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Building stairway codes specify the size and placement requirements for safe, accessible stairway landings & platforms.
The minimum recommended stair landing length is 36" (or a length and width sufficiently greater than the swing of the door if a wider door is present).
This stairway landing or platform dimension is often also expressed as "a minimum of 36-inches in the direction of travel.
This means that where codes like the IBC require a public access stairway (occupancy of more than 50) to be at least 44-inches wide, the platforms will have to be 44-inches in the direction of travel as well; the same IBC permits a 36-inch wide stairway for occupancies of 50 or less, thus permitting the stairway length of 36 inches in the direction of travel. Using the 2003 IRC as a stair landing code example, we obtain the requirement for landings at the top and bottom of the stairway and a maximum stair rise of 12 feet before an intermediate landing is required.
Our photograph at left illustrates an antique stairway at el Jaral de Berrio Hacienda in central Mexico. And though it should go without saying, the recommended stairway landing or platform width is equal to the stairway width. The minimum recommended stair landing length is 36" (or a length and width sufficiently greater than the swing of the door if a wider door is present. Notice that a stair top landing is not required if the door at the top of the stair opens away from the stairwell. We often find older one and two family homes at which a door opens directly onto a stairway without a top landing platform.
As you can see in our photo at left, a door is opening out over a stairwell and no landing is provided. Because the ergonomics of a person placing their hand on a doorknob and opening the door tends to guide where they put their foot in stepping out and down, the absence of a landing here is a serious trip and fall hazard that is prohibited by building codes and by good construction practice. In industrial settings where there may be special requirements for maintenance of equipment but not normal walking traffic, a landing or platform requirement will differ. Reader Question: I am finishing my basement and planning to install a landing at the bottom of the stairway that will be 2 steps (one actual step) down to the floor. My question is - since there is no door at the bottom of the steps, is there still a requirement that the landing be 36" deep? Due to the proximity of a support post, the landing will only be 2'9" deep, unless I come back up another step and have three steps down from the landing.
Typically building stair codes specify that in the direction of travel the stairway landing or platform shall have a dimension at least as great as the width of the stairway.
In one approach the builder would back up far enough from the end of the stairs to have room for a full width landing, insert the landing there and then continue the stairs down to the left. The user would walk down stairs, and near the end, step onto a full-sized landing, make a left turn, walk across the landing, and continue one or two or however many necessary additional steps to get down to the finished floor. But our email discussion you point out a competing difficulty: moving the landing up one stair tread runs into a headroom clearance with the floor above.
As I understand your illustration (above left), the problem is that making the landing length (in direction of travel) equal to the width of what I am guessing is a 36-inch wide stairway means that you'd have to build the platform out intruding into the otherwise free space of the room below. If the inspector will not accept your stair as drawn, you may have to open the ceiling, install blocking or headers to allow you to move the post over to get enough room, then intrude the landing those few inches into the room beyond. As our friend Nizar in the photo is demonstrating at his home near Rabat, in Morocco, it can be very difficult to open a door that swings out over a step while you're standing on the step.
Like the example shown above, this is a trip hazard but in this case also it's also difficult to enter the building at all.
While standing on the step the person trying to open the door has to step backwards, down the steps, while opening this security door. The stairway landing shown at left includes a window that lacks a guard railing or safety glass. Thinking he was walking down a level hallway he instead stepped into air and fell down a stair such as this one. Safety glazing or window guards are required for locations such as that shown in our photograph. Handrailings at intermediate stairway platforms should be continuous and should be accessible in the area of stair passage. There is a railing along the upper stairway starting at a newell on the fourth stair platform but not along the steps formed by the four platforms (marked in yellow) except along the left wall (marked in green) where no one will ever set-foot. In the area of principal walking assage from the two sides of this four-riser lower stairway there is no handrailing. On wide stairways you may get by with a pair of wall rails or a railing down the stair center.
I imagine that the architect who designed these stairs liked the attractive and open design with a two-sided approach to the stairway. The entry platform or landing at exterior stairs must comply with size and guardrail requirements as do interior stairs and landings.
The concrete platform was poured right against building siding, providing a protected entry path into the structure for wood destroying insects.
The combination of platform poured against siding and poor drainage sending water towards the house walls increases the risk of insect attack as well as ice formation in winter at this New York home. Stair treads and landings subject to wet conditions shall be designed to prevent the accumulation of water.
Anon your top guardrail needs to meet the height requirements for balconies and landings - typically 43-inches along horizontal walking surfaces such as a landing platform.
Most codes want the stair guard to also be 42-inches in heigh but will allow that to drop to 34-inches if the top of the stair guard is also to serve as a handrail. Continue reading at PLATFORMS & LANDINGS FAQs or select a topic from the More Reading links or topic ARTICLE INDEX shown below.
ACTS is a not-for-profit corporation that provides health, safety, industrial hygiene, technical services, and safety publications to the arts, crafts, museums, and theater communities. ACTS also will not accept money or take advertising in our publications from manufacturers of artists materials or businesses whose interests could conflict with ours. Our recommended books about building & mechanical systems design, inspection, problem diagnosis, and repair, and about indoor environment and IAQ testing, diagnosis, and cleanup are at the InspectAPedia Bookstore.
The Illustrated Home illustrates construction details and building components, a reference for owners & inspectors. Persons using assistive technology might not be able to fully access information in this file. Three days after the initial visit, Andrea feels better with fewer stools per day, but Marcus has had worsening vomiting and diarrhea. The decision to change from oral to intravenous antibiotics may be based on Marcus' increased vomiting and on his clinical decline.
Salmonella infection, perhaps by decreasing the usual protection offered by normal bowel flora, and thus decreasing the infectious dose necessary to cause illness.
Public Safety Canada would also like to thank the Canadian Association of Chiefs of Police (CACP) for their dedication and commitment to the issue of the misuse and abuse of prescription drugs. Additionally, pharmaceuticals can be harmful to the environment when disposed of improperly such as in landfills or waterways, thus creating potentially dangerous environmental exposure to chemicals. In June 2011, Public Safety Canada (PS) hosted a national workshop on the Illicit Use of Pharmaceuticals in Vancouver, attended by 100 participants representing federal, provincial and municipal law enforcement as well as health officials, including physicians and pharmacists. This document identifies examples of initiatives, mostly Canadian, to reduce the harms related to the illicit use and disposal of pharmaceuticals, with a specific focus on awareness-raising. It is hoped that presenting these practices will provide practical information for those seeking to identify and implement effective practices such as hosting municipal, regional or provincial prescription drug return initiatives.
