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Towards implementation of Evidence-Based Clinical
Practice Guidelines (CPGs)
Dr. Yasser S. AmerMBBCh, MPed, MHI, CPHQ, FISQua
Quality Management DepartmentMedical-City Wide CPGs Steering Committee
Research Chair for Evidence-Based Health Care & Knowledge Translation
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Training Plan Program
Training Program Title :
Towards Implementation of Evidence-Based Clinical Practice Guidelines
Training Program Duration : Four (4) hours
Targeted Employees : • Department Quality Team Members• Department CPG Committee Members• Residents/ Interns
Training Programs Goals : To provide participants with an overview on the state-of-the-art knowledge, skills, and tools on using evidence-based clinical practice guidelines in daily practice at King Saud University Medical City
Training Program Objectives: At the end of the training program, participants should be able to:1. Define Evidence-Based Medicine (EBM) and Clinical Practice Guidelines (CPGs).2. Discuss the rationale and aims for using CPG.3. Name the stakeholders involved in CPGs.4. Identify types of CPGs.5. Recognize standards of trustworthy or high quality CPGs6. Describe the difference between the (de novo) development versus adaptation of CPGs.7. Define CPG implementation and recognize different types of CPGs implementation tools.8. Discuss facilitators and barriers to implementation of CPGs.9. Memorize CPGs that are applicable in the concerned department of the target audience.10. Locate and access the CPGs (online and/or offline) that are applicable in the concerned department of the target
audience.11. Identify which sections to read in the CPG full documents.12. Recognize the contact person(s) for CPGs in the concerned department of the target audience.13. Recognize the composition of the CPG program at KSUMC.14. Appraise CPGs using the AGREE II Instrument.15. Understand the CPG-related QI/ accreditation standards.
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CPGs: Definitions, concepts and standards
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Uncertainty!.....Probability!Sir William Osler (1849 – 1919)
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The Epsom Derby, 1821 (oil on canvas) by Theodore Gericault; Louvre, Paris, France – Slide Courtesy of Prof. Abdelhamid Attia
Importance of ResearchPeople observe what they expect to observe, until shown otherwise
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Importance of ResearchPeople observe what they expect to observe, until shown otherwise
• http://www.youtube.com/watch?v=IEqccPhsqgA&list=PLSC6ykdWzbjHk4fKrmB94yj11dqfkXF0U
57 years later!Sallie Gardner (horse) at a Gallop
Eadweard Muybridge in 1878 – 3 seconds silent film, USA
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Importance of ResearchPeople observe what they expect to observe, until shown otherwise
Sallie Gardner (horse) at a Gallop Eadweard Muybridge in 1878 – 3 seconds silent film, USA
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“EBM” - birth of a termUpdate of CMAJ series on how to read a
paper
JAMA User guides 1991authors seek a new term
Clinical epidemiology?
Scientific medicine?
Evidence-based medicine!Research evidence should guide clinical
practice! Wasn’t it always that way?!
Slide courtesy of Dr. Paul Glasziou
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Evidence-Based Medicine (EBM) Movement: Not new!• 865–925 Al-Razi (Rhazes)
1st need for experiments, comparisons in clinical studies
• 981–1037 Ibn Sina (Avicenna)test effect of drugs on humans not animals only
• 1987 David M. Eddy, MD, PhD ‘EB’ in EBCPGs, policies in workshops, manual
• 1992 Gordon Guyatt, MD‘EBM’ term in JAMA
• 1996 David Sackett, MD‘EBM’ definition in BMJ
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How can we find the research that will improve the care of our patients?
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Slide courtesy of Dr. Paul Glasziou
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Two Different Approaches to Evidence-Based Practice
Clinical Practice Guidelines (CPGs)•“Top-down” approach• Tell clinicians how to practice• Favored by health care systems
Evidence-Based Medicine (EBM)•“Bottom-up” approach• Teach clinicians how to find answers• Favored by medical educators
Slide courtesy of Prof. Afaf Ibrahim
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The EBM Triad
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Knowledge TranslationKnowledge transfer & exchange
Implementation science/ researchResearch utilization
System/ Provider and Quality ImprovementDissemination & diffusion Research useKnowledge transfer & uptake
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Definition: (old)
“Systematically developed statements to assist
practitioner and patient decisions about
appropriate health care for specific clinical
circumstances” (IOM 1990)
Clinical Practice Guidelines (CPGs)
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“Statements that include Recommendations
intended to optimize patient care that are
informed by a Systematic Review of evidence
and an assessment of the benefits and harms of
alternative care options” (IOM-AHRQ 2011)
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Although CPGs have been identified as tools for improvement of patient healthcare outcomes, there is an increasing and often unmanageable volume of published CPGs that creates confusion for healthcare providers due to the variability in the quality of these CPGs (Altokhais 2016, Greenhalgh 2014)
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Evidence Pyramid (Study design)
SR
RCT
Cohort
Case control
Case series
Case report
Expert opinion
I
II
III
IV
A
B
C
Leve
ls o
f Evi
denc
eG
rades of Recom
mendations
MA
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The proposed new EBM pyramid.
