Overview of the progress of the KSUMC Clinical Practice Guidelines Adaptation and Implementation Program in the Department of Pediatrics which is the most active department in the program

1. King Saud University Medical City
Clinical Practice Guidelines Program
PEDIATRICS Departmental Quality Team (DQT)
PEDIATRICS CPGs Departmental Committee
CPGs Implementation & Auditing
Jumada'I 1436 - March 2015KSUMC-Wide CPGs Committee – Pediatrics Departmental CPGs subCommittee
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Presented By
Dr. Yasser Sami Amer
MBBCh, MS Pedia, MS HC Inf, CPHQ
Coordinator/ Advisor, KSUMC-Wide CPG Steering Committee
Coordinator, Pediatrics DQT
Coordinator, R & D, QMD
Member, eSiHi CPOE Physicians Team
Member, G-I-N AWG, IWG, PMWG

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3. 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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"Colofón-Libro de Medicina de Razi" by Muhammad ibn Zakariya al-Razi - Transferred from http://en.wikipedia.org/wiki/Image:Colophon-Razi's_Book_of_medicine_for_Mansur.jpg. Licensed under
Public Domain via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Colof%C3%B3n-Libro_de_Medicina_de_Razi.jpg#mediaviewer/File:Colof%C3%B3n-Libro_de_Medicina_de_Razi.jpg
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Who was the First Epidemiologist?
HIPH Alex

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The EBM Triad

7. 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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8. CPGs New Definition
CPGs are “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”.
Committee on Standards for Developing
Trustworthy CPGs (IOM-AHRQ 2011)

9. KSUMC CPG PROGRAM
current status 2015 - 1436
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11. Clinical Practice Guidelines (CPGs) Program
of King Saud University Hospitals/ Medical City
KSUHs Taskforce Responsible Staff from:
Clinical Practice Guidelines Steering Committee;
Quality Management Department;
Clinical Departments (CPGs Departmental
subCommittees);
Shaikh Abdullah Bahamdan Research Chair for
Evidence-Based Health Care and Knowledge
Translation;
Top Management & Leadership of College of Medicine
and University Hospitals (Future KSU Medical City)
09 JAN 2014Antibiotic Prophylaxis in Surgery 11

12. 21 KSUMC CPGs Subcommittees
1. 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 Medicine
8. 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 Medicine
21. Department of Infection Control
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New (in progress)
1. Department of Occupational Health & Safety
2. Department of Clinical Nutrition

13. Department of
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14. Guidelines International Network
(G-I-N)
www.g-i-n.net
EBHC-KT Chair, King Saud University
Org. Member since 2009
(1st Member from Gulf & 3rd Member from MENA Countries)
Founded in Nov.
2002

15. Adaptation of CPGs
Is 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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KSUMC CPGS IN ALL DEPARTMENTS APPROVED BY CGC
(FEB 2015 - JUMADA'I 1436)
# CPGs approved # CPGs in progress
*Pooling specialties
(reviewers)
DEM actively participated in
adaptation or review of CPGs from
other department (i.e. PED & MED)
PED the most active department in terms of adaptation,
implementation and auditing of CPGs (6 finalized, 6 in progress, 4
fully implemented, 2 with outcome results of auditing

19. Pediatrics
3/5/2015CPGs Adaptation & Implementation in KSUMC: KAUH 2014 19
+1 CPG
reviewed

20. How to access the KSUMC CPGs?
 PAPER
1. CPG Binder (full document)
2. Forms (Implementation
tools)
3. Algorithm Booklet
 ELECTRONIC
Online:
1. QMD website (KSU email)
2. G-I-N website (EBHCKT)
Offline: (intranet)
Desktop Icon
FUTURE:
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22. CPG Binder in the Wards
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23. FORMS
(algorithms, pathways, physician orders)
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24. The Clinical Algorithm Booklet
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Coloured clinical
algorithms of
four Pedia. CPGs:-
1.Acute asthma
2.DKA
3.N. Jaundice
4.FUS