Public Safety Canada has been involved in a number of prescription drug return initiatives and can provide information on the misuse and abuse of pharmaceuticals as well as valuable resources and advice on holding a prescription drug drop day. The DEA's National Take Back Initiative has been a major source of influence and the DEA has been exceptionally supportive in developing Canadian take back initiatives.
According to the American Controlled Substances Act, pharmacies and reverse distributors cannot legally take back controlled substances; they must be disposed of by the DEA. In addition, the DEA has created a law enforcement database which ensures that locations are registered and that pharmaceuticals will be legitimately collected and destroyed.
On May 12, 2012, the Niagara Region Public Health, in association with the NRPS, OPP, OACP and PS, hosted a Drug Drop Day for the 12 municipalities that make up the region of Niagara. To describe the process for collection, identification, securing and destroying reclaimed medications. To raise public awareness of the various potential public safety and environmental threats posed by inappropriate use, storage and disposal of these medications. The May 2012 Drug Drop Day was attended by 426 vehicles and over 400kg of medications were collected. An awareness campaign accompanied the Drug Drop Day and several materials were created such as stickers, flyers and poster. Additional tools from the Niagara Region Drug Drop Day such as a budget, budget template, operational plan, inventory form and communications strategy are available at Appendix B. In September 2012, the Ministry of the Environment (Ontario) filed a regulation requiring the proper end-of-life management of post-consumer waste pharmaceuticals and sharps.
Comprehensive promotion and education activities to improve consumer awareness and knowledge of the collection network.
Police services may wish to consider this new regulation when providing their outreach for collection. Medi Drop is a program that offers a safe place for the public to dispose of unused, unwanted or expired medication for free. The drop boxes are emptied on a regular basis by the CCPS Evidence Unit who documents each collection to track the medications that have been collected and to monitor the program. In developing the Medi Drop program, the CCPS was successful in obtaining donations from the private sector to get the drop boxes made. The advertising materials developed not only promote Medi Drop, but also provided education for the general public about the risks associated with keeping unused medications at home and with the unsafe disposal of medications.
Tip: Securing the drop-off boxes with high quality locks and ensuring safe disposals with continuous video surveillance is key. Ottawa Public Health, in collaboration with Ottawa Community Housing via the Aging in Placeinitiative, hosted several Medication Clean-Out days. The project's awareness materials provide dual messaging about safety (misuse, abuse and environmental safety) and well-being. Public Health Nurses work with senior residences to arrange the collection and pick-up of unused or expired medications that are then disposed of at a pharmacy. Tip: Facilitate access for vulnerable populations by providing drop off sites where they reside.
The PCPSA was created in 1999 and its mandate is to manage unused or expired medications in a cost efficient and environmentally acceptable manner that meets government policy or legislation. In partnership with Public Safety Canada, the Capital Regional District and Pharmasave, the PCPSA organized a contest in British Columbia to raise awareness with youths about medication returns. The Health Canada, Office of Controlled Substances, can, in some cases, reimburse the costs associated with the destruction of collected medications, which contain controlled substances. Health Canada's Environmental Impact Initiative (EII) has the mandate to reduce environmental and indirect human health impacts of substances in products regulated under the Food and Drugs Act. WHEREAS the Canadian Association of Chiefs of Police, in Resolution #08-2004, called upon the Federal, Provincial and Territorial Ministers of Health to prioritize the implementation of safeguards, in consultation with Canadian Policing and Pharmaceutical representatives, to prevent the further diversion of prescription drugs to the illicit drug trade. BE IT FURTHER RESOLVED that the CACP urges all members to undertake data collection on pharmaceutical-related incidents, as well as participate in monitoring and surveillance efforts in partnership with health authorities, in order to track trends in illicit pharmaceutical use. Prescription drug misuse has become a significant and growing public health and safety concern across Canada and the United States. Media reports have also focused on some First Nations communities in Northern Ontario which report exceptionally high rates of prescription opioid addiction and abuse. From an enforcement perspective, the criminality associated with prescription drug misuse includes fraudulent use of the health care system, pharmacy robberies and trafficking; meanwhile, these 'licit' drugs challenge traditional supply reduction approaches.
The Canadian Centre on Substance Abuse (CCSA) recently announced the launch of a National Prescription Drug Misuse Strategy which is being co-chaired by CCSA along with the Nova Scotia Department of Health and Wellness and the Alberta Coalition on Prescription Drug Misuse.
The following is the budget for the Niagara Region Drug Drop Day held on May 12, 2012 and is included as an example of potential costs incurred during a Drug Drop Day.
The Niagara Region Public Health developed a comprehensive communications strategy for their Drug Drop Day. To promote Drug Drop Day, where the general public can drop off their unused or expired prescription medications for safe disposal. Locally disposal option - outside of regional drops off, one unified day throughout municipalities to drop off Rx medications. The NRPS sent out this letter to confirm the date, time and location for the event in each community.
The aim of the project would be to provide much faster speeds and higher bandwidths than are currently available.
Last fall we laid down cover boards as part of an ongoing monitoring project to track salamander populations.
Spend the afternoon exploring the trails on the property and helping us look for pollinator species.
For the most up to date information, please visit the clubs' websites or contact them directly. The Deep River Golf Club, located beside Highway 17, as you enter the Town of Deep River, was designed by world-renowned golf course architect Stanley Thompson. The club offers a Jack Rabbit program for kids, a racing program for teens, adult lessons, equipment rentals, tours, a heated chalet, a wilderness cabin, and the opportunity to race in the Silver Spoon Ski Fest and the club championships. The Mount Martin Ski Club (MMSC) maintains 12 runs including a glade run and 2 terrain parks (with jumps, rails and boxes), and is service by a T-bar, right in the Town of Deep River.