M Hassan Murad et al. Evid Based Med 2016;21:125-127©2016 by BMJ Publishing Group Ltd
New evidence pyramid
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It’s peer-reviewed, therefore it must be OK?
Slide courtesy of Dr. Paul Glasziou
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methods
Benefits
Risks/ Burden
QoE!
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LevelEvidence
(LoE)
GradeRecomm.
(GoR)
Strength
EVIDENCE PYRAMID
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Crisis in EBM?
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What is ‘real EBM’ and how to achieve it?
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What is ‘real EBM’ and how to achieve it? (cont’d)
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Relationships between Quality Improvement (QI) and Evidence-Based Medicine (EBM).
Paul Glasziou et al. BMJ Qual Saf 2011;20:i13-i17
Copyright © BMJ Publishing Group Ltd and the Health Foundation. All rights reserved.
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HWCPG-SURG-001
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CPG-OBGYN-001
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HWCPG-ENT-001 (ABRS) 2013
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WhyDo we need
CPGs?
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Rationale for CPGs• Worldwide concerns about:-
▫Unexplained variation/ variability in CP!
▫Rising healthcare costs!
▫Exponential growth of health information!
• Aim of CPGs:-To facilitate more consistent, effective and efficient practice and improve health outcomes for patients
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CPGs:For whom?
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Stakeholders (TEAM)
•Physicians•Nurses•Pharmacists•Technicians•Technologists•Decision makers•Patients•Public
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Types of CPGs1. Evidence-Based CPGs (evidence-
based methodology)2. Consensus/ expert-based CPGs
Which type do you think is better?
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The EBM Triad
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CPGs on the Web
Producers Finders
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Guideline Producers• Specialized (professional) societies• Healthcare Organizations• Governmental (National) organizations:
NICE, SIGN, NHMRC, ,etc.• International organizations
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Organization Name Country URL Producer
Finder
Guidelines International Network (G-I-N) International http://www.g-i-n.net F
World Health Organization (WHO) International http://www.who.int/topics P
National Institute for Health & Care Excellence (NICE)
UK http://www.nice.org.uk/page.aspx?o=ourguidance P
Scottish Intercollegiate Guidelines Network (SIGN) UK http://www.sign.ac.uk/guidelines/
index.html P
National Guidelines Clearinghouse (NGC), AHRQ USA http://www.guidelines.gov F
EBSCO DynaMed USA dynamed.ebscohost.com/user/login
Institute for Clinical Systems Improvement (ICSI) USA http://www.icsi.org/knowledge/ P F
US National Library of Medicine, National Institutes of Health (PubMed) USA
http://www.ncbi.nlm.nih.gov/pubmed
OR http://www.pubmed.govF
Google Scholar USA https://scholar.google.com/?hl=ar&safe=on
F
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CPG Producers: National Agencies
NICENational Institute for Health & Clinical Excellencewww.nice.org.uk
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NICE Guidance
132 CPGs
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CPG Producers: National Agencies
SIGNScottish Intercollegiate Guidelines Networkwww.sign.ac.uk
14 groups
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World Health Organization
• WHO guidelines for safe surgery: safe surgery saves lives (2009)
• Best Practice Guidelines on Emergency Surgical Care in Disaster Situations (2007)
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CPGs Finders• National Guidelines Clearinghouse (NGC/
AHRQ)• Guidelines International Network (G-I-N)• EBSCO DynaMed• PubMed/ MedLine• Google Scholar
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CPG Finders
AHRQ-NGCNational Guideline
Clearinghouse
www.guidelines.gov
> 408 CPGs
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Shaikh Bahamdan’s Research Chair for Evidence-Based Health Care & Knowledge Translation
Member of G-I-N since Oct. 2009Free access to International CPG Library of G-I-N
http://c.ksu.edu.sa/ebhc
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CPG FindersPubMed: US National Library of Medicine,
National Institutes of Health (NIH)
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Specialized Societies: PEDIA AAP
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SURG RCS
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SURG ACOS
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MED ACP
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FM/PC AAFP
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OBS-GYNE RCOG
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CARDIO ESC
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PSYCH The Maudsley Hospital
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PSYCH APA
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ORTHO AAOS
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Radiology ACR
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Radiology ACR
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What makes a trustworthy CPG?
