHLIGHTS (CHILDREN AND ADULTS)

• Organization of the annual day of training in child psychiatry on the subject of violence and aggressiveness ("Phénomènes de violence et conduites agressives"). Over 255 registrations; • Thanks to a $2,000 donation from Ordinacoeur, the child psychiatry team was able to make purchases for leisure activities; • Visit by Francine Lussier, neuropsychologist, to assess 18 French-speaking children and by Yves Turgeon for one teenager; • Preparation for the visit by Accreditation Canada; • Training given to employees: o OMEGA; o risk management; o therapeutic nursing plan, action plan for continuous quality improvement. OUTLOOK FOR 2008–2009
• Implementation of the action plan for continuous quality improvement; • Implementation of the integrated service network; • Implementation of intermediate resources; • Evaluation of all residential resources. Statistics for Mental Health
2006–2007
2007–2008
Department
Licensed
Licensed
Number of
Number of
of medico
of medico
admissions presence occupation
admissions presence occupation
capacity
capacity
Department 350, short- Out of 325 days: 52.8 Specialty
2006–2007
2007–2008
Children Adults Children
Special education Psychoeducation 67 Neuropsychology 15 19 Various on-site follow-up 99 clients of different ages. 113 clients of different ages.
ADMINISTRATIVE SERVICES BRANCH


HUMAN RESOURCES - HIGHLIGHTS
• Local bargaining with the three unions present and signature of a local collective agreement approved by the parties in attendance; • Preparatory work for rollout of new computer systems; • Centralization of management activities at the head office in Gaspé; • Participation in the institution's strategic planning exercise; • Contribution to developing regional workforce plans for nursing, pharmacy, occupational therapy and OUTLOOK FOR 2008–2009

• Implementation of the provisions of local collective agreements; • Rollout of new computer systems; • Certification of the following positions: nurse, nursing assistant and respiratory therapist; • Review of replacement activity management; • Review of certain processes, particularly those related to staffing workforce requirements and human resource development; • Implementation of a continuous quality improvement plan. Statistics for Human Resource Activities
Management staff
2006–2007
2007–2008
Full-time equivalents Regular staff
Full-time equivalents for casual staff Grand total in full-time equivalent positions
Statistics for Training Activities
2006–2007
2007–2008
Staff category
Management staff $410,275 $420,397
Main acquisitions
Main capital acquisitions
Diagnostic and therapeutic equipment
Source of financing
Ophthalmic laser Dermatology laser Endoscopy equipment Mobile radiology device Miscellaneous equipment for emergency and intensive care Other equipment and software
Carts for pharmacy Carts for food services Foundation: $140,000 (the Software and equipment – Digital patient records balance from the Agence) INFORMATION TECHNOLOGY - HIGHLIGHTS
• Finalization of the rollout for the computer system of the Pharmacy Department (SyPhaC); • Implementation of a new management system for visits and appointments (MédiVisit); • Implementation of a new management system in radiology (SIR); • Continued work on the Quebec Electronic Health Record (EHR); • On-going implementation of digital patient records; • Rollout of the laboratory management software for cytology and pathology (Omnitech); • Continued implementation of a new human resource management system (employee record, call list, electronic timesheet, etc.); • On-going integration of the information technology environments of the CSSS; • Development of an information management plan in conjunction with the Communications Department.
OUTLOOK FOR 2008–2009

• Finalization of the rollout for the computer system of the Pharmacy Department (SyPhaC); • Implementation of a new management system for visits and appointments (MédiVisit); • Implementation of a new management system in radiology (SIR); • Continued work on the Québec Electronic Health Record (EHR); • On-going implementation of digital patient records; • Rollout of the laboratory management software for cytology and pathology (Omnitech); • Continued implementation of a new human resource management system (employee record, call list, electronic timesheet, etc.); • On-going integration of the information technology environments of the CSSS. INCOME STATEMENT
Main activities – Revenues
2006–2007
2007–2008
Agence de développement de réseaux locaux des services de santé et services sociaux [development agency for local health and social services $49,588,517 $47,978,857 networks] or Ministère de la Santé et des Services sociaux $1,996,960 $2,207,743 Sale of services $106,799 $107,620 $52,109,498 $50,807,291 Main activities – Expenses
$23,652,061 $25,693,121 $6,811,463 $7,611,401 $3,606,147 $3,613,939 $1,575,967 $1,726,121 $16,672,292 $12,272,401 $52,317,930 $50,916,983 Surplus revenues over operating budget expenses ($208,432) ($109,692)
* Under the balanced-budget agreement signed with the Agence de santé et de services sociaux [local health and social services agency]
and the Ministère de la Santé et des Services sociaux for fiscal year 2007–2008, the authorized deficit for the CSSS was $150,274.
Ancillary activities generated a surplus of $124,760, bringing the overall surplus to $15,068.
The complete financial report and our auditors' report are available from the head office of the CSSS de La Côte-de-Gaspé.
TECHNICAL SERVICES BRANCH

