Overview of the progress of the KSUMC Clinical Practice Guidelines Adaptation and Implementation Program in the Department of Pediatrics which is the most active department in the program
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Clinical Practice Guidelines implementation & Auditing in the Pediatrics Department in King Saud University Medical City
1. King Saud University Medical City
Clinical Practice Guidelines Program
PEDIATRICS Departmental Quality Team (DQT)
PEDIATRICS CPGs Departmental Committee
CPGs Implementation & Auditing
Jumada'I 1436 - March 2015KSUMC-Wide CPGs Committee – Pediatrics Departmental CPGs subCommittee
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Presented By
Dr. Yasser Sami Amer
MBBCh, MS Pedia, MS HC Inf, CPHQ
Coordinator/ Advisor, KSUMC-Wide CPG Steering Committee
Coordinator, Pediatrics DQT
Coordinator, R & D, QMD
Member, eSiHi CPOE Physicians Team
Member, G-I-N AWG, IWG, PMWG
3. Evidence-Based Medicine (EBM) Movement: Not new!
865–925 Al-Razi (Rhazes)
1st need for experiments, comparisons in clinical studies
981–1037 Ibn Sina (Avicenna)
test effect of drugs on humans not animals only
1987 David M. Eddy, MD, PhD
‘EB’ in EBCPGs, policies in workshops, manual
1992 Gordon Guyatt, MD
‘EBM’ term in JAMA
1996 David Sackett, MD
‘EBM’ definition in BMJ
Jumada'I 1436 - March 2015
"Colofón-Libro de Medicina de Razi" by Muhammad ibn Zakariya al-Razi - Transferred from http://en.wikipedia.org/wiki/Image:Colophon-Razi's_Book_of_medicine_for_Mansur.jpg. Licensed under
Public Domain via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Colof%C3%B3n-Libro_de_Medicina_de_Razi.jpg#mediaviewer/File:Colof%C3%B3n-Libro_de_Medicina_de_Razi.jpg
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7. Definition: (old)
“Systematically developed statements to
assist practitioner and patient decisions
about appropriate health care for specific
clinical circumstances” (IOM 1990)
Clinical Practice Guidelines (CPGs)
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8. CPGs New Definition
CPGs are “Statements that include
Recommendations intended to
optimize patient care that are
informed by a Systematic Review of
evidence and an assessment of the
benefits and harms of alternative care
options”.
Committee on Standards for Developing
Trustworthy CPGs (IOM-AHRQ 2011)
11. Clinical Practice Guidelines (CPGs) Program
of King Saud University Hospitals/ Medical City
KSUHs Taskforce Responsible Staff from:
Clinical Practice Guidelines Steering Committee;
Quality Management Department;
Clinical Departments (CPGs Departmental
subCommittees);
Shaikh Abdullah Bahamdan Research Chair for
Evidence-Based Health Care and Knowledge
Translation;
Top Management & Leadership of College of Medicine
and University Hospitals (Future KSU Medical City)
09 JAN 2014Antibiotic Prophylaxis in Surgery 11
12. 21 KSUMC CPGs Subcommittees
1. Department of Pediatrics
2. Department of Critical Care
3. Department of Psychiatry
4. Primary Care/ Family Medicine Clinics
(Ambulatory Care Services)
5. Department of Pharmacy
6. Department of Emergency Medicine
7. Department of Medicine
8. Department of Orthopedic Surgery
9. Department of Otorhinolaryngology
10. Department of Ophthalmology
11. Department of Cardiac Sciences/ KFCC
(Cardiology – Cardiac Surgery)
12. Department of Surgery
13. Department of Obstetrics &
Gynecology
14. Department of Dermatology
15. Department of Anesthesiology
16. Department of Laboratory Medicine &
Pathology
17. Department of Nursing
18. Department of Radiology
19. Health Education Center
20. Department of Rehabilitation Medicine
21. Department of Infection Control
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New (in progress)
1. Department of Occupational Health & Safety
2. Department of Clinical Nutrition
15. Adaptation of CPGs
Is the systematic approach to the endorsement
and/or modification of a guideline(s) produced in
one cultural and organizational setting for
application in a different context. Adaptation
may be used as an alternative to de novo
guideline development, e.g., for customizing (an)
existing guideline(s) to suit the local context.
http://www.adapte.org/
http://www.g-i-n.net/
17. 3/5/2015
6
10
5
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1111
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6
22
1
2
0
111
0
2
0
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00
0
2
4
6
8
10
12
KSUMC CPGS IN ALL DEPARTMENTS APPROVED BY CGC
(FEB 2015 - JUMADA'I 1436)
# CPGs approved # CPGs in progress
*Pooling specialties
(reviewers)
DEM actively participated in
adaptation or review of CPGs from
other department (i.e. PED & MED)
PED the most active department in terms of adaptation,
implementation and auditing of CPGs (6 finalized, 6 in progress, 4
fully implemented, 2 with outcome results of auditing
40. CPG implementation strategies
Dissemination Process (print/ e-/website)
Local Clinical Champions.