The Deep River and Area Minor Soccer Club (DRAMSC) is a club promoting the wonderful game of soccer for children in the age from 5 to 19 years living in Deep River, Laurentian Hills, and Head, Clara, and Maria. The Deep River Duplicate Bridge Club fosters a friendly, welcoming and comfortable place to enjoy Duplicate Bridge. The club has a well equipped Cessna 150 located at the Deep River grass airstrip just to the west of Deep River off Highway 17.
There is no refueling at Deep River Airstrip, but there is at Pembroke airport, a short ~15 to 20 minute flight away. The Deep River and Area Family Enrichment Network (FEN) is a non-profit organization governed by a Volunteer Board of Directors. The Deep River Players is an amateur theatre company that performs two to three shows a year, holds public workshops, and generally provides a home for theatre lovers in this beautiful town and surrounding environs. Active in our community since 2006, we are Rotarians working together for the benefit of our community and in support of the international community service initiatives of Rotary International. The Town of Deep River encourages citizens to participate in their community by volunteering for one of our advisory committees.
The purpose of the Official Plan is to guide the physical development of the Town of Deep River by articulating policies and land use designations that describe and promote the desired future form of the Town. Proponents may also wish to consult the Zoning By-law when purchasing property or establishing a new business. The Planning Act of Ontario grants municipalities the authority to review and approve site plans for certain types of development in accordance with established municipal requirements. The Committee of Adjustment is appointed by Council to deal with minor problems in meeting municipal zoning by-law provisions. It should be desirable for the appropriate development or use of the land, building or structure. The Town of Deep River is proud of the diverse range of recreational services available to our community. If we currently do not offer a program that you would like to participate in, please feel free to contact us and we will work towards implementing it. Please contact the Recreation Department for more information as to how to become a coach or an assistant coach.
In the future, we would like to offer direct forms of communication including e-mail, text message and phone. For further details please see the attached advertisement which was also posted in the NRT. This legislation makes historic changes to the Ombudsman’s mandate, allowing the Office of the Ombudsman to help more Ontarians.
As a resident of the Town of Deep River, you may submit a formal complaint by phone at (613) 584-2000 extension 126 or by visiting Town Hall at 100 Deep River Road and asking to speak with the Chief Administrative Officer. What is the Ombudsman's new mandate as a result of the Public Sector and MPP Accountability and Transparency Act, 2014 (also known as Bill 8)? As a result of legislative changes, the Office of the Ontario Ombudsman will now oversee Ontario’s 444 municipalities, 82 school boards, and 21 universities. The Ombudsman will have the authority to investigate complaints about Ontario’s municipalities including about municipal councils, local boards and municipally-controlled corporations, with some exemptions.
Anyone who has a concern about a municipality, university or school board can complain, including residents, students, staff, parents, and family members. Our Office will not replace any local integrity commissioner, ombudsman, or other office that deals with complaints, but we can review decisions of those bodies to ensure the appropriate policies and procedures were followed. The Ombudsman will be able to investigate complaints about the administrative conduct of municipalities, including complaints about council members, local boards, and municipally-controlled corporations (with some exceptions).
Under the Ombudsman Act, all complaints, including the identity of the complainant, are confidential and investigations are conducted in private. Seneca is at the forefront of providing student-focused teaching and learning that is redefining how people think about postsecondary education. Sommes-nous prets a partager les donnees du dossier pharmacologique informatise des patients hospitalises? To compare clinical and economic outcomes in patients receiving traditional meropenem dosing (1 g Q8H) with alternative dosing (500 mg Q6H) before and after the implementation of an autosubstitution policy based on pharmacodynamic evidence of equivalence. A retrospective chart review of patients prescribed meropenem 5 months prior to (September 2008 – February 2009) and 5 months after the implementation of the autosubstitution policy (February – July 2009) for P&T committee approved indications was conducted.
28 patients who received meropenem 1 g Q8H and 29 who patients received 500 mg Q6H met our inclusion criteria. The pharmacodynamically optimized alternative dosing regimen of meropenem revealed similar clinical outcomes with significant economic benefits compared to the traditional dosing in the 5 month pre and post implementation period of the autosubstitution policy. Antibiotic prophylaxis is uniformly recommended for all clean-contaminated, contaminated and dirty procedures.
More than half the surgeries (53.8%, n=284) were not fully compliant with all aspects of the guideline.
Obtaining blood samples from children is an activity which impacts patients, families and caregivers daily. This study evaluated the extent of agreement between PGCs determined in samples obtained via ports using the push-pull method and FLPs in children with febrile neutropenia.
Children with cancer with single or double-lumen ports who were receiving gentamicin participated in this prospective study.
The push-pull method of blood sampling is a reliable and safe option for obtaining PGC results in children with ports.
In adult patient with febrile neutropenia, there is no difference in efficacy between single and double gram negative coverage antibiotic regimens.
To compare the effectiveness and safety of a double coverage gram negative antibiotic regimen to a single coverage gram negative antibiotic regimen in pediatric febrile neutropenia patients.
Retrospective review of patients who received piperacillin-tazobactam with or without gentamicin.

A novel vancomycin dosing nomogram has been developed and successfully validated at two major Canadian teaching hospitals. For meropenem, maintaining time above minimum inhibitory concentration (MIC) relative to dosing interval (%T>MIC) at ?40% may improve clinical outcome. The use of multiple medications can increase the risk of adverse effects, drug interactions and non-compliance with drug therapy, all of which may result in less-than-optimal health outcomes. To examine the number and types of drugs being used by seniors, and how utilization changes as seniors age. This study examined claims for 1,039,642 seniors on public drug programs in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia and PEI from 2002 to 2008, representing over 80% of the senior population in those provinces in 2008. Findings suggest a high proportion of seniors may be at risk for drug interactions and other adverse events due to the number of medications they are taking. Adherence to antiretroviral is important to mitigate resistance and adolescents are considered to be high-risk for poor adherence. To determine the feasibility of a large-scale and long-term adherence study using electronic monitoring in an adolescent HIV-positive population in Uganda and to compare accuracy of pill count (PC) and self report (SR) adherence determination with adherence determination using electronic medication vials (eCAPs). Fifteen patients were included: 40% were female, the mean age was 14, the mean baseline CD4 count was 244, and average treatment duration was 9 months prior to study entry.
