Post on 21-Jan-2017
بســـــم الله الرحمـــــن الرحـــــيم
In the name of Allah. Most Gracious, Most Merciful
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Evidence-Based Clinical Practice Guidelines (CPGs)
Adaptation & Implementation in Hospitals of Two
Universities in MENA
Presented ByDr. Yasser Sami Amer, MBBCh, MS
MS Pediatrics, MS Healthcare InformaticsHospital CPGs Advisor, EBRU, QMD KSUMC
General Coordinator, Hospital-Wide CPG CommitteeMember, G-I-N Adaptation WG steering grou
From Alexandria University Hospitals in Egypt to King Saud University in
Saudi Arabia
1999
2006
2004
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First Postgraduate Master thesis in [Clinical Practice Guidelines Adaptation & Implementation]
in Alexandria University Faculty of Medicine, Egypt
Alexandria University HospitalsHealthcare Quality Directorate
Center for Evidence-Based Clinical Practice Guidelines
(AUH – HCQD, CEBCPGs)(Founded Nov. 2008)
http://www.med.alexu.edu.eg/cebcpgs/ Member of Guidelines International Network
(G-I-N)(Since May 2009)
2005• It all started with a• VISION…….. a DREAM !
2007• Then a Thesis
2008• Then a Foundation………• A Reality ! ………..CEBCPGs
History of the Center
IS THE SECOND MEMBER OF G-I-N FROM THE MIDDLE EAST, ARAB & AFRICAN COUNTRIES;
AFTER SUDAN EVIDENCE-BASED ASSOCIATION (SEA) SINCE 2009.
(ACCORDING TO G-I-N ANNUAL REPORT 2009)
Founding Members 2008• Prof. Dr. Mahmoud Elzalabany• Prof. Dr. Tarek Omar• Prof. Dr. Nabil Dowidar• Prof. Dr. Afaf Ibrahim• Dr. Yasser S. Amer• Dr. Hossam Ashour• Eng. Ahmed Mourady
First Workshop in Egypt: Adaptation of CPGs2009 (AFM-GIN-ADAPTE)
*12 M.Sc. Theses plus 1 Ph.D. thesis to produce 13 Adapted EBCPGs
4 Finalized Adapted CPGs by CEBCPGs, HCQD-AUHs through MSc Theses (till 3/2012) in PEDIATRICS DEPT.:1- Treatment of Acute Childhood Asthma in ER - AUCH: Dr. Yasser Sami Amer (Finalized, Approved , Disseminated & Implemented).2- Treatment of Positioning & Attachment Breast Feeding Problems in BFCC - AUCH: Dr. Georgina Ramsis (Finalized & Approved).3- Triage and Acuity Scale in A & E Dept., AMUH: Dr. Mary Christeen Nabiel Sharobeem (Finalized, Approved & Disseminated ) – the only thesis outside the Pediatrics Dept.4- Treatment of HIE in Neonates in NICU: Dr. Walid Gamal AbdelKhaliq (Finalized & Approved).5- Treatment of ADHD in children in AUCH: Dr. Mariana Iskander Amin (Finalized & Approved).6-Management of Acute Bacterial Meningitis in AUCH: Dr Mariam Adly (Finalized & Approved).9 Adapted CPGs in progress by Pediatrics Dept. & CEBCPGs, HCQD-AUHs through MSc/PhD Theses (till 8/2012):1. Diagnosis of acute attack of seizures in AUCH: Dr. Soheir Farouk AbdelSalam
(Finalization Phase).2. Treatment of acute attack of seizures in AUCH : Dr. Islam Yousry A.Moneium (Set Up
Phase).3. Management of Epilepsy in children in AUCH: Dr. Shimaa Anwar (Set Up Phase)4. Treatment of Childhood Autism in AUCH: Dr. Farioz Ibrahim (Finalization Phase).5. Treatment of Chronic Asthma in AUCH: Dr. Reem Galal Ghazal (Finalization Phase).6. Treatment of Community Acquired Pneumonia in AUCH: Dr. Zobaida Eltazmany
(Finalization Phase).7. Treatment of Allergic Rhinitis in AUCH: Dr. Shahinaz (Set Up Phase).
