Evaluating best practice implementation within a network of 6 rehabilitation centres across Canada Presented by: Laura Mumme Koning C, Kras-Dupuis A, Mumme.

Evaluating best practice implementation within a network of 6 rehabilitation centres across Canada

Presented by: Laura Mumme

Koning C, Kras-Dupuis A, Mumme L, Hsieh J, and the SCI KMN

Overview

Section Section Name Slide No.

1. Background 3

2. Implementation Science 5

3. Evaluation plan 8

4. Challenges & Accomplishments 12

SCI KMN Background

• Spinal Cord Injury Knowledge Mobilization Network

• 6 Canadian rehabilitation sites (Calgary, Edmonton, Toronto, London, Montreal, Québec City)

• Goal: Adopt and utilize the best available practices in SCI care to improve outcomes in the areas of pressure ulcers, pain, and bladder functioning based on an implementation science framework.

• Clinical Best Practice Guidelines for Pressure Ulcer Prevention and Management in SCI

Foothills Medical Centre: SCI

Rehabilitation Clinic

Glenrose Rehabilitation Hospital

The SCI KMNThe SCI KMN

NIRN – Implementation Science

• National Implementation Research Network (http://nirn.fpg.unc.edu/)

Framework• Implementation teams• Improvement cycles• Implementation drivers (competency &

organizational)• Stages of implementation (exploration, installation,

initial implementation, full implementation)

Objectives

1. To translate available evidence in the areas of pressure ulcer, bladder function and pain management into clinical practice.

2. To create an efficient infrastructure and facilitating environments for the implementation of best practices.

3. To improve health outcomes in patients who receive best practices in the areas of pressure ulcer prevention, bladder and pain management.

SCI Best Practice Recommendations (BPR) – Pressure ulcers

1. Risk Assessment

2. Education

• Determined by Delphi voting process– Stakeholder spectrum representation– Anonymous votes– 4 rounds of voting (48 BPR 2 Non-negotiable BPR)

Performance Measures

• Performance Measures Working Group (PMWG) formed

• List of suggested PM circulated– looked at scope (impact of intervention or

implementation process)– looked at target (patient, provider, or system)

• Online voting & teleconferences to achieve consensus

Examples of PM selected

• Risk Assessment– Percentage of new patients with documentation of

comprehensive pressure ulcer risk assessment within 24hrs (Objective #1)

• Education– Percentage of patients who (within 2 weeks prior to

discharge) indicate that the structured and individualized education for prevention and management of pressure ulcers was effective (Likert scale 0-10) (Objective #3)

Data Elements

• Evaluation and Data Management Team (EDMT) formed

• Teleconferences and online discussion to achieve consensus

• Data for central collection• Examples:

– Time risk assessment completed (24hr clock)– Total score of patient survey (range 0-50)

Challenges

• Achieving consensus

• Accommodating the needs of all 6 sites

• Measuring the implementation process (objective #2)

Accomplishments

• Engaged community of practice

• Provided national benchmarks

• Effective collaboration and communication between sites

• Very prolific group

• Structured organization with defined roles (e.g. terms of reference)

Evaluation Plan – Key Learnings

• Critical component

• Guides decision making

• Dedicate large amount of time

• Defines how to measure objectives

• Demonstrates that we are doing what we said we were going to do

Next Steps

• Start collecting data (initial implementation)

• Establish a feedback system

• Finalize implementation process data elements

Thank You!

• Questions??

Contact: Laura Mumme, [email protected]