A large-scale adherence study in Uganda is feasible using a more robust electronic monitoring system. Published guidelines for traumatic brain injured (TBI) patients include routine phenytoin prophylaxis for post-traumatic seizures (PTS).
The incidence of PTS, potential drug interactions, rates of adverse drug reactions (ADR), and actual phenytoin utilization following TBI at The Ottawa Hospital (TOH) was unknown, therefore this project aimed to characterize these aspects of TBI. In TBI patients at TOH, current phenytoin dosing results in lower than intended LD and MD and when phenytoin levels are evaluated, the therapeutic range is maintained for the minority of patients.
Pharmacotherapeutic problems (PTPs) are common in older people and can result in significant morbidity and mortality. The objectives of this study are to describe: 1) The types of PTPs present in patients who present to the clinic, and 2) medication assessment activities of the pharmacist. PTPs are common in older people with cognitive impairment or dementia, can be readily identified and managed by a clinical pharmacist.
The efficacy of natural products (NPs) is being evaluated using randomized controlled trials (RCTs) with increasing frequency, yet a search of the literature did not identify a widely accepted critical appraisal instrument developed specifically for use with NPs.
The objective of this project was to develop and evaluate a critical appraisal instrument sufficiently rigorous to be used in evaluating RCTs of conventional medicines with a section specific for use with single entity NPs, including herbs and natural sourced chemicals.
A new instrument for the critical appraisal of RCTs of NPs was developed and tested that is distinct from other available assessment instruments in its systematic development and validation. The ADapting pharmacists’ skills and Approaches to maximize Patient’s drug Therapy effectiveness (ADAPT) blended e-learning and experiential program (being piloted across Canada) aims to help pharmacists integrate professional skills required for collaborative patient care into everyday practice.
To describe the demographics of the ADAPT pilot cohort, their preparedness and motivation levels and reasons for participating. The pilot cohort of ADAPT participants represents both new and experienced practitioners with varied backgrounds. Opportunities to improve patient safety are hindered by wide-spread under-reporting of medication errors. A comparative case study analysis of medication error reporting practices and beliefs at four community hospitals in Nova Scotia was completed using focus groups (with physicians, pharmacists, and nurses) and in-depth interviews (with risk managers).
Careful analysis of the textual data identified themes related to incentives for, barriers to, and positive facilitators of medication error reporting. These results could be used by hospitals to encourage reporting of medication errors and ultimately make organizational changes leading to a reduction in the incidence of medication errors and an improvement in patient safety.
Mental health disorders pose a significant burden to the Canadian health care system, both from an epidemiological and financial perspective.
Medication incidents from the ISMP Canada database were collected from October 7, 2000 to July 29, 2009. A total of 88 incidents were included in the analysis; 82 had an outcome of harm, and 6 had an outcome of death. The results of this analysis can provide insights into areas for system improvements for the use of psychotropic medications. At the Children’s Hospital of Eastern Ontario, medication related events represent the highest percentage of patient safety incidents (28%). To identify and prioritize potential failures in morphine prescribing, so that these parts of the morphine prescribing process in greatest need of change are acted upon.
A failure mode effects analysis (FMEA) was used by the multidisciplinary team to diagram the process of prescribing morphine and to brainstorm potential failure modes and predict their effects should the failures occur in real-time. 70 failure modes were identified and prioritized these using severity, detectability and frequency as scores. Can a Pharmacy Student-Pharmacist Model Be Used to Overcome Challenges and Sustain Admission Reconciliation? Although many hospitals have started implementing admission medication reconciliation, sustaining it for all patients organization-wide can be challenging. One pharmacy student coordinated the process in the 120-bed oncology hospital; other students provided support when needed.
Main challenges identified and addressed through the process map evaluation and collaborative effort were: 1) difficulty in identifying patients requiring a BPMH 2) efficiently tracking completed BPMHs with a paper-based recording system and 3) competing pharmacist workload priorities limiting time for reconciliation. A collaborative model was developed that optimally facilitated an effective process of students (conducting BPMHs) supporting pharmacists in achieving target patient admission reconciliation. The Right Honourable Justin Trudeau Prime Minister of Canada (middle) and the Honourable Ralph Goodale, Minister of Public Safety and Emergency Preparedness (4th from right) attended the 23rd Canadian Legislative Conference of the International Association of Fire Fighter (IAFF) in Ottawa on Monday, April 18, 2016. The Canadian Disaster Database (CDD) contains detailed disaster information on more than 1000 natural, technological and conflict events (excluding war) that have happened since 1900 at home or abroad and that have directly affected Canadians.
But note that not all model building codes explicitly require the 36" dimension and instead commonly state that in the direction of travel the landing dimension shall be no less than the width of the stairway. The platform or walking surface can be wider, of course, such as occurs when stairs end at a balcony, deck, or walkway. Some opine that if the door swings into a room, away from that top step, the hazard is reduced and a landing is not required.
Doors in the fully open position shall not reduce a required dimension by more than 7 inches.
So if your stairs are 36-inches wide the codes want the platform to run 36-inches in the direction of travel.
This might mean that the landing is two or even three steps higher, to get enough room away from an obstructing wall found in the direction of run of the stairs. And even if you did so, you have a supporting post that intrudes back into the walking space. If your stairway is 36-inches in width, then typical codes want the run direction of the landing to also be 36-inches.
Someone who falls down these stairs is at risk of suffering extra severe injuries should they fall into and break the window glass, or worse, fall right through the window. S., was returning from a night-time bathroom visit when, elderly, frail, and confused in the dark, he turned left instead of right.
Incomplete handrailings invite falls if stair users are likely to walk where there is no graspable handrailing or where open rail ends at intermediate platforms or landings form snag hazards.
It is possible that a local official approved these stairs though in my view they are unsafe. That may comply with the letter of the law in the view of some designers or code compliance officers but in my opinion this is an unsafe stair that would be difficult for elderly or people with walking and stair disabilities.
I would expect an alert building code compliance officer to interpret this as an unsafe stair and call out this as a code defect. I'd have put a handrailing down the steps exactly where the architect would omit it - in the area marked by yellow at the right angle between the two stair treads on the two sides of the platform rectangle. In addition, because of weather exposure entry platforms are at risk of additional slip trip and fall hazards from water, snow and ice, or algae and moss. And yes, as you can see in our photograph (above left) it is possible to combine a stair-guardrail with a handrailing along a stairway.
