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Wolfe DL, Hsieh JTC, Kras-Dupuis A, Campbell K, Flett H, Koning C and the SCI KMN Team

Online Delphi to Identify Targets for Best Practice Implementation and Associated Performance Measures. Wolfe DL, Hsieh JTC, Kras-Dupuis A, Campbell K, Flett H, Koning C and the SCI KMN Team. The Spinal Cord Injury Knowledge Mobilization Network (SCI KMN). What is the SCI KMN?.

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Wolfe DL, Hsieh JTC, Kras-Dupuis A, Campbell K, Flett H, Koning C and the SCI KMN Team

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  1. Online Delphi to Identify Targets for Best Practice Implementation and Associated Performance Measures Wolfe DL, Hsieh JTC, Kras-Dupuis A, Campbell K, Flett H, Koning C and the SCI KMN Team The Spinal Cord Injury Knowledge Mobilization Network (SCI KMN)

  2. What is the SCI KMN? • We are … 6 Canadian rehabilitation centres uniformly applying the principles of Implementation Science to facilitate best practice adoption • Supported by the National Implementation Research Network • Funded by … Overall Objectives • To translate available evidence in the areas of pressure ulcer, bladder function and pain management into clinical practice • To create an efficient infrastructure and facilitating environments for the implementation of best practices • To improve health outcomes in patients The Spinal Cord Injury Knowledge Mobilization Network (SCI KMN)

  3. SCI KMN Comprises: Foothills Medical Centre: SCI Rehabilitation Clinic Glenrose Rehabilitation Hospital

  4. Developing the SCI KMN: Initial Steps Specific Objectives • Identify initial implementation targets for prevention and management of pressure ulcers • Starting Point  Draft Canadian CPGs (Dr’s Pamela Houghton & Karen Campbell) • Goal  Identify 2 “Non-negotiable” practices and 3 “optional” • Develop related performance measures • Establish and engage a Community of Practice How???  Specific Strategies • Conduct modified Delphi exercise to seek consensus • Facilitate engagement via an online collaboration platform (Microsoft SharePoint) The Spinal Cord Injury Knowledge Mobilization Network (SCI KMN)

  5. Applying the Delphi Approach for Selecting Best Practice Targets Standard Delphi Technique • Delphi method is a structured communication technique, originally developed as a systematic, interactive forecasting method which relies on a panel of experts & features: • facilitation of multiple rounds of anonymous input, summary, revision, (i.e., iterative prioritization or culling) • pre-defined stop criterion (e.g. # of rounds, achievement of consensus, stability of results) Key Features of the SCI KMN Delphi • Representative stakeholders Multiple perspectives, balanced across sites and stakeholders types. • Online Facilitation Evidence syntheses (SCIRE, CPGs), SharePoint discussion board, Online document libraries for reference, Online surveys • a priori Delphi rules/principles Anonymity, timelines, between round data synthesis / presentation / feedback / discussion, adapt as needed. The Spinal Cord Injury Knowledge Mobilization Network (SCI KMN)

  6. Delphi Rounds 1 - 3 Rounds 1-3: Selecting Practices as Targets for implementation • Successive rounds of Delphi consideration and voting • 2 “Non-negotiable” and 3 “Optional” practices for sites to consider implementing • Participants voted according to the following criteria: Evidence-base; Importance; Need; Feasibility; Sustainability; Scalability 1. ASSESSMENT: Conduct a comprehensive, systematic assessment of risk factors 2. EDUCATION: Provide structured pressure ulcer prevention education DRAFT Canadian Practice Guidelines on Pressure Ulcers 48 Practices Best Practices 1……………...12 Best Practices 1……………...23 Round 3 Round 2 Round 1 The Spinal Cord Injury Knowledge Mobilization Network (SCI KMN)

  7. Delphi Rounds 4-6 Delphi Rounds 4-6: Determining Relevant and Feasible Performance Measures • Post-Round 3 and Round 4 activities focused on developing options for consideration; Round 5 was adapted into a sub-committee that refined and culled to identify 10 options for final selection in Round 6 The Spinal Cord Injury Knowledge Mobilization Network (SCI KMN)

  8. Performance Measures Overall 1.  % of patients with a pressure ulcer, documented by stage/location Risk Assessment 2.  % of new patients with comprehensive pressure ulcer risk assessment within specified time frame 3.  % of patients identified as having an action plan with their PU risk assessment. Education 4.  % of patients with documentation of structured education pertaining to strategies for prevention and management of pressure ulcers 5.  % of patients who indicate that the structured education for prevention and management of pressure ulcers was effective based on the following criteria: a.   I received information/strategies appropriate for me b.   I understood information/strategies that I received c.   The delivery methods/content adequately met my learning needs d.   I am confident that I can apply information/strategies that I received e.   I apply this knowledge to my daily routine The Spinal Cord Injury Knowledge Mobilization Network (SCI KMN)

  9. Implications & What We’re Doing Now • We needed these practices and performance measures to proceed with the business of implementation • Now  Active implementation planning with most sites implementing aspects of the practices (improvement cycles). • *** Engagement in the Delphi set the stage for establishing a cross-discipline community of practice. • Now  Evolving configuration of Microsoft SharePoint to promote work within and across teams The Spinal Cord Injury Knowledge Mobilization Network (SCI KMN)

  10. “Please Sir – I Want Some More” The Spinal Cord Injury Knowledge Mobilization Network (SCI KMN)

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