Big Changes through Small Steps Atlantic Note Quality Improvement Workshops

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EPIC/PHSIQuality Improvement Workshop The
Journey Ahead
Khalid Aziz November 10, 2006
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And as for teamwork
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it is clearly the journey, not the
destination, that counts
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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?

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Timelines for change summary
Site responsibilities Coordinating 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 November 2006 - Workshop Site representatives attend as learners and educators 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 February 2007 - Teleconference First regional teleconference of Site EPIC Teams 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 December 2007 - EPIC evaluation Evaluate processes and outcomes December 2007 - EPIC evaluation Evaluate processes and outcomes
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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

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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 (!)

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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

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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

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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)

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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)

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Timelines for change post-workshop

• November-December 2006 Coordinating centre
  responsibilities - Communication
• Feedback on EPIC 1 results
• Newsletter
• Teleconferences
• Recording the process nationally

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Timelines for change post-workshop

• 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

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Timelines for change post-workshop

• 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

Potential Site EPIC Team members include
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Timelines for change post-workshop

• 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

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Timelines for change post-workshop

• 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)

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Timelines for change EPIC readiness

• 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)

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Timelines for change EPIC readiness

• 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)

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Timelines for change EPIC readiness

• 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

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Timelines for change EPIC readiness

• January-February 2007 One Button Reports

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Timelines for change EPIC readiness

• January-February 2007 One Button Reports

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Timelines for change EPIC progress

• 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.

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Timelines for change EPIC evaluation

• 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

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Timelines for change summary
Site responsibilities Coordinating 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 November 2006 - Workshop Site representatives attend as learners and educators 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 February 2007 - Teleconference First regional teleconference of Site EPIC Teams 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 December 2007 - EPIC evaluation Evaluate processes and outcomes December 2007 - EPIC evaluation Evaluate processes and outcomes
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Questions???
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Early surfactant administration the Winnipeg
experience

• How can we make sure that surfactant
  administration is timely?