Accreditation CanadaAccreditation CanadaCritical care teamCritical care team

ByByNorah Khathlan MDNorah Khathlan MD

Assistant Prof. PediatricsAssistant Prof. PediatricsConsultant Pediatric IntensivistConsultant Pediatric Intensivist

Director PICUDirector PICUJanuary/ 2009January/ 2009

Accreditation Canada ?Accreditation Canada ?

• Vision is to be the leader in raising the bar Vision is to be the leader in raising the bar for health quality. for health quality.

• Mission is to drive quality in health Mission is to drive quality in health services through accreditation.services through accreditation.

• Accreditation is a continually evolving Accreditation is a continually evolving process.process.

• provides organizations with a roadmap for provides organizations with a roadmap for improvement that focuses on actions and improvement that focuses on actions and results results

Accreditation Canada defines Accreditation Canada defines accreditationaccreditation as: as:

– A process to A process to evaluateevaluate and and improveimprove the the quality quality of services.of services.

– Involves Involves examiningexamining everyday activities and everyday activities and services against services against standards of excellence.standards of excellence.

•DefineDefine

•Measure Measure QUALITY QUALITY

•Report on Report on

•ImproveImprove

Quality definitionQuality definition

““The degree to which health services for The degree to which health services for individuals and populations increase individuals and populations increase

the likelihood of desired health the likelihood of desired health outcomes and are consistent with outcomes and are consistent with current professional knowledge”.current professional knowledge”.

Note that the above definition implies that Evidence Note that the above definition implies that Evidence based management and measurement improve based management and measurement improve outcomes.outcomes.

Accreditation Canada the Accreditation Canada the guidelinesguidelines

• Recognition levels :Recognition levels :– AccreditationAccreditation– Accreditation with condition: ReportAccreditation with condition: Report– Accreditation with condition: focused Accreditation with condition: focused

visitvisit– Accreditation with condition: report & Accreditation with condition: report &

focused visit.focused visit.– Non AccreditationNon Accreditation

Accreditation recognitionAccreditation recognition

• Five factors are considered in determining the Five factors are considered in determining the most appropriate recognition award:most appropriate recognition award:– QualityQuality– RiskRisk– Repeat recommendationsRepeat recommendations– High priority recommendations identified by High priority recommendations identified by

Accreditation Canada.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 & ROPsPatient safety issues, including patient safety goals & ROPs

– Number of other high priority recommendations in Number of other high priority recommendations in any team. 4 or more high priority any team. 4 or more high priority recommendations.recommendations.

KAUH VisionKAUH Vision

KAUH will be KAUH will be internationally recognized internationally recognized among the best evidence-among the best evidence-

based health centers in based health centers in the Middle Eastthe Middle East

Patient safetyPatient safety

• Safety is ”freedom from accidental injury Safety is ”freedom from accidental injury because of medical care or medical errors”.because of medical care or medical errors”.

• Patient Safety is defined as the prevention Patient Safety is defined as the prevention and mitigation of unsafe acts within the and mitigation of unsafe acts within the health care systemhealth care system

Critical care teamCritical care team

• 17 standards: 17 standards: “Client Centered Care”“Client Centered Care”– Process of preparing client for Intensive care:Process of preparing client for Intensive care:

• Admission criteriaAdmission criteria

• OrientationOrientation

• Informed consent.Informed consent.

– Process of assessment to confirm diagnosis.Process of assessment to confirm diagnosis.– Care & treatment planning process:Care & treatment planning process:

• Timely access to diagnostic servicesTimely access to diagnostic services

• Information exchange between teamInformation exchange between team

• Informing clients & family of preparation & results of Informing clients & family of preparation & results of tests.tests.

Critical care teamCritical care team

• Standards Standards cont.cont.::– Care & treatment process includes developing, Care & treatment process includes developing,

implementing and monitoring a therapeutic plan implementing and monitoring a therapeutic plan to achieve intended results.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.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.Keeping integrated health records.– Code of ethics, standards of practice and Code of ethics, standards of practice and

legislations.legislations.

Critical care teamCritical care team

• Standards Standards Cont. Cont. ::– Processes for appropriate implementation & Processes for appropriate implementation &

integration of clinical practice guidelines and EB integration of clinical practice guidelines and EB care.care.

– Process for review and revision of individual plan Process for review and revision of individual plan of care & treatment.of care & treatment.