GENERAL - HIGHLIGHTS

• Implementation of the management system for sanitary maintenance tasks at the CSSS and consolidation • Reorganization of specialized employee positions (electricians, carpenters, day labourers); • Job reorganization for biomedical technicians; • Implementation of the management system for preventive maintenance of equipment and systems; • Job reorganization for the Commissioner and Laundry Truck Operator; • Creation of the position of Department Head, Hygiene and Sanitation; • Reorganization of security, telephony, and reception services; • Creation of a standing committee of representatives from public organizations in Gaspé (Cégep, school board, CSSS and Town of Gaspé). OUTLOOK FOR 2008–2009
• Update of the internal emergency measures plan; • Review of laundry work processes based on "lean healthcare" concepts (Kaizen); • Implementation of the management system for fee-parking lots; • Reorganization of hazardous materials (waste) management; • Update of the Workplace Hazardous Materials Information System (WHMIS); • Introduction of a management process for residual and domestic materials; • Consolidation of sanitary maintenance activities at Barachois; • Analysis of transportation between CSSS institutions; • Reorganization of the management and repair process for home care equipment; • Follow-up further to the recommendations of Accreditation Canada. CAPITAL ASSET COMPONENT - HIGHLIGHTS
• Preliminary preparation of functional and technical programs for the Centre d'hébergement Mgr-Ross and Rivière-au-Renard; • Preparation of temporary work for the out-patient clinics and emergency department of Hôpital Hôtel-Dieu; • Construction of the MRI lobby ($650,000); • Refitting of units on floors 3, 5 and 7 ($240,000); • Repairs to the exterior cladding of Mgr-Ross ($1.3 million); • Conduct of a feasibility study for a geothermic project at Mgr-Ross; • Mechanical and sanitation inspection of the major ventilation systems of the CSSS; • Realization of energy conservation projects, phase 1 ($200,000); • Replacement of the on-call telephone contact system ($100,000).
OUTLOOK FOR 2008–2009

• Preparation of functional and technical programs (FTPs) for the component of services to functionally dependent seniors at the Centre d'hébergement Mgr-Ross and construction of the new 32-bed centre in Rivière-au-Renard ($8 million); • Refitting of out-patient clinics and emergency department ($1.5 million); • Early stages of developing a real estate master plan; • Installation of two sterile hoods for the pharmacy; • Early stages of preparing the functional and technical program (FTP) for Hôpital Hôtel-Dieu; • Conduct of phases 2 and 3 of the energy conservation project ($1.5 million); • Conduct of several asset maintenance projects (e.g.: fire systems, elevators, flooring, oxygen distribution, replacement of doors and exterior cladding) ($1.7 million); • Construction of a hazardous materials warehouse ($360,000); • Installation of infrastructures for parking lot management ($350,000); • Correct the slab in the ambulance area ($300,000).
ANNUAL REPORT BY THE LOCAL SERVICE QUALITY AND COMPLAINTS COMMISSIONER