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WHO Patient Safety Friendly Hospital Initiative in the Eastern Mediterranean Region
Alexandria University Children’s Hospital
G-I-N 2009 Lisbon
G-I-N 2012 Berlin
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“The Adapted ADAPTE Process for CPGs Adaptation”
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3 New Tools3 Modified Tools
For the Guideline Adaptation: A Resource Toolkit Version 2.0
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http://qualitysafety.bmj.com/content/22/Suppl_1/43.1.abstract?sid=302fcfca-c444-4bd3-a295-c75c811b7d49 (last cited 7/6/2014 in BMJ Quality & Safety)
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Evidence-Based Clinical Practice
Guidelines (CPGs)Adaptation &
Implementation Program Launching CPGs Implementation
in King Saud University Medical City
(KSUMC) Presented ByDr. Yasser Sami Amer, MBBCh, MS
MS Pediatrics, MS Healthcare InformaticsHospital CPGs Advisor, EBRU, QMD KSUMC
General Coordinator, Hospital-Wide CPG CommitteeMember, G-I-N Adaptation WG steering grou
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KSUMC CPG PROGRAMcurrent status 2013 – 2014
Antibiotic Prophylaxis in Surgery 34
Clinical Practice Guidelines (CPGs) Program of King Saud University Hospitals/ Medical City
KSUHs Taskforce Responsible Staff from:Clinical Practice Guidelines Committee;Quality Management Department;Clinical Departments (CPGs subcommittees);Shaikh Abdullah Bahamdan Research Chair for Evidence-
Based Health Care and Knowledge Translation;Top Management & Leadership of College of Medicine
and University Hospitals (Future KSU Medical City)
09 JAN 2014
CPG Program Relations (integration)
HOSPITAL-WIDE CLINICAL PRACTICE GUIDELINES COMMITTEE (July 2009)
QT
EBHC-KT
QMD
KSUMC CPGs Program
Guidelines International Network (G-I-N)www.g-i-n.net
EBHC-KT Chair, King Saud UniversityOrg. Member since 2009
(1st Member from Gulf & 3rd Member from MENA Countries)
Founded in Nov. 2002
KSUMC CPGs in Numbers Hospital-Wide CPG Committee Members: 27 Departments participating in CPG Program: 21 Health topics identified for CPG projects: 53 CPG adaptation projects finalized: 33 CPGs finalized & approved by CPG Committee: 19 CPGs finalized & implemented: 17 CPGs uploaded to QM website & relevant desktop in points of
care: 17 CPGs implemented & audited (data collected): 8 CPGs implemented & audited (data analyzed): 3
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Who is the contact person for EBCPGs in your department?
Head, Department CPG Subcommittee Members, Department CPG Subcommittee Department Quality Focus teams (former
Accreditation teams) Hospital CPG Advisor and CPG Committee General
Coordinator Medical Secretary, Hospital CPG Committee
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Pediatrics
+1 CPG reviewed
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Critical Care (ICU)
+1 CPG reviewed
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Medicine
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Psychiatry
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Pharmacy (Drug Info Center)
+16 CPG reviewed
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Ophthalmology
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Orthopedics
+1 CPG reviewed
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Otorhinolaryngology (ENT)
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Obstetrics & Gynecology
+2 CPG reviewed
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Surgery
+1 CPG reviewed
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Nursing
+3 CPG reviewed
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PCC (Family Medicine)
+6 CPG reviewed
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Anesthesiology
+1 CPG reviewed
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Emergency Medicine
+10 CPG reviewed
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Dermatology
Examples of KSUMC Clinical Practice Guideline Adaptation
& Implementation Projects
presented and/or published in International Conferences AND
National Events
The adapted CPG for Management of Diabetic Ketoacidosis in children from the Department
of Pediatrics• Presented by Dr. Sara Mohamed, Associate Professor &
Consultant of Pediatric Endocrinology & Metabolism and Head of Pediatrics CPGs Subcommittee presented in two international conferences:-1. American Endocrine Society Conference, San
Francisco, USA. CPG: challenges and opportunities in 14/6/2013 ENDO 2013 15-18/6.