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Standards for high quality CPGsIOM 2011 – G-I-N 2012 – AGREE 2013
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Standards for trustworthy CPGsIOM 2011 G-I-N 2012
1- Establishing Transparency 1- Decision making process. 2- Methods
2- Management of COI 3- COI
3- (GDG) composition 4- GDG composition
4- (CPG – SR) intersection 5- Evidence reviews
5- Assign/ link to (LoE) & (GoR) 6- Rating of E & Rs
6- Articulation of (Rs) 7- CPG Rs (formulation/ wording)
7- External Review 8- Peer review & stakeholder consultation
8- Updating 9- Expiration & updating
10- Scope of CPG
11- Financial support/ sponsoring organization
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How to assess of the quality of any CPG?
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23 Items in 6 Domains USER’S MANUAL page 7
DOMAINS No. of Items
1 Scope & Purpose 3
2 Stakeholder Involvement 3
3 Rigour of Development 8
4 Clarity & Presentation 4
5 Applicability 3
6 Editorial Independence 2
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CPG development methodologies
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CPGsWhat to do?
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Read
AdoptAdapt
Develop
CPGs ?Slide courtesy of Prof. Nabil Dowidar
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CPGsDEVELOPMENT
(de novo)vs.
ADAPTATION
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Different Options to deal with CPGAdoption
Adaptation
Rejection
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Process/ Methods
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Adaptation of CPGsIs the systematic approach to the endorsement and/or
modification of a guideline(s) produced in one cultural and organizational setting for application in a different context. Adaptation may be used as an alternative to de novo guideline development, e.g., for customizing (an) existing guideline(s) to suit the local context.
http://www.adapte.org/http://www.g-i-n.net/
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Team - TopicTotal Number of Health Topics for CPGs from all departments
53
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Selecting a CPG Topic Prevalence of the condition (high volume) Patient safety concern (high risk) Under-, over-, misuse of intervention(s) Burden due to the condition Practice variation Costs of different practice options Likelihood of effectiveness of CPG Potential for improving quality of care and/or
outcomes Existence of relevant good quality CPGs
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KSUMC Protocol for New CPG
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Health/ Clinical/ Key QuestionsPatient (& disease characteristics)
Intervention(s)
Professionals (Target users)
Outcomes (purpose of the CPGs)
Healthcare settings (& context)
CPG Scope: PIPOH Model
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Health Question Tool (modif.)
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Inclusion / Exclusion CPGs Selection Criteria (6) 1. Methods of Development: Evidence-Based CPGs:
(Detailed Methodology not Consensus-based CPGs (Expert opinion)
2. Author(s): Organization and Specialized Society not single authors.
3. Country: International not national CPGs.4. Date of Publication: range of year of publications: last 5
years or less (e.g. 2011 – 2016) – except if none!
5. Language: English CPGs only6. Status: only Original source CPG (de novo developed)
rather than adapted CPGs
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CPG selection criteria Tool (new)
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CPGs on the Web
Producers Finders
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How to assess of the quality of any CPG?
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The concept of the ‘LIVING’ CPG
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End of Finalization Phase1. After end of External review2. CPG Dept. committee submit finalized CPG draft to R & D Unit,
Quality Management Department for review;3. Submit to CPG Steering Committee for review of adaptation
process methodology and final approval;4. Congratulations letter to Chairman of department5. Start dissemination and implementation in relevant
departments;6. Follow up, clinical auditing & measurement in relevant
departments;
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:: Evidence to practice/ knowledge to action cycle ::
CPG Implementation (CPGI)
Strategies & Tools
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CPGI“The concrete activities and interventions undertaken to turn policies into desired results“Guidelines for clinical practice: from development to use. IOM, 1992
CPGs Practice
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CPG “Implementability”
Set of characteristics that PREDICT the relative ease of implementation of CPG recommendations.
Implementability…….BEFORE implementation
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How to Measure Implementability?
Ease and accuracy of translation of guideline advice into systems that influence care.
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Dissemination & Implementation
Nothing could be more frustrating than producing a CPG that is then ignored by not being disseminated
nor implemented nor updated.
The concept of the ‘LIVING’ CPG
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CPGI Tools
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Adapt/ design CPGI Tools to be made available at the point of care (* MR/ EMR)
Examples• Clinical Algorithms• Integrated Care/ Clinical Pathways• Protocols• Policies & Procedures• Chart Documentation/ forms (e.g. Physician Order
Sets: paper vs. CPOE system +/- CDSS)• Quick Reference Guides/ Physician Guides &
Pocket Guide/Reference Cards (at-a-glance summary of key recommendations).