Bill 83 led to a number of changes in how complaints are handled by the health network. Local service quality and complaints commissioners now report directly to the Board of Directors at their institution and are appointed by that Board. The commissioners must now perform exclusive functions under section 33 of the Act respecting health services and social services. This section stipulates that local service quality and complaints commissioners must deal with complaints sent to them or act on their own initiative. They must also promote the independent nature of their role, the rights of users and the complaint examination process. This was the context of the first full year of the new complaint examination process. Certain data are provided below; however, for the full data, please contact the Local Service Quality and Complaints Commissioner of the CSSS de La Côte-de-Gaspé. Promotion of the complaint examination process
Since changes were made to the complaint examination process in 2006–2007, the number of complaints to
the CSSS de La Côte-de-Gaspé has increased by over 100%, up from 38 complaints in 2005–2006 to 77 in
2007–2008. This increase is particularly attributable to the promotion conducted by the Local Service Quality
and Complaints Commissioner among the staff, the Residents' Committee of the Centre d'hébergement
Mgr-Ross and the general public during the regional promotional tour for the complaint examination process.
The process also benefited from greater visibility within the institution through posters and information
brochures. Nevertheless, in 2008–2009 the Commissioner intends to continue promoting both the
complaints process and the rights of users. The Commissioner also plans to work with the awareness
campaign slated to accompany the institution's revised code of ethics in the next year.
Complaints received by the CSSS de La Côte-de-Gaspé
Complaints
20072008 Variances %
Received during the fiscal year Resolved during the fiscal year Processing rejected after summary examination or Complaints
Type of complaints
Medical Examiner
Services and care received Living environment and material resources Financial matters Individual rights Local Service Quality and
Medical Examiner (medical
Handling time
Complaints Commissioner
complaints)
ANNUAL REPORT BY THE USERS' COMMITTEE AND RESIDENTS' COMMITTEE

HIGHLIGHTS

• Assume the role of the Users' Committee until implemented; • Requests that specialized transportation be used more by the Centre d'hébergement Mgr-Ross; • Close follow-up regarding the quality of food at the Centre d'hébergement Mgr-Ross; • Request that the parking areas for families be respected; • Support the steps taken by certain families in their reflections on the well-being of their loved ones; • Participation in the CSSS Board of Directors; • Rigorous monitoring of security at the main entrance to the Centre d'hébergement Mgr-Ross; • Implementation of the CSSS Users' Committee in January 2008; • Implementation of regulations for functioning by the Users' Committee. A detailed report is available from the office of the Users' Committee at 418 368-3301, extension 4313. REPORT BY THE BOARD OF PHYSICIANS, DENTISTS AND PHARMACISTS
The report by the Board of Physicians, Dentists and Pharmacists of the CSSS de La Côte-de-Gaspé is available from the Board. REPORT BY THE PHARMACOLOGY COMMITTEE

HIGHLIGHTS

• New medications added to the form: Merrem, Avastin; • Vaponephrine pulled from the Canadian market; • The following medications removed from the form: Tequin (for severe hypoglycemia and hyperglycemia), Ketek (kidney failure, exacerbation of myasthenia gravis and syncope); • Number of medications in the night cart removed and sample cabinet abolished; • Medication substitution: Tiazac and Coumadin; • Group prescription: oral contraception at the emergency department and Youth Clinic; • Introduction of several protocols: A) Pantoloc IV B) Remicade C) Cefazoline and probenecide D) Xigris E) total parenteral nutrition F) Heparine (low dose and regular dose) is under way; • Creation of a user guide for Fragmin (thrombophlebitis and pulmonary embolism) and one for Narcan (requires too many nursing interventions); • User guide for opiates currently being developed; • Creation of a computerized discharge prescription; • Two studies are under way: o Assessment of the medical procedure at the Centre d'hébergement Mgr-Ross; o Hysterectomy. OUTLOOK FOR 2008-2009
• Rework old protocols and missing protocols; • Create a tangible form and make sure every medication submitted is studied; • Create a newsletter to improve communication among health professionals. REPORT BY THE MULTIDISCIPLINARY BOARD

HIGHLIGHTS

• Proceed with the amendment to the regulation concerning the term of officers' mandates in the document entitled "Règlement de régie interne du Conseil multidisciplinaire" [regulation on internal government by the Multidisciplinary Board]; • Maintain the delegation of Multidisciplinary Board members to sit on various in-house committees at management's request; • Launch and apply the Multidisciplinary Board's recognition award program; • Maintain the communication mechanism introduced between the Executive Board and the members of the CSSS Multidisciplinary Board; • Follow up on the CSSS budget for training and professional development; • Participate in the implementation of a policy on intern supervision; • Implement peer committees; • Participate in the consultation process for implementation of the clinical project at the CSSS de La Côte- • Participate in meetings of the CSSS Board of Directors based on the availability of interested members; • Proceed with the assessment of the SysÉval program; • Ensure follow-up on the "Clinical Advisor" file; • Ensure follow-up on the "Social Work Technicians" file.
OTHER INTERVENTIONS IN 2007–2008


