Nov. 9, 2006EPIC QI WorkshopSlide 1 EPIC/PHSI Quality Improvement Workshop: The Journey Ahead Khalid...
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Transcript of Nov. 9, 2006EPIC QI WorkshopSlide 1 EPIC/PHSI Quality Improvement Workshop: The Journey Ahead Khalid...
Nov. 9, 2006 EPIC QI Workshop Slide 1
EPIC/PHSIQuality Improvement Workshop: The
Journey Ahead
Khalid AzizNovember 10, 2006
Nov. 9, 2006 EPIC QI Workshop Slide 2
And as for teamwork … …
Nov. 9, 2006 EPIC QI Workshop Slide 3
… … it is clearly the journey, not the destination, that counts
Nov. 9, 2006 EPIC QI Workshop Slide 4
The Journey
• What happens when you get back to your centres?
• What timelines are expected?
• What tools will you have?
• What will CNN provide?
• What can your centre provide?
Nov. 9, 2006 EPIC QI Workshop Slide 5
Timelines for change: summary
Site responsibilitiesCoordinating centre
responsibilities
Pre-workshop
• Decide to join EPIC • Consider resources • Choose site representatives
• Invite and inform site representatives
• Share EPIC/PHSI goals
November 2006 - Workshop: Site representatives attend as learners and educators
Post-workshop
• Develop Site EPIC Team• Site EPIC Team chooses local
interventions, outcomes and communication strategies
• Organize EPIC sites • Facilitate interventions, data
management, and communication
EPIC readiness
• Site EPIC Team prepares for first intervention(s)
• Documentation of timelines
February 2007 - Teleconference: First regional teleconference of Site EPIC Teams
EPIC progress
• Review process outcomes• Feedback results to staff
• Facilitate review and feedback of process data
December 2007 - EPIC evaluation: Evaluate processes and outcomes
Nov. 9, 2006 EPIC QI Workshop Slide 6
Timelines for change: Pre-workshop
October-November 2006: Site responsibility – consider available resources for initial steps
• Consider centre experience
• Consider facility resources
• Consider personnel involvement
Nov. 9, 2006 EPIC QI Workshop Slide 7
Timelines for change: Pre-workshop
October-November 2006: Site responsibility – initiating involvement in EPIC/PHSI
• Decide to join EPIC
• Choose site representatives
• Ponder pre-workshop questions (!)
Nov. 9, 2006 EPIC QI Workshop Slide 8
Timelines for change: Pre-workshop
October-November 2006: EPIC coordinating centre responsibility – promoting involvement in EPIC/PHSI
• Invite site representatives
• Inform site representatives
• Share workshop objectives and rationale
Nov. 9, 2006 EPIC QI Workshop Slide 9
Timelines for change: Workshop
November 2006: Site and coordinating centre roles
• Site representatives attend workshop
• Information and idea sharing
• Promote site representatives as learners and educators
Nov. 9, 2006 EPIC QI Workshop Slide 10
Timelines for change: post-workshop
November-December 2006: Coordinating centre responsibilities
• Organize EPIC sites into regions
• Disseminate and develop existing list of interventions from previous EPIC
• Provide support for the development and dissemination of new interventions, like caffeine for CLD prevention (promoting worksheets)
Nov. 9, 2006 EPIC QI Workshop Slide 11
Timelines for change: post-workshop
November-December 2006: Coordinating centre responsibilities – Database facilitation
• Database facilitation
• Clarification of process and outcome measures
• CNN One Button Reports (Jan 2007)
Nov. 9, 2006 EPIC QI Workshop Slide 12
November-December 2006: Coordinating centre responsibilities - Communication
• Feedback on EPIC 1 results
• Newsletter
• Teleconferences
• Recording the process nationally
Timelines for change: post-workshop
Nov. 9, 2006 EPIC QI Workshop Slide 13
November-December 2006: Site responsibilities – Site EPIC Team development
• Workshop attendees and site leadership evaluate EPIC process and resources required
• Site identifies potential team members
Timelines for change: post-workshop
Nov. 9, 2006 EPIC QI Workshop Slide 14
• Data abstractor• ID consultant• Infection control nurse• Laboratory manager• Neonatologist• Nurse educator• Nurse practitioner
• Nursing team leader or frontline person
• Pharmacist• Resident physician• Respiratory therapy team
leader or frontline person• Unit administrator
Timelines for change: post-workshop
Potential Site EPIC Team members include:
Nov. 9, 2006 EPIC QI Workshop Slide 15
November-December 2006: Site responsibilities – Site EPIC Team meets and evaluates EPIC process