2. European society of pediatric endocrinology conference, Milan, Italy in 20/9/2013 – DKA Guidelines: Saudi Experience.
Featured Poster Presentation Number: FP32-6 Poster Board Number: MON-282https://endo.confex.com/endo/2013endo/webprogram/Paper6468.html
A
DISCLOSURES: Nothing to disclose
Development and implementation of Clinical Practice Guidelines in Pediatric Endocrinology: Challenges and opportunities
Sarar Mohamed, Hala Omer, Nasir Al Jurryaan, Amir Babiker, Hessah Al-Otibi, Rana Hasanato, Shaikh Iqbal ,Mohamed Elfaki Osman, Nouf Alkhemis, Ali Abdo, Abdulrahman Al-NemriDepartment of Pediatrics & Chemistry, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
The adapted CPG for Management of Bipolar Disorder from the Department of Psychiatry
•Presented by Dr. Yasser Amer, AND Professor Lubna Al-Ansary presented in 10th International Guidelines International Network (G-I-N) Conference in San Francisco, USA in 18-21 August 2013 and presented the KSUMC CPG Program activities in the G-I-N Adaptation Working Group Meeting in SF, USA
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G-I-N 2013 San Francisco
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The Adapted CPG FOR Central Vascular Access Device (CVAD) FROM THE NURSING DEPARTMENT
Featured in the E-VAN May 2014 issue (Electronic Newsletter of AVA) by Ms Maan Ciocson.
Publication in JAVA (in progress) by the CPG Adaptation working group.
National Representation
• 15-16/5/2013: Active participation in ‘Developing Strategic Vision
for Saudi Center for Evidence-Based Health Care,
Ministry Of Health workshop, Riyadh, KSA
•KSU College of Medicine & University Hospitals Representatives
were Professor Lubna Al-Ansary, Dr. Ayman Abdo, Dr. Yasser S. Amer
and Ms. Nada Alkhamis )
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PART I
EBM?....EBP?...CPG?
Evidence-Based Clinical Practice
GuidelinesConcepts & Definitions
Two Different Approaches to Evidence-Based Practice Clinical Practice Guidelines (CPGs)
•“Top-down” approach• Tell clinicians how to practice• Favored by health care systems
Evidence-Based Medicine (EBM)•“Bottom-up” approach• Teach clinicians how to find answers• Favored by medical educators
EBP definitionThe integration of best
research evidence with clinical expertise and patient valuesSackett et al 2000
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Evidence-to-practice process
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Knowledge Translation
Implementation research
System/ Provider and Quality Improvement
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Evidence-to-Practice
Clinical Care GAP
Current Practice
Best Practice
Clinical Care GapCPGs
Decrease
Practice
variation
Informed clinical decision making
Implementation ScienceKnowledgeTranslation
Quality/
Performance
Improvement
Patient Safety/
Care &
Satisfaction
09 JAN 2014
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What is “EBM” NOT?• What we have always done !;
(not old hat or just the same old medical practice; as evidenced in wide practice variation)
• “Cookbook Medicine”!EBM specifically advocates for individualized application of evidence to patient care, not forcing patient care to conform to generalized evidence
• Only a cost-cutting trick !;it is intended to guide practitioners to provide the best, not necessarily the cheapest, care.
• Only RCTs !;(Also with best relevant evidence applicable to the situation in question)
– EBM is tracking down the best external evidence from scientific research to answer our clinical question(s)…
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Definition: (old)“Systematically developed statements to assist
practitioner and patient decisions about appropriate health care for specific clinical circumstances” (IOM 1990).
Increasing international interest in the development and implementation of CPGs.
Clinical Practice Guidelines (CPGs)
CPGs New Definition
CPGs are “Statements that include Recommendations intended to optimize patient care that are informed by a Systematic Review of evidence and an assessment of the benefits and harms of alternative care options”.Committee on Standards for Developing Trustworthy CPGs (IOM-AHRQ 2011)
Why do we n
eed
CPGs?
Rationale for CPGs•Worldwide concerns about: ▫Unexplained variations in clinical
practice▫Rising health care costs▫Exponential growth of information
• Aim of Clinical Practice Guidelines:▫To facilitate more consistent, effective and efficient
practice and improve health outcomes for patients
Who needs
CPGs?