• Meetings with the Executive Committee;
• Meeting with the joint labour/management committee for training; • Process for membership in the Association des conseils multidisciplinaires du Québec [Quebec association of multidisciplinary boards]; • Working committee: draft policy on dress; • Consultation regarding the policy on visiting hours; • Assistance with the health profile by the Agence de la santé et des services sociaux; • Assistance with the meeting to present the strategic plan; • Production of an information brochure on the definition, role and functions of the Multidisciplinary • Letter concerning the recruitment of professionals to the Human Resources Branch. CONSULTATION ON INTERNAL DOCUMENTS
The comments and recommendations of our executive were requested three times during the mandate concerning the following internal documents: • Draft policy on dress; • Draft policy on managing internships; • Draft policy on tobacco; • Draft policy on visiting hours. OUTLOOK FOR 2008-2009
• Maintain the delegation of Multidisciplinary Board members to sit on various in-house committees at management's request; • Participate in the Regional Multidisciplinary Board; • Participate in the meetings of the CSSS Board of Directors based on the availability of interested • Become a member of the Association des conseils multidisciplinaires du Québec; • Maintain the Multidisciplinary Board's recognition award program; • Participate in the process to recruit professionals to the CSSS de La Côte-de-Gaspé; • Cooperate with management to introduce a performance appraisal program; • Follow up on the training and professional development file and the training budget at the CSSS de La Côte-de-Gaspé; • Participate in implementing a policy on intern supervision; • Maintain the communication mechanism introduced between the Executive Board and the members of the CSSS Multidisciplinary Board; • Publicize the activities and achievements of Multidisciplinary Board members through the "Pourparler" • Implement peer committees; • Participate in the Strategic Planning Steering Committee of the CSSS de La Côte-de-Gaspé; • Participate in the consultation process on implementing the clinical project at the CSSS de La Côte-de- • Ensure follow-up on the "Clinical Advisor" file. REPORT BY THE BOARD OF NURSES
HIGHLIGHTS:
• Participation in various meetings of the Board of Directors based on member availability; • Training on the therapeutic nursing plan given by the Order to various nursing staff members; • Collaboration with implementing the continuous quality improvement process; • Positioning with respect to the skills of nursing staff through training activities; • Recommendations on various CSSS policies: restraint protocol, dress, tobacco, Workforce Development Plan, report by Stérile Conseil, systematic follow-up for COPD clientele, wound protocol, etc.; • Participation in the exchange forum with the Executive Committee and in the presentation of the health and well-being profile for the territory's population. OUTLOOK FOR 2008-2009
• Participate in various meetings of the Board of Directors of the CSSS de La Côte-de-Gaspé based on member availability; • Maintain the recognition awards given to nurses and nursing assistants at the CSSS de La Côte-de- • Follow up on: training, training budget and professional development as well as representation at various • Participate in the Strategic Planning Steering Committee of the CSSS de La Côte-de-Gaspé; • Continue participating and following up on the various committees on which members of the Board of • Participate and ensure all requests made by the Director General and make recommendations; • Implementation of the therapeutic nursing plan effective April 2009.

Source: https://www.cssscotedegaspe.ca/fichiers/csss/Publications/Rapport_annuel/rap_annuel_2007_2008_version_finale_anglaise.pdf

Canadian

Canadian Pari-Mutuel canadienne du pari mutuel Elimination Guidelines © Her Majesty the Queen in Right of Canada, as represented by the Minister of Agriculture and Agri-food Canada, 2016 Catalogue: A22-147/2016 ISBN: 978-0-660-03756-1 CONTENTS INT RODUCT ION………………………………………………….4

English.pdf

"PROTEZIONE CIVILE EDUCATIONAL" - www.casaleinforma.it/pcivile V° Contingente CRI at the Italian Red Cross Hospital in Baghdad September – October 2003 PROTOCOL FOR THE TREATMENT OF BURNS AT THE ITALIAN RED CROSS HOSPITAL IN BAGHDAD Document drawn up by Dr. Sandro Gregorio doctor at the Orthopaedic and Trauma O.U at the "G. Gaslini" Institute in Genova.