Evidence based medicine - is it magic?

Transkript

1 Evidence based medicine - is it magic? Erfaringer med implementering av kunnskapsbasert praksis i sykehus Johny Kongerud

2 Competence building in evidence-based practice Department of respiratory medicine, Rikshospitalet Oslo University Hospital Project leaders: Karin Borgen, Johny Kongerud, Aina Presthus Project management : Cathrine M. Lofthus, Erlend Smeland, Otto Smiseth, Elisabeth Søyland, Kari R. Hovde

3 Background National Health Plan, Regional health strategy, the strategy plans for Oslo University Hospital encourage evidence based practice (EBP) among health professionals Oslo University Hospital aims to be a leading institution for the intention of practicing EBM

4 How to reach the goals for EBP Consultative board structure in all clinics and departments that coordinates clinical procedures and policies patient care and patient information mini-method assessments competence building in EBP throughout the clinic Leadership anchoring at all levels is mandatory and leaders should provide the mandate Intensify competence building in EBM in all clinics and departments Pilot project in the Department of Respiratory Medicine, Rikshospitalet

5 Pilot project 2014 Preparations Inform and motivate all employees in the Respiratory Department of preliminary plans Anchor pilot project in hospital management and in own clinic Facilitate practical implementation Meeting rooms and workplaces with internet access Plan and allocate time for staff to participate in internal and external courses Schedule venues to work and discuss EBP Planning seminar, request guest speakers Preparing hospital intranet site with tools for evidence based management Available mini-ipads

6 Pilot project Objectives Increase awareness of evidence based practice Increased attention for critical evaluation of own practice Provide all employees with training in EBP Select highly motivated employees to attend national/international/university courses in EBP to educate local facilitators/teachers

7 Pilot project Objectives Incorporate good routines for working evidence based Provide appropriate tools for practicing EBP Planning good routines and venues for the practice of EBM in the future Evaluation of the project Validated self-administered questionnaires registration of attitude and implementation Longitudinal observation (Before start, after 3, 6 and 12 months) No names on the questionnaires

8 Internal/External support The National Knowledge Center Per Vandvik Library, Faculty of Medicine, University of Oslo Elisabeth Svensen Deputy CEO Cathrine Lofthus Staff for Research, Education and Innovation Elisabeth Søyland, Kari Hovde Staff Medicine, Health Care and Development Karin Borgen Chief of HLK Otto Smiseth

9 Presentation and motivation for the pilot project

10 Main structure for competence building and practical training All employees introduced to basic concepts articles and/or e-learning course in evidence-based practice before seminars All employees participated in two mini-seminars: Introduction to evidence-based practice first seminar for physicians and nurses together (Food and beverage) Second seminars are held separately for doctors and nurses. Some employees attend advanced courses or participate in college courses (Høyskolen i Bergen (Nurses)) 15 credits (studiepoeng) preparing to be "trainers" for other employees and participate in continuous guidance

11 (cont) Main structure for competence building and practical training Journal clubs Junior physicians and students weekly formulate clinical questions and present their answers Group of doctors prepare a guideline or an evidence based procedure the next 6 months

12 Results to be expected All employees of the department should know the main principles behind EBP have worked knowledge based with at least one product that has been of benefit for the department have evaluated the department s routines and made them suitable for working knowledgebased make room for critical appraisal of own practice

13 Evaluation of the pilot project among doctors (n=11) Really disagree Really agree EBP results in best patient treatment Critical appraisal of scientific knowledge is important I believe barriers regarding EBP is managable EBP takes too much time I know how to use EBP to change practice I am confident in my own ability to use EBP in my practice

14 Evaluation of the pilot project among doctors (n=11) cont. Have you last 8 weeks Critical appraisal of a scientific study Defined a PICO question Presentation of scientific knowledge in a report or presentation > two colleagues Communicated knowledge from a scientific study to a patient/next of kin Use of EB guideline or a systematic review to change clinical practice Never 1-3 times 4-5 times 6-8 times >8 times

15 When do we need competence in EBP? Practical training for students, interns, nurses and doctors in specialist training and as a part of the department's ongoing definition of good practice Quick lookup in scientific literature databases bedside Shared decision making (explore patients preferences and needs) Preparation of a mini-method reviews Preparation of procedures, guidelines and patient pathways

16 No magic hard work and enthusiasm

17 We will manage! And you too!

18 Oslo universitetssykehus som helhet Fusjon av fire (tre) sykehus i Alle de tidligere sykehus hadde ulik erfaring med kunnskapsbasert praksis og dette ble brukt i videre arbeid med implementering i hele det nye sykehuset EKS: Kreftavdelingen hadde lenge hatt systematisk arbeid med kunnskapsbasert praksis ved sykepleierne Marie Bruheim og Kjersti Stokke i spissen og med god forankring hos klinikkleder Sigbjørn Smeland Intensivavdelingen og PO-avdelingene i akuttklinikken hadde lenge arbeidet med kunnskapsbaserte prosedyrer og var initiativtakere til Nettverk for fagprosedyrer. Se

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20 OUS, som helhet 2013: Innfører kunnskapsbasert praksis relatert til all innføring av nye metoder, i tråd med nasjonal føringer 2014: Pilot om innføring av kunnskapsbasert praksis i Lungeavdelingen 2015: Ledersak der sykehusledelsen ønsker at alle avdelinger skal få erfaring med kunnskapsbasert arbeidsmetode 2016: Sykehuset er klar for et skritt videre - og en ny ledersak for systematisk implementering av kunnskapsbasert praksis

21 Hva mer? Nye kunnskapsbaserte prosedyrer Utarbeidet 18 mini-metodevurderinger Utarbeidet 67 kunnskapsbaserte prosedyrer (noen med pasientinformasjon) (40 under utarbeidelse) Ledermøtet besluttet i mars 2015 at alle avdelinger ved sykehuset skal lage to kunnskapsbaserte prosedyrer innen 2016/2017 Følgende avdelinger får ønsket bistand om å arbeide mer kunnskapsbasert: Lungeavdelingen (RH), Olafiaklinikken, Sterilavdelingen, Karavdelingen, Akuttpsykiatrisk avdeling i tillegg til Kreftavdelingen, Lungeavdelingen og evt intensivavdelingene/po-avdelingene. Mini-metodevurdering ved ny behandlinge

22 Redskaper Egen internettside med ressurser til arbeidsprosessene Kontinuerlig egne kurs for ledere og ressurspersoner Deltar som initiativtakere når konferanser som denne skal holdes Plan om å holde oss ledende innen arbeid med mini-metodevurderinger og kunnskapsbaserte prosedyrer Fagrådstruktur utvikles i noen klinikker og der kunnskapsbasert arbeid kan planlegges og implementeres Interne erfaringsmøter der ledere og initiativtakere kan lære av hverandre Styrende dokumenter om arbeidsprosesser ved innføring av kunnskapsbasert praksis

23 Mål innen 2017 Har evaluert piloten i Lungeavdelingen (RH) og hatt en ledersak om temaet for å sikre fremdrift i implementeringen Være ledende innen minimetodevurdering og kunneksbaserte prosedyrer i Norge Alle avdelinger har erfaring med kunnskapsbasert arbeidsmetode via prosedyrearbeid Ingen nye metoder innføres i sykehuset uten først å gjennomføre en mini-metodevurdering. Ha minst tre avdelinger som har innført kunnskapsbasert arbeidsmetode

24 Erfaringskonferanse til høsten i OUS, ? - for å dele erfaringer ved innføring av kunnskapsbasert praksis i avdelinger?