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EPIC/PHSI Quality Improvement Workshop: The Journey Ahead

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EPIC/PHSI Quality Improvement Workshop: The Journey Ahead Khalid Aziz November 10, 2006 The Journey What happens when you get back to your centres? – PowerPoint PPT presentation

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Title: EPIC/PHSI Quality Improvement Workshop: The Journey Ahead


1
EPIC/PHSI Quality Improvement Workshop The
Journey Ahead
Khalid Aziz November 10, 2006
2
And as for teamwork
3
it is clearly the journey, not the
destination, that counts
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?

5
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
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

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 (!)

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

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

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)

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)

12
Timelines for change post-workshop
  • November-December 2006 Coordinating centre
    responsibilities - Communication
  • Feedback on EPIC 1 results
  • Newsletter
  • Teleconferences
  • Recording the process nationally

13
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

14
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
15
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

16
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)

17
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)

18
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)

19
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

20
Timelines for change EPIC readiness
  • January-February 2007 One Button Reports

21
Timelines for change EPIC readiness
  • January-February 2007 One Button Reports

22
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.

23
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

24
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
25
Questions???
26
Early surfactant administration the Winnipeg
experience
  • How can we make sure that surfactant
    administration is timely?
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