1. 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

2. Overview SectionSection NameSlide No. 1.Background3 2.Implementation Science5 3.Evaluation plan8 4.Challenges & Accomplishments12

3. 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

4. Foothills Medical Centre: SCI Rehabilitation Clinic Glenrose Rehabilitation Hospital The SCI KMN

5. NIRN – Implementation Science National Implementation Research Network (http://nirn.fpg.unc.edu/)http://nirn.fpg.unc.edu/ Framework Implementation teams Improvement cycles Implementation drivers (competency & organizational) Stages of implementation (exploration, installation, initial implementation, full implementation)

6. 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.

7. 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)

8. 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

9. 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)

10. 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)

11. Challenges Achieving consensus Accommodating the needs of all 6 sites Measuring the implementation process (objective #2)

12. 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)

14. 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

15. Next Steps Start collecting data (initial implementation) Establish a feedback system Finalize implementation process data elements

16. Thank You! Questions?? Contact: Laura Mumme, laura.mumme@albertahealthservices.calaura.mumme@albertahealthservices.ca