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


And as for teamwork … …


… … it is clearly the journey, not the destination, that counts


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?


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


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



October-November 2006: Site responsibility – initiating involvement in EPIC/PHSI

• Decide to join EPIC

• Choose site representatives

• Ponder pre-workshop questions (!)



October-November 2006: EPIC coordinating centre responsibility – promoting involvement in EPIC/PHSI

• Invite site representatives

• Inform site representatives

• Share workshop objectives and rationale


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


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)



November-December 2006: Coordinating centre responsibilities – Database facilitation

• Database facilitation

• Clarification of process and outcome measures

• CNN One Button Reports (Jan 2007)


November-December 2006: Coordinating centre responsibilities - Communication

• Feedback on EPIC 1 results

• Newsletter

• Teleconferences

• Recording the process nationally



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



• 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:


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



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)



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


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)



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



January-February 2007: “One Button Reports”



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


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


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


Questions???


Early surfactant administration: the Winnipeg experience

How can we make sure that surfactant administration is timely?

Nov. 9, 2006EPIC QI WorkshopSlide 1 EPIC/PHSI Quality Improvement Workshop: The Journey Ahead Khalid...

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