25. Desktop Icon
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Desktop Icon

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28. QMD Website
http://medicinequality.ksu.edu.sa/
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32. G-I-N WEBSITE (INTERNATIONAL
GUIDELINE LIBRARY)
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37. Neonatal Jaundice
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38. Acute asthma
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39. DKA
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40. CPG implementation strategies
Dissemination Process (print/ e-/website)
Local Clinical Champions.
Awareness raising/ training activities.
Networking and linking with existing
projects (e.g. Dept. Clinical Rounds, CPD/CME activities, Accreditation, etc..).
Patients as champions for change.
Regular M & E (Auditing) (The ‘living’ CPG concept!).
Thursday,
March 5, 2015
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41. Adapt/ design CPG implementation tools
available at the point of care (* MR)
TYPES
1. Clinical Algorithm.
2. Integrated Care/ Clinical Pathways*.
3. Protocol and/ or Policy & Procedure
4. Chart Documentation/ checklists/ forms (e.g. Physician Order Sets* later
CPOE/eSIHI).
5. Quick Reference Guides/ Physician Guides & Pocket Guide/Reference Cards (at-a-
glance summary of key recommendations 5 or 1-2 pages).
6. Clinical audit criteria (tool)
7. Quality (outcome/performance) measures
8. Slide Presentation.
9. Wall Poster.
10. Patient Resources/ Information (health education guides).
11. Foreign language Translation (Non-English, Non-Arabic).
12. Implementation Tool Kits (collections of tools and/or strategies).
13. Staff Training/ Competency Material. Thursday,
March 5, 2015
CPGs Implementability & Implemen.tation - Dr. Yasser Amer
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42. How to read the KSUMC CPGs full
documents? 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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43. Health/ Clinical/ Key Questions
Patient (& disease characteristics)
Intervention(s)
Professionals (Target users)
Outcomes (purpose of the CPGs)
Healthcare settings (& context)
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2013
EBCPGs: Dr. Yasser Sami Amer 43
CPG Scope: PIPOH Model

44. Evidence Pyramid
SR
RCT
Cohort
Case control
Case series
Case report
Expert opinion
I
II
III
IV
A
B
C
LevelsofEvidence
GradesofRecommendations

45. Level
Evidence
(LoE)
Grade
Recomm.
(GoR)
Strength
EVIDENCE PYRAMID

46. GRADE Methods
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48. Recommendation sample (GoR = LoE)
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49. Who is the contact person for EBCPGs in your
department?
 Head, Departmental CPG subCommittee:
Dr. Sarar Mohamed
 Members, Departmental CPG subCommittee (#?)
 Head, Department Quality Team:
Dr. Mohamed El-Faki
 Coordinator, KSUMC-Wide CPG Steering Committee:
Dr. Yasser Amer
 Medical Secretary, KSUMC-Wide CPG Steering Committee:
Ms. Dorothy Villena, Ms. Sheila Rivera
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50. Results of the Outcome measurement of CPGs
implementation in Pediatrics: DKA
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51. Results of the Outcome measurement of CPGs implementation in
Pediatrics: Severe sepsis/ septic shock in PICU
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52. Examples of KSUMC Clinical
Practice Guideline Adaptation
& Implementation Projects
presented and/or published in
International Conferences AND
National Events

53. The adapted CPG for Management of
Diabetic Ketoacidosis in children from the
Department of Pediatrics
 Presented by Dr. Sara Mohamed, Associate Professor &
Consultant of Pediatric Endocrinology & Metabolism and Head
of Pediatrics CPGs Subcommittee presented in three
international conferences:-
1. American Endocrine Society Conference, San Francisco,
USA. CPG: challenges and opportunities in 14/6/2013 ENDO
2013 15-18/6.
2. European society of pediatric endocrinology conference,
Milan, Italy in 20/9/2013 – DKA Guidelines: Saudi
Experience.

54. Featured Poster Presentation Number: FP32-6 Poster Board Number: MON-282
https://endo.confex.com/endo/2013endo/webprogram/Paper6468.html
A
DISCLOSURES: Nothing to disclose
Development and implementation of Clinical Practice Guidelines
in Pediatric Endocrinology: Challenges and opportunities
Sarar Mohamed, Hala Omer, Nasir Al Jurryaan, Amir Babiker, Hessah Al-Otibi, Rana Hasanato, Shaikh Iqbal
,Mohamed Elfaki Osman, Nouf Alkhemis, Ali Abdo, Abdulrahman Al-Nemri
Department of Pediatrics & Chemistry, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia

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The Endocrine Society’s 97th Meeting & EXPO (ENDO 2015) March 5 – 8 2015,
San Diego, USA By Dr. Sarar Mohamed

57. Thank YOU all for listening
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Contact Information: Dr. Yasser Sami Amer
Emails: yasser3amer@yahoo.com; yamer@ksu.edu.sa
Mobile: +966-50-857-7246, +966-51-525-2439
Office: +966-11-46-91341