Title of presentation How to include the patient ideas but still deliver ...
Transcript of Title of presentation How to include the patient ideas but still deliver ...
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latrobe.edu.au CRICOS Provider 00115M
Title of presentation Name of presenter Title of presenter School / Faculty / Division
xx Month 201x
How to include the patient ideas but still deliver best practice with wound care ? Assoc Prof Bill McGuiness PhD, RN, FAWMA Head of School School of Nursing & Midwifery College of Science, Health & Engineering [email protected]
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2 La Trobe University
Outline
• Patient centered care
• Evidenced based practice
• Interfacing both models of care
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3 La Trobe University
Evidenced based practice (EBP)
the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”
(Sackett D, 1996)
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4 La Trobe University
EBP elements
Population based Normal distribution
Ranking of rigor Levels of evidence
Strength of evidence Plan health care resources
Quality & resources
Science of practice
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5 La Trobe University
The rise of the clinical guideline
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6 La Trobe University
Criticism of EBP
‘Cook book’ care Stereotyping
Promotes a hierarchy of care
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7 La Trobe University
Patient centered care (PCC)
Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions (Institute on Medicine. "Crossing the Quality Chasm: A New Health System for the 21st Century” 2011)
“Cultural competence is the delivery of health services that acknowledges and understands cultural diversity in the clinical setting and respects individuals' health beliefs, values, and behaviors.” (HasnainWynia Romana 2006)
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8 La Trobe University
Aspects of PCC
Individual based Collaboration & respect
Art of practice Caring
Clinician experience, attitude and creativity
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9 La Trobe University
Criticism of PCC
Tokenism Hospital hotel
Focus on e-health
Can’t be resourced
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How do we combine the principles of evidence based care with
patient centered care
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Start with yourself
Who owns the
health concern
How do I respond
when the patient
rejects my advice
What are my
personal biases or
prejudices How creative am I
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Establish a collaborative relationship with the patient
What does the
patient want
What is the
patients motivation
How is the patient
getting their
information &
support
What resources
does the patient
have available
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Where is the best location for the care ?
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Travel time: 20 mins Wait time: 15 mins Consult time: 10 mins
Referral time: 2 wks Travel time: 30 mins Wait time: 20 mins Consult time: 20 mins
Referral time: 6 wks Travel time: 90 mins Wait time: 35 mins Consult time: 10 mins
Referral time: 4 weeks Travel time: 30 mins Wait time: 30 mins Consult time: 20 mins
An example – Centre of care
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Dear Dr
I have a saw
leg
Response time: 2 hrs E-Consult time: 30 mins
Referral time: 0 wks Travel time: 0 mins Wait time: 0 mins Consult time: 0 mins
Response time: 3 hours Travel time: 0 mins Wait time: 0 mins Consult time: 10 mins
3D printing time: 3 hrs Travel time: 0 mins Wait time: 2 days Consult time: 0 mins
E-technology options
EWMA/AWMA position paper
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16 La Trobe University
Alternative care locations
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Culture of the care setting
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“You did what with the #@* bandage”
Clinician attitude
“I can’t get rid of her. She just wants to talk”
“Please sit still Ethel so I get the best image”
“Waste of my time seeing another obvious
venous ulcer”
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19 La Trobe University
Managing Wounds as a Team -2014
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20 La Trobe University
The team
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21 La Trobe University
(Modified from Dorahy & Hamilton 2009)
Decision making
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Setting the expectations
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Consider informal care contracts
What the health care
agency will provide
What the patient will
provide
Expected outcomes Time lines
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My clinic
I will make every effort to replicate Jenifer
Hawking's legs by:
Reduce the fluid in your leg
Prevent infection of your leg ulcer
Minimize the pain
Help stop the leak and the stink
Me
I will make every effort to
Keep my leg dry
Wear the support bandages
Let Bill know if I am concerned
Be cheerful and humorous
The Patient
The stinking leg ulcer will heal and be out of my life, Dear
Outcome
No longer than 12 weeks to heal
Timeframe
One Fredo frog (flavor determined by the complainant if complaint upheld)
Penalty for non performance
Ethel contract
Monthly
Review
Home weekly and clinic monthly, unless I need to see Bill for entertainment
Care location
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Achieving the outcomes collaboratively
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Involve the patients in monitoring
Phone photos
Compare with other
patients Leg club©
Social media
Diaries
Pain
Food Teach other patients
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Provide feedback as motivation
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Be flexible
Open to new ideas
Alternative service
options
Learn from other
clinicians
Let peer support
resolve some
problems
Coach more than a clinician
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29 La Trobe University
Some warnings
• You are a registered health professional
• Bound by code of ethics
• Governed by criminal, common and statute law
• Patient center approach should only involved
• Approved devices or products
• Systems that maintains the personal safety of the clinician
• Are legal
• Comply with your personal and professional ethics
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So how do we involve the patient in and EBP environment?
Your knowledge of the
evidence and
experience
Patient expectations
& motivation
Creative
re-engineering of care
Legal Professional and Ethical Framework
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Passionate &
Persistent &
Creative
World peace &
global warming
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Thank you
latrobe.edu.au CRICOS Provider 00115M
…and how
has the
pain been?