Expression of interest information pack

Critical Care Clinical NetworkStandardised inotropes and vasopressors: Implementation pilotsubcommittee group

Project background

The Critical Care Clinical Network (CCCN) works with critical care clinicians to improve the quality of care and patient experiences in Victorian critical care Units (ICU/HDU/Critical Care Units). A key priority area for CCCN is to reduce variation in clinical practice and improve consistency of care. A method identified to achieve this is through the use of standardised guidelines.

In 2016, the Victorian ICUs identified the need to standardise the central administration of inotropes and vasopressors. Standardisation of inotropes and vasopressors will aid in reducing medication error and as such patient harm. It will also benefit clinicians through ensuring access to up-to-date evidence based guidelines and reducing the need for unit’s to create or review their guidelines. Moreover, it will reduce staff training and potential confusion for those who work across multiple sites.

The project is currently in phase three - implementation phase. This will involve four pilot hospitals (inner metro, outer metro, private and regional) being provided with change management strategies, support and resources to implement:

- Nine inotropes and vasopressors guidelines

As well as review:

- Inotropes and vasopressors learning package: a resource used by Liverpool ICU (NSW) and endorsed by the Agency for Clinical Innovation (ACI). It outlines physiology relevant to inotrope and vasopressor use, the clinical indication and mechanism of action for commonly used inotropes and vasopressors, how to calculate drug doses for these and learning activities.

Purpose of the subcommittee group

To be an expert group that guides, monitors and supports the Standardised inotropes and vasopressors: Implementation pilot.

Objectives of the subcommitteeThe subcommittee objectives are to:

utilise their expertise to support the Clinical Fellow in ensuring effective implementation of the pilot

support pilot sites in the implementation of the guidelines and learning package through enhancing their ability to apply change management and quality improvement principles

review the pilot measures and results (see Appendix 1)

promote the Standardised inotropes and vasopressors: Implementation pilot with critical care clinicians across Victoria

provide advice on upscaling the project on completion of the pilot.

Subcommittee Terms of Reference The subcommittee operates under the following terms of reference:

encourage the generation of new ideas and the sharing of local innovation in quality improvement collaborate with peers and relevant bodies to promote and enable the effective implementation of the pilot identify recommendations for participating project sites to best achieve outcomes and provide strategies if sites

have difficulties subcommittee members may also be required to undertake actions between meetings.

Subcommittee composition

The subcommittee will consist of the following types of members:

ICU clinicians of all levels i.e. we want clinicians of varying experience levels to bring their expertise to the project e.g. new graduate nurses, ICU registrars, pharmacists, nurse educators etc.

members from Ambulance Victoria / Adult Retrieval Services Victoria

members from the Critical Care Clinical Network and Safer Care Victoria

Consumers.

Length of membership

The appointment will be for the length of the pilot from 19 June – 8 November 2018.

Responsibilities of subcommittee members

Subcommittee members are expected to:

actively contribute in meetings and network activities bring ideas and local innovation to the subcommittee’s attention following consultation with peers, and other

health professionals promote the project within their department and organisation submit an apology to the secretariat if unable to attend sign a confidentiality agreement proxy representatives will be considered.

Time commitment: meetings

The expectation is that subcommittee members will attend 4 x 2 hour meetings during the pilot (see timeline with subcommittee times highlighted in Appendix 2). The dates of the meetings are:

19 June 12 July 21 August 8 November.

The subcommittee meetings will have a prescribed structure, outlining the purpose and action plans for each meeting. The proposed process will cover structured topics for each meeting with outcomes to be achieved. A quorum is achieved with 50 per cent plus one of members in attendance at a meeting within 20 minutes of the scheduled commencement time of the meeting.

Members will not reveal any confidential or proprietary information entrusted in the course of their duties. Upon cessation of membership, and thereafter, the member shall not reveal any confidential or proprietary information, which they obtained while a member of the subcommittee, and may not use or retain, or attempt to use or retain, any such information, documents or data (see separate confidentiality form).

How to apply

The CCCN is seeking expressions of interest (EOI) from individuals to be part of the subcommittee for the Standardised inotropes and vasopressors: Implementation pilot. To participate in the subcommittee, please complete the following by COB 8 June 2018 and email to criticalcare.clinicalnetworks@safercare.vic.gov.au:

1. Complete the EOI form which outlines your background, interest and the relevant experience you’ll bring to the pilot.

2. Complete the Confidentiality and conflict of interest form.

Frequently asked questions

Who is Safer Care Victoria?Safer Care Victoria (SCV) is the state’s healthcare quality and safety improvement agency. SCV works with consumers, families and carers, clinicians and health services to monitor and improve the quality and safety of care delivered across our health system.

Relevant publications

SCV Strategic plan 2017–2020

SCV Corporate plan 2017–2018

SCV framework for Clinical Networks

Clinicians as partners: A framework for clinician engagement

What is Safer Care Victoria’s relationship with the Department of Health and Human Services?SCV is an administrative office Administrative Office of the Department of Health and Human Services.

Under section 14(1) of the Public Administration Act 2004, an Administrative Office head is responsible to the Secretary in relation for the general conduct and effective management of the functions and activities of the Administrative Office.

At a functional level, SCV provides advice to the department on clinical quality and the safety implications of policy,

planning and funding decisions.

What are the SCV Clinical Networks?Our 11 Clinical Networks link SCV with clinicians in health and community services, drawing on their expertise to drive improvements. They play an important role in supporting high quality healthcare, which is person-centered, safe and effective.

The Clinical Networks are tasked with:

identifying and implementing care that is supported by the best available research

improving the quality and safety of care delivered to patients

monitoring the performance of health services over time

providing advice to SCV and the Department of Health and Human Services.