• Applicability to local needs
• Choose “best fit” with centre goals and priorities
• Determine order of intervention
• Determine local process outcomes
• Consider items for further or new reviews
Timelines for change: post-workshop
Nov. 9, 2006 EPIC QI Workshop Slide 16
November-December 2006: Site responsibilities – Site EPIC Team meets and plans local communication strategies
• Electronic (e-mail, website, newsletter)
• Group education (education day, inservice)
• Visual (control charts, poster, newsletter)
• Administrative (policy change, passive methods)
• Interactive (focus groups, bedside teaching)
Timelines for change: post-workshop
Nov. 9, 2006 EPIC QI Workshop Slide 17
January-February 2007: Site responsibilities – Site EPIC Teams prepare for and initiate first intervention
• Interventions selected (eg earlier use of surfactant in delivery room, or starting TPN within 4 hours of birth)
• Process outcome selected (eg times of first surfactant dose)
• Staff made aware of nature of and rationale for intervention
• Documentation and abstraction issues clarified
• (One button reporting functioning – baseline data collected)
Timelines for change: EPIC readiness
Nov. 9, 2006 EPIC QI Workshop Slide 18
January-February 2007: Site and coordinating centre responsibility – Regional Site EPIC Teams hold teleconferences to compare progress and share barriers and facilitators to the EPIC process
• Share interventions selected• Share process outcome measures• Share communications strategies• Share documentation and abstraction strategies• Feedback to coordinating centre support needs (eg CNN
database requirements)
Timelines for change: EPIC readiness
Nov. 9, 2006 EPIC QI Workshop Slide 19
January-February 2007: Coordinating centre responsibility – facilitate initiation of first EPIC interventions
• Finalize One Button Reports for use in control charts
• Troubleshoot barriers to EPIC readiness in selected centres
• Develop national communication strategy (website, newsletter)
• Document progress in each centre (as well as nature and timing of interventions)
• Feedback centre needs into CNN database infrastructure
Timelines for change: EPIC readiness
Nov. 9, 2006 EPIC QI Workshop Slide 20
January-February 2007: “One Button Reports”
Timelines for change: EPIC readiness
Nov. 9, 2006 EPIC QI Workshop Slide 21
January-February 2007: “One Button Reports”
Timelines for change: EPIC readiness
Nov. 9, 2006 EPIC QI Workshop Slide 22
March-April 2007: EPIC sites review feedback from first 3 months of interventions
• Evaluate effect of intervention(s) on process outcome(s) (eg trend of timing to first surfactant dose)
• Feedback process outcome(s) to staff in NICU and to coordinating centre
• Reinforce intervention(s) as necessary or consider other interventions.
Timelines for change: EPIC progress
Nov. 9, 2006 EPIC QI Workshop Slide 23
December 2007: Coordinating centre evaluates EPIC/PHSI
• Summarise interventions and timelines for each centre
• Summarise effects on process outcomes (eg time to first dose of surfactant)
• Initiate analysis of clinical outcomes (nosocomial infection rates and chronic lung disease)
• Revise functionality of CNN database based on feedback from EPIC sites
Timelines for change: EPIC evaluation
Nov. 9, 2006 EPIC QI Workshop Slide 24
Timelines for change: summary
Site responsibilitiesCoordinating centre
responsibilities
Pre-workshop
• Decide to join EPIC • Consider resources • Choose site representatives
• Invite and inform site representatives
• Share EPIC/PHSI goals
November 2006 - Workshop: Site representatives attend as learners and educators
Post-workshop
• Develop Site EPIC Team• Site EPIC Team chooses local
interventions, outcomes and communication strategies
• Organize EPIC sites • Facilitate interventions, data
management, and communication
EPIC readiness
• Site EPIC Team prepares for first intervention(s)
• Documentation of timelines
February 2007 - Teleconference: First regional teleconference of Site EPIC Teams
EPIC progress
• Review process outcomes• Feedback results to staff
• Facilitate review and feedback of process data
December 2007 - EPIC evaluation: Evaluate processes and outcomes
Nov. 9, 2006 EPIC QI Workshop Slide 25
Questions???
Nov. 9, 2006 EPIC QI Workshop Slide 26
Early surfactant administration: the Winnipeg experience
How can we make sure that surfactant administration is timely?