EVIDENCE-BASED
CARE
PROGRAM
©2004-2010 Grey Bruce Health Network
www.gbhs.ca
GBHN
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Program began in 2001 and now consists of 11
hospital sites, partnering 3 corporations in Grey and
Bruce with Open Source Order Sets
The corporations are unified in providing consistent
care according to evidence based standards and
expert practice recommendations
All clinical practices are evidence / expert based
Together we form a collective mind in the pursuit of
better patient outcomes
Evidenced Based Care
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This program coordinates, educates and
evaluates the development and
implementation of clinical pathways, order
sets and other evidence-based care tools.
The program is based on current evidence
and clinical practice guidelines, as well as
addressing workflow issues and the needs
of rural healthcare
What is a Clinical Pathway?
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A mapping of a patients condition that organizes,
sequences and times the major interventions of
nursing staff, physicians and other departments for
a particular case type, subset or condition
Research shows this mapping improves patient
outcomes and reduces length of stay
All pathways are generalized and must be critiqued
to the individual
Pathways are nursing tools, are initiated by nursing
and DO NOT require a Physician order
What is an Order Set?
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Order sets replace “Preprinted orders” that were
traditionally individual physician specific
Order sets can be implemented ONLY by the
physician when signed by them or delegate
Order sets are diagnosis specific and based on
published guidelines and research
Order sets are initiated for MOST RESPONSIBLE
diagnosis for admission
Order sets are generalized in approach and
critiqued to the individual and their comorbidities
Where does the evidence
come from?
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The ideal evidence-based system would have
automatic links summarizing all relevant and
important research evidence about all clinical
problems, and update you whenever a patients
chart was accessed, based on their diagnosis and
co-morbidities.
Critical thinking of the practitioner is still the vital
link to successful patient outcomes
Research data
The Development Teams and Annual Review Teams
review the Research Data found to create and update
our Clinical Pathways
How do we find the
evidence?
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Review published guidelines for various diagnosis
and organizations
The EBC Program chairs an expert based
multidisciplinary team who is responsible for up to
date practice guidelines
Being a member of Open Source Order Sets grants
access to expert advice and practices from across
Canada
Workflow and resource considerations from front
line staff
What if there is no
evidence?
 Personal
 Expert
experience
opinion
Comparison
of
Expert-Based Care
and
Evidence-based Care
Expert-based Care
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Expert opinion
Experts or publication by experts
essential
Hierarchical approach
Expert-to-pupil relationship
High value of clinicians
Evidence-based Care
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Critical analysis by interested reader
Electronic access essential
Democratic approach
More egalitarian relationship
Increased scrutiny of technology for
proven benefit before adoption
High value of statisticians as well as
clinicians
Clinical Pathways aim to
have…
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The right people
Doing the right things
At the right time
In the right place
With the right outcome
All with attention to the patient experience
And to compare planned care with care
actually given
Who is Impacted by
Pathways and Order Sets?
Corporate Level
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Improved financial outcomes resulting
in a ‘snowball’ reaction across the
network
Enables acute care institutions to
serve mandated populations by
decreasing ALC volumes
Caregiver and Client
-Improved quality and coordination of care
-Improved clinical outcomes
-Reduced practice variations
-Increased use of Best Practice
-Improved communication and information
transfer across multi-disciplinary teams and
organizations
-Provide consistent patient education across
the network
Responsibilities of Allied
Health Professionals
 Participate - at the corporate level
 Participate – at the caregiver level
 Participate – at the patient level
Clinical Pathway Packages
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Preprinted orders/order sets
Clinical pathway/expected outcomes
Teaching checklist
Patient pathway
Discharge checklist
Patient education materials
Associated links (smoking cessation support;
CHF/Stroke clinics
Available Pathways
Include (but not limited to)
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General Medicine
– Eg. Community Acquired Pneumonia (CAP)
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Medical Oncology
– Eg. Febrile Neutropenia
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General Surgery
– Eg. Total Hip Replacement
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Labour and Delivery
– Eg. Vaginal Birth
Available Order Sets
Include (but not limited to)
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Adult Subcutaneous Insulin Order Set
C-Diff Treatment Order Set
Newborn Circumcision Order Set
ACS Thrombolytic Therapy Order Set
Cellulitis Admission Order Set
Many more developed and being
developed
Available Clinical Protocols
Include (but not limited to)
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Bowel Care Clinical Protocol
Hypoglycemic Clinical Protocol
Hyperkalemia Clinical Protocol
ALC Clinical Protocol
DVT Treatment Clinical Protocol
And many more developed and being
developed
Additional Linked
Information
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Associated Documents are linked to the
order set by clicking on the plus sign beside
each order set
These (AD) include referral forms, external
associated educational workshops info
Clinical Protocols (CP) that are listed within
the associated order set also have an
additional link here for viewing and printing
How to use order sets?
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Order sets are used in the same fashion as hand written
Physician orders
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Order sets are printed from source on demand – copies are NOT
to be kept on hand unless otherwise specified by EBC program
R indicates mandatory order unless crossed out by physician.
Open Box indicates optional order, activated when checked R.
(Note: pre checked medication routes DO NOT authorize the
use of the drug unless drug itself selected)
Reference to additional information, policies, protocols are
provided for guidelines and decision making support
Next Steps
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Document in plan is an electronic version of
the traditional paper pathway; 2 currently
released are Acute Coronary Syndrome and
Community Acquired Pneumonia
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Linkage of evidence electronically
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CPOE (Computer Physician Order Entry)
Data
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Nurses and Health Care Professionals
are now being heard from the bedside
Data can be tracked requiring best
practice standards shown to be met
Careplans (document in plan) will be
used more effectively and consistently
Contact Information for
Suggestions/Comments
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Open forum on order set repository links directly to
the program
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Contact information on web site
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Andrea Rawn
EBC Program Co Ordinator
Education/Utilization Coordinator
Evidence Based Care Program
arawn@gbhs.on.ca