Each clinical network has a Governance committee, an INSIGHT (data and evidence) subcommittee and various other working groups that will provide clinical leadership, expertise and advice to SCV.

A core principle for the Clinical Networks is to always act in the best interests of consumers and the wider Victorian community.

As part of our commitment to consumer representation, we include consumers and/or carers on each of our Clinical Network’s Governance, INSIGHT committees and expert working groups. We need consumer representatives from throughout regional, rural and metropolitan Victoria. Teleconferencing options are supported.

To ensure consumers are able to contribute as true partners in Clinical Network activities, all consumer representatives will be provided with appropriate orientation on commencement.

Q. What is the Critical Care Clinical Network (CCCN)

Mental Health Clinical Network

Infection Clinical Network

Renal Clinical Network

Older People Clinical Network

Emergency Clinical Network

Cardiac Clinical Network

Paediatric Clinical Network

Palliative Care Clinical Network

Critical Care Clinical Network

Stroke Clinical Network

Maternity and Newborn Clinical

Network

The Critical Care Clinical Network (CCCN) consists of the 40+ public and private critical care units across regional and metropolitan Victoria.

The network is governed by a multidisciplinary steering committee led by Clinical Advisors Associate Professor Nerina Harley and Associate Professor Graeme Hart. The steering committee held its inaugural meeting in September 2015. The CCCN is supported by a program manager, Monica Holdsworth.

The Critical Care Clinical Network (CCCN) works with intensive care clinicians to improve the quality of care and patient experiences in Victorian critical care units. The CCCN operates across organisational boundaries to facilitate and support quality improvement activities to improve critical care. The network promotes sharing of innovation, knowledge and information with clinicians to spread local innovations and encourage continuous learning. 

What is the Governance committee?The Clinical Network governance committees represent the consumer and clinician member interests, and provide a mechanism for making decisions as well as an avenue for two-way information exchange with SCV.

What is the INSIGHT subcommittee?The Clinical Network INSIGHT subcommittees facilitate the identification and use of meaningful clinical data. Specific to this committee is the ability to identify, analyse and interpret data and use this information to participate in decision-making processes to inform the work of the clinical network.

What are the expert working groups?Subcommittees or working groups will be mobilised to address specific issues and are considered an important engagement strategy for the networks.

Appendix 1

Standardised inotropes and vasopressors: Implementation pilot – outcome measures

1. Pilot baseline/ outcome measures (requires multidisciplinary consultation)

All ICU / Critical Care Units need to collect the following measures pre and post the pilot:Measure 1: Current ICU/ Critical Care Unit’s inotropes and vasopressors guidelines/current practice

Measure 2:.Smart pump drug library entries for inotropes and vasopressors (if applicable)

Measure 3: Confidence rating for change process

Measure 4: Live bed side data collection of the following (de-identified data)

- indication for inotrope/vasopressor

- concentration of inotrope/vasopressor

- dose of inotrope/vasopressor

Measure 5: Reason for variation from provided guidelines (if applicable)

Number required in pre-data and post dataset:- Measure 4 to be collected for up to 5 patients on adrenaline and noradrenaline and up to 2 for the

remaining inotropes and vasopressors- NB. If site doesn’t use all the listed inotropes and vasopressors in the guidelines or doesn’t reach the

provided number, collect the data for as many possible.

Standardised inotropes and vasopressors: Implementation pilot subcommittee EOI information 6

Appendix 1 (cont.)

Standardised inotropes and vasopressors: Implementation pilot – data collection form

Standardised inotropes and vasopressors: Implementation pilot subcommittee EOI information 7

Date

Infusion Medication Adrenaline Dobutamine Dopamine

Isoprenaline Levosimendan Metaraminol

Milrinone Noradrenaline Vasopressin

PreparationAs recorded on current infusion bag/syringe

in ml ofTotal dose volume fluid

Current dosage being administered

mcg/min mg/min mL/hr

(from pump/fluid balance chart)Other (specify units)unit/hr

Why is the patient receiving this infusion?

Decreased Blood Pressure

Decreased Heart Rate

Decreased Cardiac Output

Other:

Was there a variation in practice from the guideline currently in use in the unit?

Yes No

If answered “Yes”, please provide a reason below:

Appendix 2

Standardised inotropes and vasopressors: Implementation pilot – timelineActivity May Jun Jul Aug Sep Oct NovEOI released 18ICUs prepare EOI- ICU identifies if ethics approval is

required- ICU collects information and data

to identify evidence practice gap

ICUs submit EOI 1CCCN Steering Committee reviews EOIs

CCCN notifies ICU of participation 15Subcommittee Meeting 1: overview of pilot, hospitals involved and chosen project measures

19

“Kick Off” Webinar 20Pilot starts 25ICUs collect pre data 25 6ICUs submit draft project plan + pre data(template will be provided)

6

Implementation Science Workshop 10Pre- implementation phase: ICUs plan, develop and test changes to address the practice gap on a small scale

10 3

Subcommittee Meeting 2: review data from sites, review their current performance

12

Teleconference (All sites TBC)Implementation phase: ICUs implement and continue to refine the change on a large scale i.e. across the unit

6 24

Site visits (individual site dates TBC)

Subcommittee Meeting 3: ongoing review of sites performance. Identify if subcommittee members to attend site visits

21

ICUs submit post data 28Post implementation Workshop 2ICUs submit end of project report 12CCCN analysis on post data and provides feedback to ICUs at sector wide forum. Develops and circulates final report

31

Subcommittee Meeting 4: review of final project report, discussions on further spread / statewide implementation of project

8

Standardised inotropes and vasopressors: Implementation pilot subcommittee EOI information 8