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Stakeholders (TEAM)•Physicians•Nurses•Pharmacists•Decision makers•Patients•Public
19th March 2013
How do w
e rea
ct to
CPGs?
Read
AdoptAdapt
Develop
CPGs ?
Different Options to deal with CPG
Adoption
Adaptation
Rejection
Process/ Methods
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Adaptation of CPGsIs the systematic approach to the endorsement
and/or modification of a guideline(s) produced in one cultural and organizational setting for application in a different context. Adaptation may be used as an alternative to de novo guideline development, e.g., for customizing (an) existing guideline(s) to suit the local context.
http://www.adapte.org/http://www.g-i-n.net/
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Hospital-Wide Policy & Procedure for Hospital CPGs Adaptation
SEPT 2013
NEW
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Team - TopicTotal Number of Health Topics for CPGs from all departments
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Selecting a CPG Topic Prevalence of the condition (high volume) Patient safety concern (high risk) Under-, over-, misuse of intervention(s) Burden due to the condition Practice variation Costs of different practice options Likelihood of effectiveness of CPG Potential for improving quality of care and/or
outcomes Existence of relevant good quality CPGs
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21 KSUMC CPGs Subcommittees1. Department of Pediatrics 2. Department of Critical Care 3. Department of Psychiatry 4. Primary Care/ Family Medicine Clinics
(Ambulatory Care Services) 5. Department of Pharmacy 6. Department of Emergency Medicine 7. Department of Medicine8. Department of Orthopedic Surgery 9. Department of Otorhinolaryngology 10. Department of Ophthalmology 11. Department of Cardiac Sciences/ KFCC
(Cardiology – Cardiac Surgery) 12. Department of Surgery 13. Department of Obstetrics & Gynecology 14. Department of Dermatology 15. Department of Anesthesiology 16. Department of Laboratory Medicine &
Pathology 17. Department of Nursing
18. Department of Radiology 19. Health Education Center 20. Department of Rehabilitation Medicine21. Department of Infection Control
New (in progress)1. Department of Occupational Health & Safety2. Department of Clinical Nutrition
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Health/ Clinical/ Key QuestionsPatient (& disease characteristics)
Intervention(s)
Professionals (Target users)
Outcomes (purpose of the CPGs)
Healthcare settings (& context)
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CPG Scope: PIPOH Model
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Health Question Tool (modif.)
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Inclusion / Exclusion CPGs Selection Criteria (6)
1. Methods of Development: Evidence-Based CPGs: (Detailed Methodology not Consensus-based CPGs (Expert opinion)
2. Author(s): Organization and Specialized Society not single authors.
3. Country: International not national CPGs.4. Date of Publication: range of year of
publications: last 5 years or less (e.g. 2010 – 2014) – except if none!
5. Language: English CPGs only6. Status: only Original source CPG (de novo
developed) rather than adapted CPGs
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CPG selection criteria Tool (new)
CPGs on the Web
CPGs on the Web
Producers Finders
Guideline Producers• Specialized societies
• National agencies NICE SIGN
Organization NameCountry
URL Producer
Finder FREE PAID
Guidelines International Network (G-I-N) Int’l http://www.g-i-n.net F √ √
World Health Organization (WHO) Int’l http://www.who.int/topics P √
National Institute for Health & Clinical Excellence (NICE) UK http://www.nice.org.uk/page.aspx?