• Mobile Apps
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• Clinical audit criteria (tool)• Quality/ Performance measures (process, outcome
KPIs)• Quality Tools (e.g. FMEA)• Slide Presentation.• Wall Poster.• Patient Resources/ Information (HE guides).• Foreign language Translation (Non-Arabic, Non-French).• Implementation Tool Kits (collections of tools and/or
strategies).• Staff Training/ Competency Material.
CPGI tools (cont’d)
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Mobile Apps for CPGs (mHealth)
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MEDICINE/ CARDIOLOGYSpecs detail
Specialty Medicine
Organization American College of Cardiology Foundation
Cost Free
System Android
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PEDIATRICSSpecs detail
Specialty Pediatrics
Organization Royal Children’s Hospital, Melbourne
Cost Free
System Android
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GeneralSpecs detail
Specialty Medicine
Organization NICE
Cost Free
System Android
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GeneralSpecs detail
Specialty General
Organization SIGN
Cost Free
System Android
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NURSINGSpecs detail
Specialty Nursing
Organization RNAO
Cost Free
System Android
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ORTHOPEDICSSpecs detail
Specialty Medicine
Organization American Academy of Orthopedic Surgeons
Cost Free
System Android
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PSYCHIATRYSpecs detail
Specialty Psychiatry
Organization (?)
Cost Paid
System Android
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General Specs detail
Specialty General
Organization Guideline Central
Cost Free/ paid
System Android
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NICE Guidance‘Tools and resources’
• Baseline assessment
• Clinical audit• E-learning
module• Slide set• Tailored
education support
• Case scenario
• Commissioning guide
• Costing statement
• shared learning
• ‘Do not do’ recommendations
• Research
recommendations
• Guidance into practice
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CPG implementation strategies/ interventions
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CPG implementation strategies
Dissemination Process (print/ e-/website)Local Clinical Champions.Awareness raising/ training activities.Networking and linking with existing projects
(e.g. CPD/CME activities, Accreditation, etc..).
Patients as champions for change.Regular M & E (The ‘living’ CPG concept!).
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Audit: Manual
• Source of data: paper patient files (before May 2015) and eSiHi afterwards
• Data collection tools: audit tools included in CPGs (review)
• Specific clinical audit criteria or KPI formulae • Data collection • Data cleansing • Data analysis • Graphical representation and reporting the results
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Audit: Electronic• Continue working on eSiHi quality solutions to
generate reports of CPG-based POWERPLANS or CPOE per diagnosis for CPG (Discern Analytics©, Power-Insight©,..etc.)
• Ensure inclusion of the identified CPG-based KPIs in the built of the new Database of the KPI project
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“Multi-faceted” are more effective than single strategies in CPGI!
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Facilitators and Barriers in CPGI
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Facilitators of CPGIDomain
Positive attitudeLearning through small group interaction
Individual
Leadership supportChampionsTeam work collaboration
Organizational
Scientific specialized association supportInter-organizational collaboration
networks
Environmental
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CPG Implementation Failure! BARRIERS!Extrinsic to CPG:provider & care system-related
Intrinsic to CPG: (>Methodology!)ambiguity – inconsistency - incompleteness
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FMEA RESULTS – Major Failure Modes
Identified potential failure modes in CPGs implementation with the highest RPN (≥ 80):-1. Auditing of the CPGs (e.g. data management process).2. Adaptation process (e.g. AGREE appraisal, Ext. review).3. Networking with existing projects.4. Awareness/training activities.5. Accessible printed & electronic implementation tools6. Advocates from clinical/ quality champions
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RESULTS - Actions taken1. Auditing: Supported by Pedia. CGC, DQT & QMD as a part of
Quality sustainability plan and CPG Program.2. Adaptation: (e.g. AGREE: 4 appraisers, Review: all
Stakeholders)3. Networking: (e.g. Dept. QIP, CPD, Accreditation, Research)4. Awareness/ training activities: Organized regularly.5. Printed & electronic copies*: Available and accessible to HC
providers at points of care. *eSiHi!6. Champions: Consultants/ senior practitioners encouraged to
get involved in CPG adaptation/ implementation.
