1. Accreditation Canada Critical care team By Norah Khathlan MD Assistant Prof. Pediatrics Consultant Pediatric Intensivist Director PICU January/ 2009

3. Accreditation Canada ? Vision is to be the leader in raising the bar for health quality. Vision is to be the leader in raising the bar for health quality. Mission is to drive quality in health services through accreditation. Mission is to drive quality in health services through accreditation. Accreditation is a continually evolving process. Accreditation is a continually evolving process. provides organizations with a roadmap for improvement that focuses on actions and results provides organizations with a roadmap for improvement that focuses on actions and results

4. Accreditation Canada defines accreditation as: –A process to evaluate and improve the quality of services. –Involves examining everyday activities and services against standards of excellence. Define Define Measure QUALITY Measure QUALITY Report on Report on Improve Improve

5. Quality definition “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”. Note that the above definition implies that Evidence based management and measurement improve outcomes.

6. Accreditation Canada the guidelines Recognition levels : Recognition levels : –Accreditation –Accreditation with condition: Report –Accreditation with condition: focused visit –Accreditation with condition: report & focused visit. –Non Accreditation

7. Accreditation recognition Five factors are considered in determining the most appropriate recognition award: Five factors are considered in determining the most appropriate recognition award: –Quality –Risk –Repeat recommendations –High priority recommendations identified by Accreditation Canada. Quality improvement at an organization wide level. Quality improvement at an organization wide level. Ethics at an organization wide level. Ethics at an organization wide level. Patient safety issues, including patient safety goals & ROPs Patient safety issues, including patient safety goals & ROPs –Number of other high priority recommendations in any team. 4 or more high priority recommendations.

8. KAUH Vision KAUH will be internationally recognized among the best evidence-based health centers in the Middle East

9. Patient safety Safety is ”freedom from accidental injury because of medical care or medical errors”. Safety is ”freedom from accidental injury because of medical care or medical errors”. Patient Safety is defined as the prevention and mitigation of unsafe acts within the health care system Patient Safety is defined as the prevention and mitigation of unsafe acts within the health care system

21. Critical care team 17 standards: “Client Centered Care” 17 standards: “Client Centered Care” –Process of preparing client for Intensive care: Admission criteria Admission criteria Orientation Orientation Informed consent. Informed consent. –Process of assessment to confirm diagnosis. –Care & treatment planning process: Timely access to diagnostic services Timely access to diagnostic services Information exchange between team Information exchange between team Informing clients & family of preparation & results of tests. Informing clients & family of preparation & results of tests.

22. Critical care team Standards cont. : Standards cont. : –Care & treatment process includes developing, implementing and monitoring a therapeutic plan to achieve intended results. Options for care are explained to family. Options for care are explained to family. Key components identified for each client. Key components identified for each client. Team members understand each other’s roles. Team members understand each other’s roles. –Processes for implementing care & treatment. Client/family education. Client/family education. Appropriate team members implement care & treatment. Appropriate team members implement care & treatment. –Keeping integrated health records. –Code of ethics, standards of practice and legislations.

23. Critical care team Standards Cont. : Standards Cont. : –Processes for appropriate implementation & integration of clinical practice guidelines and EB care. –Process for review and revision of individual plan of care & treatment. –Continuing care needs of client assessed & documented and communicated at transfer. –Process for monitoring quality of care. –Process for reviewing clinical practice guidelines.

24. Critical care team Standards Cont. : Standards Cont. : –Indicators of performance are identified. –Quality improvement items: Identifying priorities of care. Needs & expectations vs. outcome Identifying priorities of care. Needs & expectations vs. outcome Improvement of selected processes. Improvement of selected processes. Communicating the results of quality improvement. Communicating the results of quality improvement. –There is ongoing monitoring of improvements in the selected processes eg. Survey/evaluation. –When necessary changes are initiated to maintain QI

25. Critical care team Actions: Actions: –Admission & discharge criteria. –Transfer rules and policies. –Reconciliation of medication. –Templates for admission to PICU orders. –Obtaining informed consent on admission to PICU. –Regular updates of families with documentation. –Daily goals sheet utilization. –Patient education form utilization.

26. Critical care team Protocols and guidelines for: Protocols and guidelines for: –Hyperglycemia & insulin. –Status Epilepticus. –Infusions of K –Infusion of Ca –Mg infusions –Acidosis –Sepsis early goal directed therapy. –Intubation: preparation, medications & indications –Sedation vacation. –Extubation : pre, peri and post extubation management –Ventilation strategy documentation. –Feeding protocols

27. Critical care team Our indicators: 5 were selected Our indicators: 5 were selected –Improve medical record documentation. Consultations Consultations Date, time, name, signature and stamp on every sheet. Date, time, name, signature and stamp on every sheet. Physician order sheet. Physician order sheet. Medication sheets. Medication sheets. Admission sheet. Admission sheet. –Patient / family education. –Improve infection control surveillance. –Improve medication practices. –Patients bill of rights and responsibilities.

28. Critical care team Improvement plan include: Improvement plan include: –Patient/family satisfaction survey. –Providing information to patient/family through leaflets and flyers. –Multidisciplinary team involvement. –Regular family meetings. –CVC care bundles. fair –Weaning ventilation bundles. poor

29. Critical care team Code sheet: Unused Desktop April 2008\Desktop July 2007\Code_Sheet_3(1).xls Code sheet: Unused Desktop April 2008\Desktop July 2007\Code_Sheet_3(1).xls Unused Desktop April 2008\Desktop July 2007\Code_Sheet_3(1).xls Unused Desktop April 2008\Desktop July 2007\Code_Sheet_3(1).xls Eye care for the comatose patient: Sep 2008\Quality care in ICU\BPISeye.pdf Eye care for the comatose patient: Sep 2008\Quality care in ICU\BPISeye.pdf Sep 2008\Quality care in ICU\BPISeye.pdf Sep 2008\Quality care in ICU\BPISeye.pdf Daily goals sheet: Sep 2008\PICU\Daily Goals Worksheet PICU final.doc Daily goals sheet: Sep 2008\PICU\Daily Goals Worksheet PICU final.doc Sep 2008\PICU\Daily Goals Worksheet PICU final.doc Sep 2008\PICU\Daily Goals Worksheet PICU final.doc Sepsis bundle: Sep 2008\PICU\Severe Sepsis Bundles PICU.doc Sepsis bundle: Sep 2008\PICU\Severe Sepsis Bundles PICU.doc Sep 2008\PICU\Severe Sepsis Bundles PICU.doc Sep 2008\PICU\Severe Sepsis Bundles PICU.doc IV Infusions of K Sep 2008\PICU\PROTOCOLS\Intravenous Potassium guidelines in PICU.doc IV Infusions of K Sep 2008\PICU\PROTOCOLS\Intravenous Potassium guidelines in PICU.doc Sep 2008\PICU\PROTOCOLS\Intravenous Potassium guidelines in PICU.doc Sep 2008\PICU\PROTOCOLS\Intravenous Potassium guidelines in PICU.doc

30. Critical care team The provision of optimal and safe critical care services is our aim