However as you see in our CIA photo, it's not difficult to add a lower handrailing along a 42-inch stair guard. A part of the fees from our consulting services goes to support our free and low-cost services for artists. We want artists to know that we have no financial incentive to make our product and safety recommendations.
The text is intended as a reference guide to help building owners operate and maintain their home effectively.
A commercial oral rehydration solution (ORS) may be used, particularly for Marcus, to provide glucose and salts.
Because of the progressive systemic nature of his illness, you also obtain blood cultures at this time. However, during hospitalization, he should be encouraged to resume drinking ORS as early as possible. The choice of antibiotics should reflect the results of stool culture and antimicrobial sensitivities.
Typhimurium has been on the rise in the United States since the early 1990s and now accounts for at least 25% of these isolates. This is a reasonable choice in light of the antimicrobial resistance and the reluctance to use fluoroquinolones in the pediatric population. Typhimurium, public health laboratories may perform bacteriophage typing or pulsed-field gel electrophoresis (PFGE) to further characterize the drug-resistance patterns of these organisms. In addition to nausea, cramps, coughing, and sweating, his eyes have begun to tear uncontrollably and he complains of having had difficulty breathing while en route to the office.
Upon returning home, he finished drinking the bottle of water he had purchased earlier from the local deli and began to get ready for work.
The neurologic exam reveals the slight tremor in his left arm, slightly slurred speech, excessive salivation, and transient fasciculations in both upper extremities. In fact, trends indicate rising rates of recreational misuse of prescription drugs by youth, the majority of whom obtain these drugs from family medicine cabinets and from friends. From an enforcement perspective, the criminality associated with prescription drug misuse includes fraudulent use of the health care system, pharmacy robberies, drug-impaired driving, and more traditional drug trafficking activity- both by organized criminals and individuals taking advantage of lucrative street markets.
The significant rise in the use of these products has led to increasing detection of chemicals in the environment, including our drinking water. The goal was to facilitate multi-sectoral discussion and to increase the overall understanding of the issue of pharmaceutical misuse from a public safety perspective.
In June 2012, the National Framework Advisory Committee met in Halifax in order to launch the development of framework objectives. It also includes examples of successful multi-agency partnerships and showcasing models where police, public health and the private sector are working together in a coordinated and effective manner, as well as practical information, budget tools and templates, and awareness materials developed to reduce the use of prescription drugs for non-medical purposes. Groups interested in developing their own initiatives are also encouraged to explore and promote other initiatives in place in their municipality or region, such as the programs mandated through provincial regulations (i.e. While not all initiatives and programs can be included in this handbook, promising practices have been selected to demonstrate the range of options that are available and which have been successfully implemented in Canada.
The National Take Back Initiative was created to allow for the disposition of unwanted, unused or expired drugs to the DEA (through the Secure and Responsible Drug Disposal Act of 2010).
All law enforcement agencies who wish to participate in the Take Back Day must register in this database. These materials can easily be altered by any municipality, region or province that wishes to hold their own pharmaceutical return day. Through this partnership, four Medi Drop boxes have been placed at police stations and hospitals throughout the city of Cornwall.
The CCPS weighs the collected medications and secures them until they can be destroyed by incineration through a contracted provider of this service. In return for the donation, the CCPS promised to add logos to the drop boxes and to pamphlets.
A brand (including the name of the program, logo, colours, etc.) was developed for Medi Drop to ensure that the program becomes known and easily recognized by the public. This website provides more detailed information about the program as well as resources for parents and youths such as links to addictions services and prevention programs.
The project aims to encourage seniors to clean out their medicine cabinets of unused or expired medications on a regular basis. OPH encourages seniors to have an annual review of their prescribed and over-the-counter medications with their physician or pharmacist to reduce the number of senior falls due to polypharmacy. Youths in high school and film schools participated in the contest with the purpose of developing a video to educate the public on the dangers of improperly disposing of unused medications. Law enforcement agencies must fill out form 3515 (Drug Offence and Disposition Report) and return it to Health Canada after 60 days have passed since the date of collection of the medications. As part of its activities to fulfill that mandate, the EII is researching existing regulatory and non-regulatory initiatives that reduce the impact of products, regulated under the Food and Drugs Act, on the environment.
Many of these costs can often be funded in-kind through private partnerships and donations from community sponsors. People drive to the canopy or tent area and hand their medications either through a window or they may pop the trunk.
It is important to record the number of vehicles that attend each site and the times they attend. At the sites where there is not a pharmacist or pharmacy student, the medications can be examined by a Drug Officer. Multiple packages would be available to suit different budgets at competitive market prices. With pollinators in decline, we want to find out what species use the reserve, and what habitat can be found here for bees and butterflies.
Shortly after, beautiful shore-front property was obtained and a clubhouse was built next to the six tennis courts, with a large hall for dining, dancing, and other special events.
With its distinct looks and challenges, this nine-hole course never becomes tiring for the 300 members and green fee players. Our main goal is to develop the character of young people as resourceful and responsible members of their community by providing opportunities, through the game of soccer, for their mental, physical, social and leadership development.
The Ontario Horticultural Association is a volunteer, charitable organization whose mission is to provide leadership and assist in the promotion of education and interest in all areas of horticulture and related environmental issues in Ontario, through an expanding network of horticultural societies dedicated to the beautification of their communities. Again, Town staff will be available to help interpret the by-law and deal with any resulting issues. Site Plan Control Review, an integral component of the municipal planning and development review process, focuses on the technical issues of site design rather than land use. Minor Variances provide flexibility so that developments which do not precisely meet the requirements of a Zoning By-law may still proceed. Citizens are encouraged to participate and take advantage of the opportunities available to learn new skills and to make new friends. We wish you a very healthy season and invite you to enjoy the benefits of participating in our community services. It is not mandatory to have a ball helmet as the Recreation Department will supply one to individual who do not have one.
Find out what’s going on, where and when, by checking for information at your local recreation centre or seniors centre, and there will be posters everywhere. In the summer months the slab is a great place to hold large events such as concerts and commercial events.