o=ourguidance P √ √
Scottish Intercollegiate Guidelines Network (SIGN) Scotland http://www.sign.ac.uk/guidelines/
index.html P √
New Zealand Guideline Group (NZGG) NZ http://www.nzgg.org.nz P √Registered Nurses Association of Ontario (RNAO) Canada http://www.rnao.org P √
National Guidelines Clearinghouse (NGC) USA http://www.guidelines.gov F √
US National Library of Medicine, National Institutes of Health (PubMed)
USAhttp://www.ncbi.nlm.nih.gov/
pubmedOR http://www.pubmed.gov
F√
(Abstracts)
√(Full
Text)
Institute for Clinical Systems Improvement (ICSI) USA http://www.icsi.org/knowledge/ P √
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AAP CPGs
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ACP CPGs
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NKF CPGs
CPG Producers:National Agencies
NICENational Institute for Health & Clinical Excellencewww.nice.org.uk
SIGNScottish Intercollegiate Guidelines Networkwww.sign.ac.uk
CPG Producers:National Agencies
Shaikh Bahamdan’s Research Chair for Evidence-Based Health Care & Knowledge Translation
Member of G-I-N since Oct. 2009Free access to International CPG Library of G-I-N
http://ebhc.ksu.edu.sa/gin/index.html
CPG Finders
PubMedUS National Library of
MedicineNational Institutes of
Health (NIH)
EVIDENCE PYRAMID ?
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EBCPGs: Dr. Yasser Sami Amer 12119th March 2013
Evidence Pyramid
SR
RCT
Cohort
Case control
Case series
Case report
Expert opinion
I
II
III
IV
A
B
CLeve
ls o
f Evi
denc
eG
rades of Recom
mendations
LevelEvidence
GradeRecomm.
Strength
EVIDENCE PYRAMID
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CPG-ICU-002 (VTE) 2013
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HWCPG-ENT-001 (ABRS) 2013
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HWCPG-PHARM-001 (Vanco)
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How to assess of the quality of any CPG?
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Assess guideline quality
ADAPTE TOOL 9 AGREE II Instrument
23 items in 6 domains 7 point response scale Domain scores Recommendations
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AGREE II 6 DomainsDOMAINS
1 Scope & Purpose2 Stakeholder
Involvement3 Rigour of Development
(Methods)4 Clarity & Presentation5 Applicability6 Editorial Independence
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The concept of the ‘LIVING’ CPG
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End of Finalization Phase1. CPG Subcommittee submit finalized CPG draft to
Evidence Base & Research Unit, Quality Management Department for review;
2. Submit to Hospital-wide CPG Committee for review of adaptation process methodology and final approval;
3. Congratulations letter to Chairman of department4. Start dissemination and implementation in
relevant departments;5. Follow up, clinical auditing & measurement in
relevant departments;
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Dissemination & Implementation
Nothing could be more frustrating than producing a CPG that is then ignored by not being disseminated
nor implemented
19th March 2013
BREAK
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PART II
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CPGsImplementation
Strategies & Tools
CPG Implementation• “The concrete activities and
interventions undertaken to turn policies into desired results“
Guidelines for clinical practice: from development to use. IOM, 1992
CPGs Practice
CPG Implementation Failure….WHY?
Extrinsic to CPG: provider-specific & care system-related
Intrinsic to CPG: ambiguity – inconsistency - incompleteness
Facilitators: QuestionsFrom your experience, what are
the most important factors that facilitate CPGs implementation?
Individual Positive attitude
Learning through small group interaction
Organizational Leadership support
Champions Team work collaboration
Environmental Professional association
support Inter-organizational collaboration networks
Facilitators
Implementability• Set of characteristics that PREDICT
the relative ease of implementation of CPG recommendations.
Implementability…….BEFORE implementation
How to Measure Implementability?
Ease and accuracy of translation of guideline advice into systems that influence care.
GLIA TOOLRichard N. Shiffman, MD, MCIS
Yale Center for Medical Informatics, Yale University
2005 - 2011
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SIGN is customizing implementation support to every CPG. Ali El-Ghorr et
al
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CPG implementation strategies
Dissemination Process (print/ e-/website)Local Clinical Champions.Awareness raising/ training activities.Networking and linking with existing
projects (e.g. Dept. Clinical Rounds, CPD/CME activities, Accreditation, etc..).
Patients as champions for change.Regular M & E (The ‘living’ CPG concept!).
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Dissemination process (1st TOOLS!!!)
• I- PRINTED MATERIAL (booklets, brochures, cards, CPG binders in some nursing stations, etc..)