Awareness raising/ training activities.
Networking and linking with existing
projects (e.g. Dept. Clinical Rounds, CPD/CME activities, Accreditation, etc..).
Patients as champions for change.
Regular M & E (Auditing) (The ‘living’ CPG concept!).
Thursday,
March 5, 2015
CPGs Implementability & Implementation - Dr. Yasser Amer 40
41. Adapt/ design CPG implementation tools
available at the point of care (* MR)
TYPES
1. Clinical Algorithm.
2. Integrated Care/ Clinical Pathways*.
3. Protocol and/ or Policy & Procedure
4. Chart Documentation/ checklists/ forms (e.g. Physician Order Sets* later
CPOE/eSIHI).
5. Quick Reference Guides/ Physician Guides & Pocket Guide/Reference Cards (at-a-
glance summary of key recommendations 5 or 1-2 pages).
6. Clinical audit criteria (tool)
7. Quality (outcome/performance) measures
8. Slide Presentation.
9. Wall Poster.
10. Patient Resources/ Information (health education guides).
11. Foreign language Translation (Non-English, Non-Arabic).
12. Implementation Tool Kits (collections of tools and/or strategies).
13. Staff Training/ Competency Material. Thursday,
March 5, 2015
CPGs Implementability & Implemen.tation - Dr. Yasser Amer
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42. How to read the KSUMC CPGs full
documents? TABLE OF CONTENTS
Preface by authors
Acknowledgments
Abbreviations
Overview material
Introduction
Statement of intent
Scope & Purpose (Health Questions PIPOH)
Recommendations (Key & details)
External review & consensus
Plan for scheduled review & update
List of funding sources
Adaptation process methodology
Implementation considerations & Tools
References
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43. Health/ Clinical/ Key Questions
Patient (& disease characteristics)
Intervention(s)
Professionals (Target users)
Outcomes (purpose of the CPGs)
Healthcare settings (& context)
19th March
2013
EBCPGs: Dr. Yasser Sami Amer 43
CPG Scope: PIPOH Model
49. Who is the contact person for EBCPGs in your
department?
Head, Departmental CPG subCommittee:
Dr. Sarar Mohamed
Members, Departmental CPG subCommittee (#?)
Head, Department Quality Team:
Dr. Mohamed El-Faki
Coordinator, KSUMC-Wide CPG Steering Committee:
Dr. Yasser Amer
Medical Secretary, KSUMC-Wide CPG Steering Committee:
Ms. Dorothy Villena, Ms. Sheila Rivera
3/5/2015 49
50. Results of the Outcome measurement of CPGs
implementation in Pediatrics: DKA
50
51. Results of the Outcome measurement of CPGs implementation in
Pediatrics: Severe sepsis/ septic shock in PICU
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52. Examples of KSUMC Clinical
Practice Guideline Adaptation
& Implementation Projects
presented and/or published in
International Conferences AND
National Events
53. The adapted CPG for Management of
Diabetic Ketoacidosis in children from the
Department of Pediatrics
Presented by Dr. Sara Mohamed, Associate Professor &
Consultant of Pediatric Endocrinology & Metabolism and Head
of Pediatrics CPGs Subcommittee presented in three
international conferences:-
1. American Endocrine Society Conference, San Francisco,
USA. CPG: challenges and opportunities in 14/6/2013 ENDO
2013 15-18/6.
2. European society of pediatric endocrinology conference,
Milan, Italy in 20/9/2013 – DKA Guidelines: Saudi
Experience.
54. Featured Poster Presentation Number: FP32-6 Poster Board Number: MON-282
https://endo.confex.com/endo/2013endo/webprogram/Paper6468.html
A
DISCLOSURES: Nothing to disclose
Development and implementation of Clinical Practice Guidelines
in Pediatric Endocrinology: Challenges and opportunities
Sarar Mohamed, Hala Omer, Nasir Al Jurryaan, Amir Babiker, Hessah Al-Otibi, Rana Hasanato, Shaikh Iqbal
,Mohamed Elfaki Osman, Nouf Alkhemis, Ali Abdo, Abdulrahman Al-Nemri
Department of Pediatrics & Chemistry, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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56. 56
The Endocrine Society’s 97th Meeting & EXPO (ENDO 2015) March 5 – 8 2015,
San Diego, USA By Dr. Sarar Mohamed
57. Thank YOU all for listening
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Contact Information: Dr. Yasser Sami Amer
Emails: yasser3amer@yahoo.com; yamer@ksu.edu.sa
Mobile: +966-50-857-7246, +966-51-525-2439
Office: +966-11-46-91341