Data expert testifies about senior home mortality rates at Wettlaufer inquiry

A senior Ontario health official will testify Friday at the Long-term Care Homes Public Inquiry. Dr. Michael Hillmer is the Executive Director of Information Management, Data and Analytics with the Ministry of Health and Long-term Care.

Third day of hearings in Toronto into the case of the former nurse who killed 8 patients in her care

A senior Ontario health official testified Friday at the Long-term Care Homes Public Inquiry. 

Dr. Michael Hillmer is the Executive Director of Information Management, Data and Analytics with the Ministry of Health and Long-term Care. 

The ongoing inquiry is looking into how nurse Elizabeth Wettlaufer kept up a near decade-long run of murdering patients in her care undetected.

Wettlaufer confessed in 2016 to killing eight elderly patients and trying to kill six more — all with injections of lethal amounts of insulin. The patients were in long-term care in Woodstock and London facilities.

It's the final day of three days of hearings being held in Toronto.

Using data models

Dr. Hillmer testified Friday that he is overseeing a project at the ministry that started in 2017 that is looking to see if data can be used to identify long-term care homes that have higher-than-expected death rates over a particular period of time.

"That's the key part, that we were trying to find homes that had higher-than-expected [death rates] and generating the expected number is what this project was all about," said Dr. Hillmer.

"We know how many people did die and so the statistical approach described here is how we get to that expected number.

In the statistical modelling approach, risk factors included sex, age, health conditions, previous conditions, acuity and reason for stay. Researchers are using the data to try to determine the risk of patients dying and then developed a standardized mortality ratio to grade homes on their number of deaths.

"This standardized mortality ratio approach, it's used extensively throughout health care, it's used in manufacturing, it's just a well accepted way to try and find outliers," said Dr. Hillmer.

According to a ministry report,  Detecting LTC Homes with Excessive Rate of Mortality , between 2015 and 2016, the rate of active clients dying was 19.6 per cent, or one in five clients.

While the modelling could become a useful tool to flag care homes that have higher than expected deaths, it has no way of determining the cause of the deaths.

The data models were tested against the Caressant Care home in Woodstock, Ont. for the time period when Elizabeth Wettlaufer murdered seven patients.

However, according to Dr. Hillmer's testimony, the results did not conclusively indicate there were any unexpected deaths during that time.

Dr. Hillmer says the modelling is still in the research stage.

"A group of experts need to come together and say, 'are these expected numbers, the predictions, are they believable, do they make sense to you, can you imagine in your mind how the model is producing these numbers?'" he said.

Preventing and detecting intentional harm

The inquiry heard Thursday about how diversion of medications has increased recently in response to the national opioid crisis.

Julie Greenall, director of projects and education at the Institute for Safe Medication Practices Canada, was the expert witness. Greenall testified that there needs to be consideration for diversion of medications beyond opioids.

"That really has been our focus, because they are the medications most commonly diverted," Greenall told the inquiry being led by Justice Eileen Gillese.
Justice Eileen Gillese will have two years to make recommendations. (Wadham College/Twitter)

"But I think the recognition that there may be diversion of other medications for various reasons is something that people really do need to start to think about."

Greenall agreed with the inquiry that the Wettlaufer murders were cases of diversion of insulin for the purpose for which  it was not prescribed.

Pharmacy technicians can also play a role in helping with medication management in long-term care. Pharmacy technicians are independently regulated health care providers who are college trained and specialize in medication management systems.

"I think pharmacy technicians could provide a very important supportive role for nurses in long-term care," said Greenall.

"There are multiple ways that they could help, but I think specifically, related to all of the kind of inventory management activities, they could just take that over."

Greenall says pharmacy technicians have a very strong knowledge of medications and medication systems.

"I think they also would really provide that oversight role; so they would really be aware of 'what is in the fridge? When were medications ordered? Why do we suddenly have to reorder this medication when we just got it?'"

Implementing a positive safety culture

Greenall discussed the idea of developing a positive safety culture at long-term care facilities with the aim of reducing the likelihood of untoward incidents.

"It's really a whole philosophy for how an organization operates," she said. "It has to be more than, 'our policy is that we're providing safe care,' it's 'what are the steps that we're taking to insure that?'"

In a positive safety culture, Greenall says frontline staff would be involved in reviewing incidents, such as falls or medication incidents, and then discuss solutions to reduce the likelihood of them reoccurring.

Testimony for the inquiry is expected to wrap up in St. Thomas, Ont. later this month. Justice Gillese has two years to come up with her recommendations.