Come on down to the Community Pool for one hour of swimming and then head upstairs for an hour of games, drinks and pizza. Information is also publicized in the North Renfrew Times newspaper and on the radio station MyFM.
These would be used during emergency situations and to notify you of service interruptions. It expands the Ombudsman’s jurisdiction to municipalities, universities and school boards. The Ombudsman will also be able to investigate complaints about school boards including, but not limited to, handling complaints about individual schools, policies, procedures and facilities.
Under the Ombudsman Act, the Ombudsman has discretion not to investigate a complaint from someone who is not personally involved in the matter, but this is based on the circumstances of each individual case. This means that you first need to contact your municipality, school board or university and access any available complaint mechanisms or appeals before the Ombudsman can deal with your complaint. The Ombudsman encourages municipalities, universities and school boards to create or reinforce local ombudsman or other complaint mechanisms and accountability offices. Issues the Ombudsman could look at (after local complaint mechanisms have failed to resolve the matter) include: conflict of interest, customer service provided by city staff, complaints about municipally-owned utilities, garbage collection, snow removal, or other municipal services. Clinical outcomes of proportion of patients afebrile at 72 hours, time to defervescence and clinical failure rate were assessed.
No significant differences in baseline demographics, indication for meropenem use, duration of therapy, and concomitant antibiotic use were observed between groups.
The type, dosing and timing of antibiotic administration is critical to its efficacy in reducing surgical infections. Gynecology-oncology (Gyn-Onc) surgeries were the highest at 85.7% (n=18) and urological surgeries were lowest at 22% (n=9).
Non-compliance was a result of inappropriate antibiotic selection, antibiotic dose and (or) timing of antibiotic administration. In children with cancer, blood samples are routinely drawn from subcutaneous central venous catheters (ports) using the discard method, finger lancet punctures (FLPs) or venipunctures to determine the plasma gentamicin concentrations (PGCs) required to individualize gentamicin dosing. PGCs were determined in blood samples obtained via the port using the push-pull method and via FLP.
Outcomes of these different antibiotic regimens have not been assessed in the pediatric population. The single coverage group received additional gram negative antibiotics more frequently than the double coverage group.
Paul’s Hospital nomogram development and 78 patients were used for Vancouver General Hospital’s nomogram development. Monte Carlo Simulations (MCS) using pharmacokinetic parameters of healthy subjects showed that prolonged infusion (PI) (?3 hours) improved probability of target attainment (pTA) over short infusion (SI). Drug classes were defined using the World Health Organization’s Anatomical Therapeutic Chemical classifications. This illustrates the importance of medication management strategies for seniors, and the need for communication between health care providers regarding seniors’ drug regimens. Adherence measurements produced by pill counts and self reporting methods appear to overestimate adherence measured electronically.
Data were collected for the first 7 days of admission (or until discharge if earlier) and included demographics, loading (LD) and maintenance (MD) phenytoin dosing parameters, phenytoin levels, seizure occurrence, potential drug interactions, concomitant medications with anti-seizure properties and documented adverse reactions secondary to phenytoin. Charts of 20 patients who were assessed between July 28-Sept 28th, 2010 were reviewed for demographic data, diagnoses, medications, and care plans.
Such an instrument would aid pharmacists and other health care providers in evaluating the evidence from trials of NPs to determine the quality of the evidence and applicability of results to their patients. The instrument is being used by pharmacists as well as academics teaching students critical appraisal skills. Understanding the pilot participants helps with understanding other results of the program evaluation.

Study Design and Methods: The ADAPT evaluation is a multi-component, mixed-methods assessment.
They recognize the need for change and are motivated to engage in ongoing education to seek skills to adapt to change and improve patient care. Data from these reports can be used to improve processes, identify areas for progress, and prevent similar errors from occurring in other settings.
Focus groups and interviews were audio taped, transcribed verbatim, and analyzed for thematic content using the template style of analysis. Incentives were thematized into three categories: patient protection, provider protection, and professional compliance.
Future research efforts should focus on evaluating the effectiveness of implementing various strategies suggested for improving medication error reporting. Given the prevalence and financial burden of treating mental disorders, it is imperative that there is a strong emphasis on safe medication practices when managing psychotropic medications. Incidents with an outcome of harm or death involving antipsychotics, antidepressants, antimaniac agents, sedatives and hypnotics were included. These incidents occur at different patient care settings including the hospital, community pharmacy and long term care.
The potential contributing factors identified provide a solid foundation for the development of solutions to minimize the recurrence of similar incidents.
Following this, the team identified causes of failure modes and prioritized these using severity, detectability and frequency.
Single point weaknesses are steps so critical that their failure would result in a system failure or adverse event. We attempted a quality improvement initiative to 1) identify and address workflow challenges and 2) explore whether a collaborative model of pharmacy student supporting pharmacists conducting best possible medication histories (BPMH) could sustain a target of > 80% of all admitted patients receiving reconciliation. All students were trained and certified in performing medication histories and reconciliation. Overall, 470 patients were admitted to inpatient units over the course of 11 weeks of observation in 2010. We believe a similar model can successfully aid other hospitals having challenges sustaining reconciliation, while providing students with the opportunity to actively learn and engage in essential direct patient care. This can be tricky because in some jurisdictions codes specify varying minimum stairway widths.
Are you saying that if there is another railing against the other wall, it would comply or are you saying that there is no way to comply with 4 platforms without a railing at the corner of the platforms (that would not look right). Make this handrailing attractive and you've changed a safety problem into a beautiful stair feature. We gratefully accept donations, but do not solicit them from the artists who call here for help and advice. While he may return to preschool as soon as he is feeling well enough to do so because direct spread from one child to another is rare, clinicians should defer to their local health departments regarding their clearance policies for convalescing children attending preschool. You note negative Babinski and his cranial nerves (CN) 2-11 appear intact, while CN 12 appears slightly abnormal. Proper disposal is an important step in lowering these levels to protect the health and safety of Canadians. Each prescription drug return initiative in this handbook differs in their approach and has been successful in overcoming challenges such as funding pressures, legal issues concerning the transportation and destruction of pharmaceuticals, and the competing priorities and mandates of partner organizations.
