Nov. 9, 2006EPIC QI WorkshopSlide 1 EPIC/PHSI Quality Improvement Workshop: The Journey Ahead Khalid Aziz November 10, 2006

Nov. 9, 2006EPIC QI WorkshopSlide 2 And as for teamwork … …

Nov. 9, 2006EPIC QI WorkshopSlide 3 … … it is clearly the journey, not the destination, that counts

Nov. 9, 2006EPIC QI WorkshopSlide 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?

Nov. 9, 2006EPIC QI WorkshopSlide 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 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 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 EPIC evaluation: Evaluate processes and outcomes

Nov. 9, 2006EPIC QI WorkshopSlide 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

Nov. 9, 2006EPIC QI WorkshopSlide 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 (!)

Nov. 9, 2006EPIC QI WorkshopSlide 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

Nov. 9, 2006EPIC QI WorkshopSlide 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

Nov. 9, 2006EPIC QI WorkshopSlide 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)

Nov. 9, 2006EPIC QI WorkshopSlide 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)

Nov. 9, 2006EPIC QI WorkshopSlide 12 November-December 2006: Coordinating centre responsibilities - Communication Feedback on EPIC 1 results Newsletter Teleconferences Recording the process nationally Timelines for change: post-workshop

Nov. 9, 2006EPIC QI WorkshopSlide 13 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 Timelines for change: post-workshop

Nov. 9, 2006EPIC QI WorkshopSlide 14 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 Timelines for change: post-workshop Potential Site EPIC Team members include:

Nov. 9, 2006EPIC QI WorkshopSlide 15 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 Timelines for change: post-workshop

Nov. 9, 2006EPIC QI WorkshopSlide 16 November-December 2006: Site responsibilities – Site EPIC Team meets and plans local communication strategies Electronic ( , website, newsletter) Group education (education day, inservice) Visual (control charts, poster, newsletter) Administrative (policy change, passive methods) Interactive (focus groups, bedside teaching) Timelines for change: post-workshop

Nov. 9, 2006EPIC QI WorkshopSlide 17 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

Nov. 9, 2006EPIC QI WorkshopSlide 18 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) Timelines for change: EPIC readiness

Nov. 9, 2006EPIC QI WorkshopSlide 19 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 Timelines for change: EPIC readiness

Nov. 9, 2006EPIC QI WorkshopSlide 20 January-February 2007: “One Button Reports” Timelines for change: EPIC readiness

Nov. 9, 2006EPIC QI WorkshopSlide 21 January-February 2007: “One Button Reports” Timelines for change: EPIC readiness

Nov. 9, 2006EPIC QI WorkshopSlide 22 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

Nov. 9, 2006EPIC QI WorkshopSlide 23 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

Nov. 9, 2006EPIC QI WorkshopSlide 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 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 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 EPIC evaluation: Evaluate processes and outcomes

Nov. 9, 2006EPIC QI WorkshopSlide 25 Questions???

Nov. 9, 2006EPIC QI WorkshopSlide 26 Early surfactant administration: the Winnipeg experience How can we make sure that surfactant administration is timely?