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CPG Implementation cycle
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CPG Implementation cycle
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Effectiveness of CPGs implementation interventions
Slide courtesy of Dr. Ulfat Shaikh
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G-I-N Working Groups (IWG, PMWG)
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The CPG lifecycle at KSUMC: The CPG Adaptation Program
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KSUMC CPG PROGRAMcurrent status 1437-2016
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Clinical Practice Guidelines (CPGs) Program of King Saud University Hospitals/ Medical City
KSUHs Taskforce Responsible Staff from:KSUMC-Wide CPG Steering Committee;Departmental CPG Committees (former CPGs
subcommittees);Shaikh Bahamdan Research Chair for Evidence-Based
Health Care and Knowledge Translation;Quality Management Department;Head of Units & Chairpersons/ Directors of DepartmentsTop Management & Leadership of College of Medicine
and University Hospitals (Future KSU Medical City)
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Guidelines International Network (G-I-N)www.g-i-n.net
EBHC-KT Chair, King Saud UniversityOrg. Member since 2009
(1st Member from Gulf & 3rd Member from MENA Countries)
Founded in Nov. 2002
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HWQPP – Standing orders development, revision & deletion (2014)
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21 KSUMC CPGs Subcommittees1. Department of Pediatrics 2. Department of Critical Care 3. Department of Psychiatry 4. Primary Care/ Family Medicine Clinics
(Ambulatory Care Services) 5. Department of Pharmacy 6. Department of Emergency Medicine 7. Department of Medicine8. Department of Orthopedic Surgery 9. Department of Otorhinolaryngology 10. Department of Ophthalmology 11. Department of Cardiac Sciences/ KFCC
(Cardiology – Cardiac Surgery) 12. Department of Surgery 13. Department of Obstetrics & Gynecology 14. Department of Dermatology 15. Department of Anesthesiology 16. Department of Laboratory Medicine &
Pathology 17. Department of Nursing
18. Department of Radiology 19. Health Education Center 20. Department of Rehabilitation Medicine21. Department of Infection Control
New (in progress)1. Department of Occupational Health & Safety2. Department of Clinical Nutrition
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0
2
4
6
8
10
12
7
10
6
232321111
01000000000
KSUMC CPGs in al l departments approved by cgc(FEB 2015 - Jumada' I 1436)
# CPGs approved
*Pooling specialties (reviewers)
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KSUMC CPGs in Numbers KSUMC-Wide CPG Committee Members: 12 Departments participating in CPG Program: 21 Health topics identified for CPG projects: 53 CPG adaptation projects finalized: 33 CPGs finalized & approved by CPG Committee: 29 CPGs finalized & implemented: 17 CPGs uploaded to QM website & relevant desktop in points of
care: 28 CPGs implemented & audited (data collected): 13 CPGs implemented & audited (data analyzed): 3
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How to access our CPGs
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Who is the contact person for EBCPGs in each clinical department?
Chairperson & members, CPG Departmental Committee
Lead & members, Department Quality Teams Department Chairman & Units’ Heads Coordinator, CPG Steering Committee: Dr. Yasser Amer Ext. # 91341, Email: [email protected] Medical Secretary, CPG Steering CommitteeMs. Dorothy Villena Ext. # 91281, Email: [email protected]
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Approved KSUMC Adapted CPGs (cont’d)
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How to read the KSUMC CPGs full documents?
Go to TABLE OF CONTENTS:-• Preface by authors• Acknowledgments• Abbreviations• Overview material• Introduction • Statement of intent
• Scope & Purpose (Health Questions PIPOH)• Recommendations (Key & details)• External review & consensus• Plan for scheduled review & update• List of funding sources• Adaptation process methodology• Implementation considerations & Tools• References
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KSUMC CPG Adaptation Program Deliverables
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CPGI• Start with prioritized with strong evidence.• Used a planned and structured approach.• Identify key stakeholders.• Understand facilitators and barriers.• Use evidence-based implementation interventions.• Monitor and evaluate effectiveness.• Modify and improve your approaches.• PLAN – DO – STUDY – ACT – ENJOY!
Slide courtesy of Dr. Catherine Marshall
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Desktop Icon
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With or without Clinical Decision Support (CDS)
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CPOE with Order Sets = In eSiHi are called “POWERPLANS”
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6 PowerPlans from Pediatrics CPGs
1. PED Diabetic ketoacidosis CPG2. PED Severe sepsis/ septic shock CPG3. PED acute asthma CPG4. PED acute bronchiolitis CPG5. PED Fever of known cause in infants 60 days or less
CPG6. NICU Neonatal Hyperbilirubinemia CPG
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5 PowerPlans from Medicine CPGs
1. MED Diabetic Ketoacidosis CPG (adults)2. MED Gout CPG3. MED Hypertensive emergencies/urgencies
CPG 4. MED oncology premedication5. PULM Asthma CPG (adults)
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1 from DEM/ ICU CPGsED septic shock (adults)
1 from Cardiology (KFCC) CPGsCARD Heart Failure CPG
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1 from Orthopedics CPGs
ORTHO persistent non-specific Low Back Pain
CPG (adults)
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2 from ENT CPGs
1. ENT Acute Bacterial Rhinosinusitis CPG (adults)
2. ENT Acute Bacterial Rhinosinusitis CPG (children)
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1 from Family Medicine CPGsFAM Dyslipidemia CPG
1 from Psychiatry CPGsPSYCH Bipolar disorder
CPG
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Paper Days!If it’s not documented, you didn’t do it!