• II- ELECTRONIC MATERIAL: (a) Full CPG copies (PDF files) on desktop of PCs in the following points of care:
• outpatient clinics (ambulatory)• nursing stations in the inpatient wards• nursing stations in the DEM• Pharmacy
(b) The QM website (KSU email log in)
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Local Clinical ChampionsClinical quality champions must be known within the organization & community as both promoting and delivering best practices (EBP) with their patients.Strategic leadership. The Healthcare Quality Handbook. JB. 26th Ed. 2011/2012
CPG Implementation Tools
:: Evidence to practice/ knowledge to action cycle
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Adapt/ design CPG implementation tools available at the point of care (* MR)
TYPES1. Clinical Algorithm.2. Integrated Care/ Clinical Pathways*.3. Protocol.4. Chart Documentation/ checklists/ forms (e.g. Physician Order Sets* later
CPOE/eSIHI).5. Quick Reference Guides/ Physician Guides & Pocket Guide/Reference Cards (at-
a-glance summary of key recommendations 5 or 1-2 pages).6. Clinical audit criteria (tool)7. Quality (outcome/performance) measures8. Slide Presentation.9. Wall Poster.10.Patient Resources/ Information (health education guides).11.Foreign language Translation (Non-English, Non-Arabic).12.Implementation Tool Kits (collections of tools and/or strategies).13.Staff Training/ Competency Material.
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Clinical algorithm• A diagram of the guideline
recommendations presented as a step-by-step decision-tree
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Clinical PathwaysSyns.: Integrated Care Pathways, Multidisciplinary pathways of care, Pathways of Care, Care Maps,
Collaborative Care Pathways.• Definition: structured, multidisciplinary care
plans designed to support …………………(3)1. implementation of CPGs and protocols.2. clinical management, clinical and non-clinical resource
management, clinical audit & financial management.3. detailed guidance for each stage in the management of a
patient with a specific condition over a given time period, including progress and outcomes.
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Care pathways differ from CPGs, protocols and algorithms as they are utilized by a multidisciplinary team and have a focus on the quality and care co-ordination.
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Pathways’ Four main Components:
1. Timeline.2. Categories of care or activities and
their interventions.3. Intermediate and long term outcome
criteria.4. Variance record (to allow deviations to
be documented and analyzed).
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Benefits1. Support the introduction of EBM and use of
CPGs.2. Support clinical effectiveness, risk management
and clinical audit.3. Improve multidisciplinary communication,
teamwork and care planning.4. Can support continuity and co-ordination of care
across different clinical disciplines and sectors.5. Provide well-defined standards for care.
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Benefits (cont’d)
6. Help reduce variations in patient care (by promoting standardization).7. Help improve clinical outcomes.8. Help improve and even reduce patient documentation.9. Support training.10. Optimize the management of resources.11. Does not override clinical judgment.
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Differences between
Clinical Algorithm Clinical Care Pathway Decision – making. Coordinating Care.
Series of questions that guide designing sequence of steps.
Goal statement that guide key elements of care, roles and sequence of activities
Generic; applicable to all patients Individualized; may be designed for individual patient (integrated care plan)
Not time-related Time-related; hours in ED, days in acute care, weeks in chronic and home care.
Staff not mentioned clearly Usually multi-disciplinary staff and should be mentioned in the care plan
Systematic actions Systematic actions
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Differences between
Clinical Algorithm Clinical Care Pathway Not outcome-related (does not
include standards or outcome of care)
Outcome-related (includes standards or outcome of care)
Only clinical processes Clinical & non-clinical processes
Maps Maps
Does not include order or priorities Includes order and priorities
Includes continuous feedback through tracking and analysing variance
Includes continuous feedback through tracking and analysing variance
No details of treatment Includes details of treatment
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Standard Order Sets/ Standing Orders
Collection of medical orders in a pre-filled ordering paper template forms or in a computerized physician/provider order entry system (CPOE) for a selected group of patients throughout the different disciplines and it is usually based on EBCPGs to standardize diagnosis and treatment.
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Two types are currently identified in KSUMC:-1) Expert/ Consensus-based order sets: these
forms are result of the collaboration of one or more clinical departments and would require careful review and clinical expertise.
2) Evidence-Based order sets (Systematic Methodology): these forms are based on hospital adapted CPGs that were officially approved by the hospital CPGs committee (refer to HWQPP – 010)
Computerized Provider Order Entry (e-SIHI)IN PROGRESS!