– Continuing care needs of client assessed & Continuing care needs of client assessed & documented and communicated at transfer.documented and communicated at transfer.

– Process for monitoring quality of care.Process for monitoring quality of care.– Process for reviewing clinical practice guidelines.Process for reviewing clinical practice guidelines.

Critical care teamCritical care team

• Standards Standards Cont. Cont. ::– Indicators of performance are identified.Indicators of performance are identified.– Quality improvement items:Quality improvement items:

• Identifying priorities of care. Needs & expectations vs. Identifying priorities of care. Needs & expectations vs. outcomeoutcome

• 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 There is ongoing monitoring of improvements in the selected processes eg. Survey/evaluation.the selected processes eg. Survey/evaluation.

– When necessary changes are initiated to maintain When necessary changes are initiated to maintain QIQI

Critical care teamCritical care team

• Actions:Actions:– Admission & discharge criteria.Admission & discharge criteria.– Transfer rules and policies.Transfer rules and policies.– Reconciliation of medication.Reconciliation of medication.– Templates for admission to PICU orders.Templates for admission to PICU orders.– Obtaining informed consent on admission to Obtaining informed consent on admission to

PICU.PICU.– Regular updates of families with documentation.Regular updates of families with documentation.– Daily goals sheet utilization.Daily goals sheet utilization.– Patient education form utilization.Patient education form utilization.

Critical care teamCritical care team

• Protocols and guidelines for:Protocols and guidelines for:– Hyperglycemia & insulin.Hyperglycemia & insulin.– Status Epilepticus.Status Epilepticus.– Infusions of KInfusions of K– Infusion of CaInfusion of Ca– Mg infusionsMg infusions– AcidosisAcidosis– Sepsis early goal directed therapy.Sepsis early goal directed therapy.– Intubation: preparation, medications & indicationsIntubation: preparation, medications & indications– Sedation vacation.Sedation vacation.– Extubation : pre, peri and post extubation managementExtubation : pre, peri and post extubation management– Ventilation strategy documentation.Ventilation strategy documentation.– Feeding protocolsFeeding protocols

Critical care teamCritical care team

• Our indicators: 5 were selectedOur indicators: 5 were selected– Improve medical record documentation.Improve medical record documentation.

• ConsultationsConsultations• Date, time, name, signature and stamp on every Date, time, name, signature and stamp on every

sheet.sheet.• Physician order sheet.Physician order sheet.• Medication sheets.Medication sheets.• Admission sheet.Admission sheet.

– Patient / family education.Patient / family education.– Improve infection control surveillance.Improve infection control surveillance.– Improve medication practices.Improve medication practices.– Patients bill of rights and responsibilities.Patients bill of rights and responsibilities.

Critical care teamCritical care team

• Improvement plan include:Improvement plan include:– Patient/family satisfaction survey.Patient/family satisfaction survey.– Providing information to patient/family Providing information to patient/family

through leaflets and flyers.through leaflets and flyers.– Multidisciplinary team involvement.Multidisciplinary team involvement.– Regular family meetings.Regular family meetings.– CVC care bundles. fairCVC care bundles. fair– Weaning ventilation bundles. poorWeaning ventilation bundles. poor

Critical care teamCritical care team

• Code sheet: Code sheet: Unused Desktop April 2008\Desktop July 2007\Code_Sheet_3(Unused Desktop April 2008\Desktop July 2007\Code_Sheet_3(1).xls1).xls

• Eye care for the comatose patient: Eye care for the comatose patient: Sep 2008\Quality care in ICU\Sep 2008\Quality care in ICU\BPISeye.pdfBPISeye.pdf

• Daily goals sheet: Daily goals sheet: Sep 2008\PICU\Daily Goals Worksheet PICU final .docSep 2008\PICU\Daily Goals Worksheet PICU final .doc

• Sepsis bundle: Sepsis bundle: Sep 2008\PICU\Severe Sepsis Bundles Sep 2008\PICU\Severe Sepsis Bundles PICU.docPICU.doc

• IV Infusions of K IV Infusions of K Sep 2008\PICU\PROTOCOLS\Intravenous Potassium guidelineSep 2008\PICU\PROTOCOLS\Intravenous Potassium guidelines in s in PICU.docPICU.doc

Critical care teamCritical care team

The provision of optimal The provision of optimal and safe critical care and safe critical care services is our aimservices is our aim