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EMR Days!“eSiHi” days
You documented it . . . . . . . . . Did you (e-) document it properly? Did you do it?
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Anesthesiology (+4)
1. Heart Failure (Adult)2. Surgical Antibiotic prophylaxis (Adult)3. Central Vascular Access Device4. Vancomycin dosing and monitoring (Adult)
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Critical Care (ICU) (2+6)1. Severe Sepsis and Septic Shock (Adult) 2. Venous Thromboembolism Prophylaxis 3. Diabetic ketoacidosis (Adult)4. Vancomycin dosing and monitoring (Adult)5. Surgical Antibiotic prophylaxis (Adult)6. Heart Failure (Adult)7. Surgical Site Infection Prevention 8. Central Vascular Access Device
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Emergency Medicine: Adult/ Pedia ( +18)1. (Acute) Asthma (Adult)
2. Diabetic ketoacidosis (Adult)3. Hypertensive emergencies & urgencies4. Severe Sepsis and Septic Shock (Adult) 5. Gout (acute gouty arthritis)6. Venous Thromboembolism Prophylaxis 7. Vancomycin dosing and monitoring (Adult)8. Surgical Antibiotic prophylaxis (Adult) (NSG
care)9. Heart Failure (Adult)10. Bipolar disorder 11. Persistent non-specific Low back pain (Acute
attack)
1. Acute Asthma exacerbations (Child)
2. Acute viral Bronchiolitis3. Diabetic Ketoacidosis (Child) 4. Fever without a source in
infants 60 days or less5. Neonatal Jaundice6. Severe Sepsis and Septic Shock
(Child)7. Status Epilepticus in (Child)8. Pediatric and neonatal
parenteral nutrition (TPN)
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Otorhinolaryngology/ ENT (1 + 2)
1. Acute Bacterial Rhino-sinusitis (Adult/ Child)2. Surgical Antibiotic prophylaxis (Adult)3. Venous Thromboembolism Prophylaxis
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Family & Community Medicine (1+3)
1. Dyslipidemia and prevention of atherosclerosis2. Gout (acute gouty arthritis/ hyperuricemia)3. Persistent Non-specific Low Back Pain4. Asthma
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Infection Control (+2)
• Surgical Site Infection Prevention • Surgical Antibiotic prophylaxis
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King Fahad Cardiac Center (2+ 8)
1. Heart Failure (Adult)2. Cardiac Artery Bypass Graft Surgery3. Hypertensive emergencies & urgencies4. Dyslipidemia 5. Venous Thromboembolism Prophylaxis6. Vancomycin dosing and monitoring (Adult) 7. Surgical Site Infection Prevention 8. Surgical Antibiotic prophylaxis (Adult)9. Pediatric and neonatal parenteral nutrition (TPN)10. Central Vascular Access Device
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Laboratory Medicine & Pathology
Review 99.99% CPGs!