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HWQPP – Standing orders development, revision & deletion (2014)
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Computerized Physician Order
Entry (CPOE)And Medication Errors!
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Current Hospital Info. System (2 icons)
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Current Hospital IS (2 icons) (cont’d)
1. KKUH – Lab Access System2. Centricity Web –PACS
Not comprehensive HIS or EMR!Not supporting CPOE!
Physicians order Ix in “paper forms” and Lab & Radio staff encode results.
Physicians order Rx in “paper” physician orders.Unclear illegible hand-writing of doctors.Paper request forms sometimes get lost or
damaged.Patient safety implications.
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With or without Clinical Decision Support (CDS)
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SOLUTION• New HIS (e-SIHI) project supports CPOE.• Physician Build team assigned to build CPOEs
in collaboration with Lab., Pharm & Nursing.• CPOEs (order sets) based on hospital
approved adapted Evidence-based CPGs.
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Expected benefits of HIS w. CPOE
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Expected benefits of HIS with CPOE
1. Reduce Medication Errors (patient safety)2. Serve as a reminder for busy clinicians (education)3. Clinical decision support during data entry
(Evidence-Based CPGs)4. Reduce time (save seconds/ mouse clicks): more
time spent with patients??5. Improve tracking & record keeping6. Improve communication & integration of patient
information.
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Protocol• What is the difference between a "clinical guideline," "practice
parameter," and "standard"?• The phrases "protocol," "practice parameter," "pathway,"
"standard," "consensus statement," etc., are used in many different contexts and may not necessarily be a clinical practice guideline.
• Clinical protocols are more specific than CPGs, defined in greater detail; provide a comprehensive set of rigid criteria outlining the management steps for a single clinical condition or aspect of organization"
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Audit Criteria/ indicators & Quality Measures
• Systematically developed statements that can be used to assess the appropriateness of specific healthcare decisions, services, structure, performance, and outcomes
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Some Examples of currently monitored indicators for year 2013-14
• Structure Indicators (2)• Clinical documentation• Performance Indicators (4)• Length of stay• Outcome indicators (18)• Medication error• Adverse drug reaction• Mortality rate• Morbidity rate•Other clinical audit criteria have been identified special to some CPGs topics
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Patient information
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Launching CPG pilot implementation Timeframe: ……… Months
Starting date: …./ …../ ……… Monitoring & Evaluation Checkpoint #1:
• TEAM (Taskforce) Essentially everyone is a
• “CPG Champion” Physicians Nurses Pharmacists Technicians Allied HC professionals Others
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Identify & Prioritize Key recommendations & outcomes
• # 1 …………………………………………………………………………………………………………….• # 2 ……………………………………………………………………………………………………………..• # 3
……………………………………………………………………………………………………………….
Identify Implementation Barriers
I. Who? Key stakeholder analysis [each…….Influence × Support: HIGH/LOW]
II. Other barriers? (e.g. equipment, medications, workflows,….etc.)
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Action plan• Timeframe: (e.g. 3 Mo., 6 Mo., 1 Yr.)• Identify targets:
• Primary: e.g. patients/clients• Secondary: e.g. Doctors, Nurses,…..etc.Strategies Short term plan Long term plan
FEB10/2
MAR APR15/4
MAY JUN JUL AUG SEP OCT
NOV DEC
• Prepare/ finalize imp. Tools (paper & E-) Final
Survey 2nd Cycle of AC
• Awareness campaignTop management/ Dept. Chair + clinical championsIT ( screens/desktops)
• Education campaign (target users, clients and carers)
• Dissemination (Formats: paper/ E-)
• Other Implementation initiatives
• System of care (change needed)
• Evaluation: M & E (Clinical Audit)
• Sustainability
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PART III
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2nd Accreditation Canada Cycle 2014
Together We did it !
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Thank YOU all for listening
Contact Information: Dr. Yasser Sami AmerEmails: yasser3amer@yahoo.com; yamer@ksu.edu.saMobile: +966-50-857-7246, +966-51-525-2439Office: +966-11-46-91341