For the Take Back Days, law enforcement representatives must be present at all take back locations.
Their Take Back Day information is in turn entered into an online public database so that individuals are able to locate the collection sites nearest them. Drug Enforcement Administration's National Prescription Drug Take-Back Days that have been held successfully twice a year throughout the United States since 2009. This greatly reduced the amount of medications that could be misused or diverted in the Niagara region. The collection boxes are locked and securely mounted to prevent removal of the box or removal of medication from within the box without a key. After the initial launch of the program through the website and distribution of the flyer, promotional activities (such as radio advertising) continued on a regular basis for about 8 months. The CCPS also created a bilingual pamphlet for the program; a copy of this pamphlet is available below.
Their website also offers lists of pharmacies that will accept medication returns in some provinces. Nine videos were submitted; a shortened version of the winning video was broadcast on television and is posted on the internet, receiving a consistent number of daily plays. The EII expects to hold broad consultations in 2013 to inform the possible development of new or updated non-regulatory initiatives.
The purpose was to promote multi-sectoral dialogue, to share information and local responses related the misuse of pharmaceuticals, and to identify areas for further action.
The Strategy will be finalized by the end of this calendar year and will stipulate specific short, medium and long term actions that can be readily put in place to prevent and reduce prescription drug misuse including those referenced in this resolution. The collection site should be easily identified by the placement of marked police vehicles, a canopy with tables and chairs and a Prescription Drug Drop-Off Day sign. For officer safety and community safety it is important that people do not exit their vehicles. If the officer can positively identify medications as narcotic, then they can be separated from the non-narcotic medications and they too will be weighed separately.
This can be done by recording a pill count, or in the case of narcotic liquid medications, by using an estimated ounce dosage remaining in the bottle.
During the initial examining area, the contents of the items for examination should be closely scrutinized to prevent unintentional breakages of the skin or perforation of the gloves. It recommends a request for proposal to see whether investors are interested in a high speed internet project in Deep River. Providing your contact information is optional and can be left blank if you wish to be anonymous. The success of the club has led its sailors to win both national and international Y-flyer championships and today, the club continues to host regattas as well as tennis tournaments. Please get in touch with any of our board members to discuss how you as a volunteer can help. Superior physical fitness is achieved through cardiovascular exercises, flexibility and strength development. Please fill out a General Inquiry Form below and submit to the Town of Deep River Planning Department (2nd floor at the Town Hall) Once received, staff will submit to Planners at the County of Renfrew for review. In Deep River, the Official Plan attempts to create a planning framework "that will foster growth, development and diversification while ensuring that the unique character of the Town is maintained.
The Zoning By-law must be considered when undertaking virtually any new construction project and many renovation projects. In Deep River, commercial, industrial institutional and medium and high density housing projects are subject to site plan control.
Obtaining a minor variance involves an application to the Committee of Adjustment by submission of an application and appropriate fee, followed by a public hearing, full consideration of the proposal, and a decision rendered.
In addition to the division of land, rights-of-way, easements and any change to your existing property boundaries also require land severance approval. It will use curriculum of fun games and challenging experiences to teach basic soccer skills such as dribbling, shooting and passing. The public can file complaints about school boards as of September 1, 2015 and municipalities and universities as of January 1, 2016. Additionally, any university that receives regular and direct government funding will now fall within the Ombudsman’s jurisdiction. If you have not already raised your complaint with a local complaint mechanism, we will refer you back to that office. The Ombudsman may consider, among other factors, the age of the complaint, if the complainant has sufficient personal interest in the subject matter, whether or not there is an alternative remedy for the complaint, if the complaint is considered frivolous or vexatious or if the matter involves a broader public policy issue. A cost minimization analysis was completed to quantify any cost savings accrued through implementation of the policy. The purpose of this audit was to evaluate the compliance with the pre-, intra-, and post-operative recommendations for antibiotic prophylaxis at a tertiary care hospital.
Agreement between PGCs determined in port and FLP blood samples was assessed by the intraclass correlation coefficient (ICC), Bland-Altman analysis and comparison of simulated dose adjustments. Wilcoxon Rank-Sum Test was used to compare duration of fever and change in serum creatinine between the two treatment groups. Although statistically significant, the change in serum creatinine in the double gram negative coverage group compared to the single coverage group was not clinically significant. Expansion of the nomogram to include patients with impaired renal function in addition to prospective evaluation of the nomogram is underway. Although it may be appropriate for a patient to be taking a high number of medications, the additional risks should be considered. The number of drugs was calculated as the number of unique drug classes a person claimed in a given year. The most commonly used drug classes were used to treat chronic conditions such as high cholesterol, high blood pressure, heart failure, and emphysema. The Memory Clinic at the Centre for Family Medicine Family Health Team is a novel, primary-care based, inter-professional clinic for patients with cognitive impairment that includes a clinical pharmacist as part of the team.
Pharmacotherapeutic interventions were necessary for most (95%) patients and consisted of discontinuing anticholinergic drugs (10%), medications without an indication (30%), untreated conditions (20%), and undertreated conditions (45%). The new assessment instrument was assembled based on content of the two lists and the addition of a Review’s Conclusion section. This component captured demographic information, preparedness and motivation levels (analyzed with descriptive statistics). Participants regularly engage in ongoing education, many possessing additional certifications. Barriers were thematized into five categories: reporter burden, professional identity, information gap, organizational factors, and fear. By analyzing the incidents involving psychotropic medications, systems based contributing factors could be identified which can inform quality improvement initiatives. A quantitative analysis was conducted to provide an overview of various trends such as the severity of outcome. A number of themes have been identified and were classified under the patient care setting where the incident occurred. Due to the voluntary nature of the Safety Reporting System, the recorded number of 38 reported events is likely an underestimation.
In order to identify challenges, process maps were developed outlining the steps in the medication reconciliation workflow.
Every landing shall have a minimum dimension measured in the direction of travel equal to the width of the stairway. Special Offer: For a 10% discount on any number of copies of the Home Reference Book purchased as a single order. He states that he carefully washed the broccoli, the oil was from a bottle he opened last week, and the pasta was from a box he had already used 2 days before.