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Medicine (6 +5)1. Asthma (Adult)2. Diabetic ketoacidosis (Adult)3. Hypertensive emergencies & urgencies4. Gout (acute gouty arthritis/ hyperuricemia)5. Lung Cancer 6. Antiemetics for Chemotherapy-induces nausea & vomiting 7. Venous Thromboembolism Prophylaxis 8. Dyslipidemia 9. Vancomycin dosing and monitoring (Adult)10. Surgical Antibiotic prophylaxis (Adult)11. Heart Failure (Adult)
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Nursing (3)• Surgical Site Infection Prevention• Central Vascular Access Device• Extravasation in chemotherapy
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Obstetrics & Gynecology (2 +3)
1. Antenatal corticosteroids for fetal maturation2. Number of Embryos to transfer in IVF
Treatment3. Venous Thromboembolism Prophylaxis4. Surgical Site Infection Prevention 5. Surgical Antibiotic prophylaxis (Adult)
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Ophthalmology (+2)
• Surgical Antibiotic prophylaxis (Adult)
• Venous Thromboembolism Prophylaxis
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Orthopedics (1 +3)1. Persistent Non-specific Low Back Pain2. Venous Thromboembolism Prophylaxis3. Surgical Site Infection Prevention 4. Surgical Antibiotic prophylaxis (Adult)
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Pediatrics (7+2)1. Acute Asthma exacerbations (Child) 2. Acute viral Bronchiolitis3. Diabetic Ketoacidosis (Child) 4. Fever without a source in infants 60 days or less5. Neonatal Jaundice6. Severe Sepsis and Septic Shock (Child)7. Status Epilepticus in (Child)8. Pediatric and neonatal parenteral nutrition (TPN)9. Acute bacterial rhinosinusitis (Child)
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Pharmacy Services (3)• Vancomycin dosing and monitoring (Adult)• Pediatric and neonatal parenteral nutrition (TPN)• Antiemetics for Chemotherapy-induces nausea &
vomiting
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Psychiatry (1+ 1?) 1. Bipolar Disorder2. Venous Thromboembolism Prophylaxis
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Physical/Rehabilitation Medicine (+1)
1. Persistent Non-specific Low Back Pain2. (?)
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Radiology/ Imaging (+4) 1. (Acute) Asthma (Adult) - ?CXR2. Acute Asthma exacerbations (Child) - ?CXR3. Acute viral Bronchiolitis - ?CXR4. Status Epilepticus in (Child) - ?CT/ MRI Brain5. Acute Bacterial Rhino-sinusitis (Adult/ Child) - ?CT/
MRI PNS
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Surgery (1 + 4) 1. Surgical Antibiotic prophylaxis (Adult/
Pedia)2. Venous Thromboembolism Prophylaxis3. Surgical Site Infection Prevention 4. Vancomycin dosing and monitoring (Adult)5. Pediatric and neonatal parenteral nutrition
(TPN)
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Examples of KSUMC Clinical Practice Guideline Adaptation
& Implementation Projects
presented and/or published in national/ international conferences
and/or journals
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Lists of publications that resulted from the program (list is not exclusive)
1. Schünemann HJ, Al-Ansary LA, Forland F, Kersten S, Komulainen J, Kopp IB, et al. Guidelines International Network: Principles for Disclosure of Interests and Management
of Conflicts in Guidelines. Ann Intern Med. 2015;163:548-553. doi:10.7326/M14-1885
2. Mohamed S. From Concept to Bedside: What Pediatricians Should Know about Synthesis of Clinical Practice Guidelines? Iran J Pediatr 2014; 24(5): 557-64
3. Ciocson MAFR, Hernandez MG, Atallah M, Amer YS. Central Vascular Access Device: An Adapted Evidence-Based Clinical Practice Guideline. JAVA 2014; 19(4): 221-37
4. Al-Ansary LA, Tricco AC, Adi Y, Bawazeer G, Perrier L et al.
A systematic review of recent clinical practice guidelines on the diagnosis, assessment and management of hypertension. PLoS One. 2013;8(1):e53744. doi:
10.1371/journal.pone.0053744.
5. Al-Otair HA, Khurshid, Alzeer AH, Venous thromboembolism in a medical intensive care unit the effect of implementing clinical practice guidelines. Saudi Med J 2012; 33
(1): 55-60.
6. Eldawlatly A, Qureshi S, Schumann R. "ROAD MAP" toward establishing clinical practice guidelines for anesthesia in morbidly obese patients undergoing weight loss
surgery. Saudi J Anaesth 2012;6:319-21
7. Wahabi HA, Alzeidan RA. Reasons behind non-adherence of healthcare practitioners to pediatric asthma guidelines in an emergency department in Saudi Arabia. BMC
Health Serv Res 2012; 12: 226 (doi:10.1186/1472-6963-12-226)
8. Wahabi HA, Al-Ansary LA. Innovative teaching methods for capacity building in knowledge translation. BMC Med Educ 2011 Oct 14;11:85 (doi: 10.1186/1472-6920-11-85)
9. Wahabi HA, Alzeidan RA, Fayed AA, Esmaeil SA, Al Aseri ZA.
Attitude and practice of the health care professionals towards the clinical practice guidelines in King Khalid University Hospital in Saudi Arabia. J Eval Clin Pract. 2011 Aug;
17(4):763-7 (doi: 10.1111/j.1365-2753.2011.01694.x.)
10. Wahabi HA, Al-Ansary LA. Great expectations from the chair of evidence-based health care and knowledge translation. Saudi Med J 2009; 30(8): 989-90.
