King Saud University Medical City

Clinical Practice Guidelines Program

PEDIATRICS Departmental Quality Team (DQT)

PEDIATRICS CPGs Departmental Committee

CPGs Implementation & Auditing

Jumada'I 1436 - March 2015KSUMC-Wide CPGs Committee – Pediatrics Departmental CPGs subCommittee

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Presented By

Dr. Yasser Sami Amer

MBBCh, MS Pedia, MS HC Inf, CPHQ

Coordinator/ Advisor, KSUMC-Wide CPG Steering Committee

Coordinator, Pediatrics DQT

Coordinator, R & D, QMD

Member, eSiHi CPOE Physicians Team

Member, G-I-N AWG, IWG, PMWG

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Evidence-Based Medicine (EBM) Movement: Not new!

865–925 Al-Razi (Rhazes)1st need for experiments, comparisons in clinical studies

981–1037 Ibn Sina (Avicenna)test effect of drugs on humans not animals only

1987 David M. Eddy, MD, PhD ‘EB’ in EBCPGs, policies in workshops, manual

1992 Gordon Guyatt, MD‘EBM’ term in JAMA

1996 David Sackett, MD

‘EBM’ definition in BMJJumada'I 1436 - March 2015

"Colofón-Libro de Medicina de Razi" by Muhammad ibn Zakariya al-Razi - Transferred from http://en.wikipedia.org/wiki/Image:Colophon-Razi's_Book_of_medicine_for_Mansur.jpg. Licensed under

Public Domain via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Colof%C3%B3n-Libro_de_Medicina_de_Razi.jpg#mediaviewer/File:Colof%C3%B3n-Libro_de_Medicina_de_Razi.jpg

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Who was the First Epidemiologist?

HIPH Alex

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The EBM Triad

Definition: (old)

“Systematically developed statements to

assist practitioner and patient decisions

about appropriate health care for specific

clinical circumstances” (IOM 1990)

Clinical Practice Guidelines (CPGs)

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CPGs New Definition

CPGs are “Statements that includeRecommendations intended tooptimize patient care that areinformed by a Systematic Review ofevidence and an assessment of thebenefits and harms of alternative careoptions”.

Committee on Standards for Developing

Trustworthy CPGs (IOM-AHRQ 2011)

KSUMC CPG PROGRAMcurrent status 2015 - 1436

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Clinical Practice Guidelines (CPGs) Program of King Saud University Hospitals/ Medical City

KSUHs Taskforce Responsible Staff from:

Clinical Practice Guidelines Steering Committee;

Quality Management Department;

Clinical Departments (CPGs Departmental

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 2014Antibiotic Prophylaxis in Surgery 11

21 KSUMC CPGs Subcommittees

1. 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 Medicine

8. 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 Medicine

21. Department of Infection Control

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New (in progress)

1. Department of Occupational Health & Safety

2. Department of Clinical Nutrition

Department of

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Guidelines International Network

(G-I-N)www.g-i-n.net

EBHC-KT Chair, King Saud University

Org. Member since 2009 (1st Member from Gulf & 3rd Member from MENA Countries)

Founded in Nov.

2002

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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KSUMC CPGS IN ALL DEPARTMENTS APPROVED BY CGC(FEB 2015 - JUMADA' I 1436)

# CPGs approved # CPGs in progress

*Pooling specialties

(reviewers)

DEM actively participated in

adaptation or review of CPGs from

other department (i.e. PED & MED)

PED the most active department in terms of adaptation,

implementation and auditing of CPGs (6 finalized, 6 in progress, 4

fully implemented, 2 with outcome results of auditing

Pediatrics

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+1 CPG

reviewed

How to access the KSUMC CPGs?

PAPER

1. CPG Binder (full document)

2. Forms (Implementation

tools)

3. Algorithm Booklet

ELECTRONIC

Online:

1. QMD website (KSU email)

2. G-I-N website (EBHCKT)

Offline: (intranet)

Desktop Icon

FUTURE:20

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CPG Binder in the Wards

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FORMS(algorithms, pathways, physician orders)

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The Clinical Algorithm Booklet

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Coloured clinical

algorithms of

four Pedia. CPGs:-

1.Acute asthma

2.DKA

3.N. Jaundice

4.FUS

Desktop Icon

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Desktop Icon

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QMD Websitehttp://medicinequality.ksu.edu.sa/

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G-I-N WEBSITE (INTERNATIONAL

GUIDELINE LIBRARY)

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Neonatal Jaundice

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Acute asthma

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DKA

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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 (Auditing) (The ‘living’ CPG concept!).

Thursday,

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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 and/ or Policy & Procedure

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) measures

8. 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. Thursday,

March 5, 2015

CPGs Implementability & Implemen.tation - Dr. Yasser Amer

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How to read the KSUMC CPGs full

documents? TABLE OF CONTENTS

Preface by authors

Acknowledgments

Abbreviations

Overview material

Introduction

Statement of intent

Scope & Purpose (Health Questions PIPOH)

Recommendations (Key & details)

External review & consensus

Plan for scheduled review & update

List of funding sources

Adaptation process methodology

Implementation considerations & Tools

References42

Health/ Clinical/ Key Questions

Patient (& disease characteristics)

Intervention(s)

Professionals (Target users)

Outcomes (purpose of the CPGs)

Healthcare settings (& context)

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2013EBCPGs: Dr. Yasser Sami Amer 43

CPG Scope: PIPOH Model

Evidence Pyramid

SR

RCT

Cohort

Case control

Case series

Case report

Expert opinion

I

II

III

IV

A

B

C

Lev

els

of

Evid

en

ce

Gra

des o

f Reco

mm

en

datio

ns

Level

Evidence

(LoE)

Grade

Recomm.

(GoR)

Strength

EVIDENCE PYRAMID

GRADE Methods

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Recommendation sample (GoR = LoE)

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Who is the contact person for EBCPGs in your department?

Head, Departmental CPG subCommittee:

Dr. Sarar Mohamed

Members, Departmental CPG subCommittee (#?)

Head, Department Quality Team:

Dr. Mohamed El-Faki

Coordinator, KSUMC-Wide CPG Steering Committee:

Dr. Yasser Amer

Medical Secretary, KSUMC-Wide CPG Steering Committee:

Ms. Dorothy Villena, Ms. Sheila Rivera

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Results of the Outcome measurement of CPGs

implementation in Pediatrics: DKA

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Results of the Outcome measurement of CPGs implementation in

Pediatrics: Severe sepsis/ septic shock in PICU

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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 three

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

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The Endocrine Society’s 97th Meeting & EXPO (ENDO 2015) March 5 – 8 2015,

San Diego, USA By Dr. Sarar Mohamed

Thank YOU all for listening

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Contact Information: Dr. Yasser Sami Amer

Emails: yasser3amer@yahoo.com; yamer@ksu.edu.sa

Mobile: +966-50-857-7246, +966-51-525-2439

Office: +966-11-46-91341