Clinician Engagement in Point of Care Audit

Transcription

1 Clinician Engagement in Point of Care Audit Stephanie Sutherns, Ms Jacinta Lee, Mr Keppel W. Schafer, Ms Jackie Doolan, Ms Lyndel Gray, Associate Professor Rebecca Kimble on behalf of the Queensland Maternity & Neonatal Clinical Guidelines Program Queensland Maternity and Neonatal Clinical Guidelines Program

2 Guidelines Program Statewide (Queensland) Maternity & Neonatal Clinical Network members requested consistent, concise, evidence based clinical guidelines Queensland (formerly Statewide) Maternity and Neonatal Clinical Guidelines Program initiated in 2008 Queensland Maternity and Neonatal Clinical Guidelines Program 2

3 Guidelines Program Clinician Engagement Currently 24 guidelines available Queensland Health Intranet National Health & Medical Research (NHMRC) portal Queensland Maternity and Neonatal Clinical Guidelines Program 3

4 Clinical Guidelines alone do not change patient outcomes Queensland Maternity and Neonatal Clinical Guidelines Program 4

5 Clinical Guideline Implementation Multifaceted implementation strategy for the Clinical Guideline Obesity Queensland Maternity and Neonatal Clinical Guidelines Program 5

6 Clinical Guideline Implementation Education & Audit Project Pilot sites at three Queensland maternity facilities Queensland Maternity and Neonatal Clinical Guidelines Program 6

7 Population Distribution Queensland Maternity and Neonatal Clinical Guidelines Program 7

8 Queensland Texas AUSTRALIA Queensland Maternity and Neonatal Clinical Guidelines Program 8

9 Queensland Public Birthing Services Cairns Rockhampton Queensland Maternity and Neonatal Clinical Guidelines Program 9

10 Purpose of the Project 1. Investigate the effectiveness of education 2. Assess the impact of clinical audit activity Queensland Maternity and Neonatal Clinical Guidelines Program 10

11 Research Question Does involvement in clinical audit activity improve clinician knowledge of clinical guideline recommendations? Queensland Maternity and Neonatal Clinical Guidelines Program 11

12 Methods Clinician engagement Education about Guideline content Prospective point of care auditing by clinicians Knowledge assessments before and after interventions Queensland Maternity and Neonatal Clinical Guidelines Program 12

13 Audits Retrospective Single clinician holding portfolio Care episode completed Minimal capacity to respond Limited clinician engagement Point of care Clinician providing care completes audit Timely responsiveness to care Improves awareness of quality cycle Improves clinician knowledge Queensland Maternity and Neonatal Clinical Guidelines Program 13

14 Pilot Design OBSERVATION: Knowledge assessment INTERVENTION: Guideline education OBSERVATION: Knowledge assessment INTERVENTION: Point of Care Audit OBSERVATION: Knowledge assessment Queensland Maternity and Neonatal Clinical Guidelines Program 14

15 Audit Tool Queensland Maternity and Neonatal Clinical Guidelines Program 15

16 Results Change in clinician knowledge of Clinical Guideline content following the education & audit interventions statistically significant (p<0.001) Positive clinician feedback in Focus Group & Evaluation Survey regarding education & audit interventions Queensland Maternity and Neonatal Clinical Guidelines Program 16

17 Percent of positive responses about the audit activity (N=72*) *Missing data excluded Queensland Maternity and Neonatal Clinical Guidelines Program 17

18 Focus Group Themes Importance of implementation strategies Reward and recognition was valued Educational approach preferred Quality cycle inclusive Queensland Maternity and Neonatal Clinical Guidelines Program 18

19 What the Staff said Having our local champion on site to help us and troubleshoot was invaluable. Queensland Maternity and Neonatal Clinical Guidelines Program 19

20 AUDITING Opportunities/Benefits Staff enthusiasm Greater staff involvement in quality & audit activities Prospective Efficient Upskilling Queensland Maternity and Neonatal Clinical Guidelines Program 20

21 AUDITING Challenges Confusion about definitions Unexpected clinical workload Culture Tool/process Clinical knowledge Queensland Maternity and Neonatal Clinical Guidelines Program 21

22 METHODOLOGY Opportunities/Benefits Pre- and Post- tests available for staff completion at all hours Queensland Maternity and Neonatal Clinical Guidelines Program 22

23 METHODOLOGY Lessons Learnt Tools important Mode of education delivery Financial incentive not so important Queensland Maternity and Neonatal Clinical Guidelines Program 23

24 What the Staff said Queensland Maternity and Neonatal Clinical Guidelines Program 24

25 Conclusion Multi-pronged implementation strategy Clinicians enthusiastic Ownership / champions pivotal to success and sustainability Executive support Queensland Maternity and Neonatal Clinical Guidelines Program 25

26 Acknowledgements: Project Group Project Sponsor: Associate Professor Rebecca Kimble Co-Clinical Leads: Dr Pieter Koorts, Ms Stephanie Sutherns Project Team: Associate Professor Leonie Callaway, Ms Lee Jones, Ms Joan Kennedy, Ms Jacinta Lee, Ms Robin Turnbull, Mr Keppel Schafer Pilot Site Champions: Ms Angie Gorry (Roma Hospital), Ms Annette Patane, Ms Marg Bradley, Ms Mischa Lawford (Gladstone Hospital), Ms Cathy Smith, Ms Karen Yates, Dr Paul Howat (Cairns Base Hospital) Pilot Site Staff: Directors of Nursing & Midwifery, Nurse/Midwife Unit Managers, Midwives & Medical Officers Reference Group Members Queensland Maternity and Neonatal Clinical Guidelines Program 26