11. Al-Ansary, L. A. and A. Alkhenizan. Towards evidence-based clinical practice guidelines in Saudi Arabia. Saudi Med J 2004; 25(11): 1555-1558.
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Conference papersNational and International Conferences:
1. Al-Ansary L. Oral presentation. KSUMC CPG program at the Second wave of CPGs at the Saudi Evidence-Based Healthcare Center, Ministry of Health (2015).
2. Mohamed S et al. Substantial Reduction in Length of Hospital Stay of Patients with Diabetic Ketoacidosis after Implementation of Clinical Practice Guidelines at a University Hospital in Saudi Arabia at Conference: ENDO 2015: The Endocrine Society's 97th Annual Meeting and Expo, At San Diego, California, USA. March 5-8 2015.
3. Amer YS. Poster. Amer YS, Alswat K, Al-Ansary L, Wahabi HA, Shaikh F. Capacity building for adaptation of clinical practice guidelines at International Forum for Quality and Safety in Healthcare, IHI/ BMJ. London, UK 2015.
4. Amer YS. Oral presentation. Babiker A, Amer YS, Wahabi H, Alswat K. Failure Mode and Effect Analysis (FMEA) For Implementation of Clinical Practice Guidelines at a Tertiary Care Teaching Hospital in Saudi Arabia at 32nd International conference of The International Society for Quality in Health Care (ISQua), Doha, Qatar, 4-7 October 2015.
5. Titi M. Oral presentation. Alhabeeb W, Titi M, Rabea N, Amer YS. Adaptation and Implementation of an Evidence-Based Clinical Practice Guideline for Management of Heart Failure in a University Medical City at the 32nd International conference of The International Society for Quality in Health Care (ISQua), Doha, Qatar, 4-7 October 2015.
6. Ciocson MAFR. Poster. Central Vascular Access Device: An Adapted Evidence-Based Clinical Practice Guideline at International Nursing Conference at KSUHS (2015).
7. Al-Ansary L. Oral Presentation. Al-Ansary L, Amer YS, Fattouh R, Adi Y. Partnering To Transform Clinical Research into Evidence-Based Health Care Guidelines at 10th International conference of Guidelines International Network 2013, San Francisco, USA. (abstract published in BMJ Quality & Safety 2013).
8. Amer YS. Poster. Abahussain E, Fatani S, Tawariji M, Al-Ansary L, Amer YS. Management of Patients With Bipolar Disorder: An Adapted Clinical Practice Guideline from King Saud University, King Khalid University Hospital, Clinical Practice Guidelines Committee, College of Medicine and Department of Psychiatry at 10th International conference of Guidelines International Network, San Francisco, USA (abstract published in BMJ Quality & Safety 2013)
9. Mohamed S. Featured Poster and oral presentation. Development and implementation of Clinical Practice Guidelines in Pediatric Endocrinology: Challenges and opportunities at ENDO 2013 The Endocrine Society's 95th Annual meeting and Expo, San Francisco June 15-18, 2013.
10. Mohamed S. Poster. Mohamed S et al. Development and implementation of clinical practice guidelines in diabetic ketoacidosis: NICE is also nice in the Middle East at 9th Joint Meeting of European Society of Paediatric Endocrinologists 19-22 September 2013.
11. Mohamed S. Oral presentation. Development and implementation of Clinical Practice Guidelines in Pediatrics Department, KSUHS: Challenges and opportunities at First Quality Day Symposium at KSUHS (2013).
12. Hasan G. Oral presentation. Sepsis in PICU: Obstacles for implementation of Sepsis Guidelines at the Saudi Critical Care Society. SCCS, Dammam. (2012). Video: http://rmsolutions.net/sccs/2012/?q=node/29
13. Hasan G. Oral presentation. Implementation of sepsis and septic shock clinical practice guidelines: overcoming the challenge at 2nd Annual International Conference of the Saudi Critical Care Society SCCS 2011, Riyadh (2011).
14. Wahabi HA. Oral presentation. From evidence to practice in countries where health policy is not evidence-based (S7) at 7th International conference of the Guidelines International Network, Chicago, USA, 2010. Link: http://www.g-i-n.net/conference/past-conferences/document-store/g-i-n-conferences/chicago-2010/presentations-chicago-2010/wahabi-s7.pdf
15. Alzeidan R. Oral presentation. Reasons behind non-adherence to pediatric asthma guidelines in emergency department of King Khalid University (S90) at 7th International conference of the Guidelines International Network, Chicago, USA, 2010.
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What is your role as a HCP in CPGs? “spread the word”
1) CPG implementers/users:“Your continuous feedback!”
2) CPG developers/adapters.3) Improvement research projects.