These include undertaking research to better understand the implications of prescription drug misuse on police resources, and facilitating increased communication between police and health officials, including undertaking joint awareness and prevention campaigns.
Each initiative may offer valuable tips for others who may wish to undertake a similar initiative.
The DEA Divisional Offices provide supplies such as boxes, printed materials, vehicles, etc.
This database is available to the public approximately six weeks prior to the take back day and can also be accessed by phone for those who do not have internet access. It is hoped that this Drug Drop Day will serve as a pilot for other jurisdictions and that it will be held on a regular basis in the Niagara region.
As syringes cannot be placed in the drop boxes, bulk sharps disposal containers have been installed at each deposit location. Recreational use seems to be most prevalent among youth - according to the Centre for Addiction and Mental Health, in 2009, 20% of students in grades 7-12 reported using at least one prescription drug without a doctor's prescription.
Where a medication has been identified as a narcotic prescription, this substance shall be taken to a further examining area where the medication can be counted and recorded by the pharmacist. In addition, parties, musical programs and community events makes the Deep River Yacht and Tennis Club a fun place to be throughout the spring, summer and fall. A heated chalet with snack bar offers users a place to socialize and warm up whether enjoying the hill during the day or when night skiing. We are strictly a non-profit organization; all instructors are volunteers who, after practicing for a number of years, became qualified for teaching. We offer FREE activities for parents, caregivers and children (age 0-6) through Play to Learn Drop-In, educational workshops and parenting programs. Town staff will work with the proponents to help interpret the by-law and work through any issues that may result. Planning staff administer the site plan control by-law are available for pre-consultation with applicants.
Planning staff at the County of Renfrew are available to review the Official Plan policies and Zoning By-law provisions which will affect applications for variance or consents. The activities in which the children will participate are designed to develop motor skills, promote physical fitness and create self-confidence as well as develop listening skills. When you submit a complaint to the Ombudsman, you will be asked to provide any documentation, correspondence or other information that you have gathered which may be relevant to your complaint.
Each complaint is assessed on a case-by-case basis to determine if an investigation is warranted. Differences in dose adjustments calculated using port and FLP PGCs were clinically insignificant in the majority (88.4%) of cases. Validation in a total of 80 test patients showed that the integrated nomogram had the highest predictive success in the St. 3-hydroxy-3-methyl-glutaryl-Coenzyme A reductase inhibitors were the most commonly used drug class among seniors aged 65 to 84, while single-ingredient angiotensin-converting enzyme inhibitors were the most commonly used class among those aged 85 and over. Person-pill-days (one day where adherence was measured for one medication in one person) was calculated for each patient and a weighted paired t-test was then used to compare the levels of adherence among all subjects for the three different adherence methods. There is a paucity of literature regarding the types of PTPs that burden these patients and that may be identified and managed by a clinical pharmacist.
Qualitative analysis of introductory posts included deductive and inductive methods to identify themes. Positive facilitators were thematized into three categories: reducing reporter burden, closing the communication gap, and educating for success.
A qualitative analysis was conducted to identify recurrent themes and contributing factors. For example, in the hospital setting, the themes identified included “multiple medications”, “incorrect dose”, “incorrect patient”, “incorrect medication”, “change in order”, “transitions of care” and “dose omission”.
Although not the sole contributing factor, prescribing practices contributed to a number of these incidents. Secondly those scored with severity 5, meaning a severe or catastrophic effect should a failure of the step occur (n = 12). Galow specializes in residential construction including both new homes and repairs, renovations, and additions.
Thanks to Alan Carson and Bob Dunlop, for permission for InspectAPedia to use text excerpts from The Home Reference Book & illustrations from The Illustrated Home. All he had to drink was tap water with dinner last evening and the bottled water from this morning. The DEA is also responsible for the transportation and destruction of the collected materials at EPA approved facilities. Narcotic medications shall be placed into one of the provided Stericycle boxes and kept separate from the other medications.
Mount Martin has been operating for over 60 years with a long history of family fun, alpine racing and great social events for the whole community. Our resource library contains parenting books and videos for borrowing and our newsletter is published regularly. The County of Renfrew will respond to this inquiry with a  Planning Checklist which will identify the policies that would be considered in the review of a formal application. A minor variance does not change the existing by-law, but rather provides relief from specific requirements of the by-law to suit special circumstances, for a site-specific property. In addition there is an upstairs viewing gallery and medium sized meeting room appropriate for ballet and socials.
Compliance with recommendations was defined as appropriate antibiotic selection, dose and timing at each stage of surgery (pre-, intra- and post-operative). The acceptable targets for the lower limit of the ICC and Bland-Altman limits of agreement were ? 0.80 and ±6%, respectively.
Addition of gram negative coverage antibiotics occurred more frequently in the single coverage group. The most frequent were initiating medications (21%), a change in dose (13%), discontinuing medications or switching to alternative medications (12% each), provide patient education (12%), and enhance adherence (10%).
Participants indicated they would report medication errors more frequently if reporting were made easier and if educated about the reporting process and timely feedback. Incidents classified under these themes were further analyzed to identify potential contributing factors. Finally, risk priority number (RPN) which is calculated based on frequency, detectability and severity (n = 5). Team performance was monitored daily, posted weekly and new process improvements were implemented weekly. Carson Dunlop Associates' provides extensive home inspection education and report writing material.
If the medications are deemed to be non-narcotic, they are simply placed in another Stericycle box.
The overall compliance with antibiotic prophylaxis at University Health Network was 46.2% (n=244). Differences in simulated dose adjustments calculated using either the port or FLP samples that differed by > 20% were considered to be clinically significant. Mean percent increase in serum creatinine was 25% in the double coverage group and 10% in the single coverage group (p = 0.03). 93%, 67% and 23% of patients had a measured compliance of greater than 95% among SR, PC and eCAP methods, respectively.
Examples of contributing factors identified included complicated instructions in orders, pre-pouring of medications and the lack of a systematic medication reconciliation process. Special Offer: For a 5% discount on any number of copies of the Home Reference eBook purchased as a single order. The response will be delayed if the information required on this form is not fully completed.
Qualitative date revealed participants wanted to improve their skills to provide better patient care and to prepare them for changes in the profession, including working within an interprofessional team.

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