Title of presentation How to include the patient ideas but still deliver

latrobe.edu.au CRICOS Provider 00115M

Title of presentation Name of presenter Title of presenter School / Faculty / Division

xx Month 201x

How to include the patient ideas but still deliver best practice with wound care ? Assoc Prof Bill McGuiness PhD, RN, FAWMA Head of School School of Nursing & Midwifery College of Science, Health & Engineering [email protected]

mailto:[email protected]

2 La Trobe University

Outline

• Patient centered care

• Evidenced based practice

• Interfacing both models of care


Evidenced based practice (EBP)

the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”

(Sackett D, 1996)


EBP elements

Population based Normal distribution

Ranking of rigor Levels of evidence

Strength of evidence Plan health care resources

Quality & resources

Science of practice


The rise of the clinical guideline

http://www.awma.com.au/publications/2011_awma_pan_pacific_pressure_injury_guidelines.pdf


Criticism of EBP

‘Cook book’ care Stereotyping

Promotes a hierarchy of care


Patient centered care (PCC)

Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions (Institute on Medicine. "Crossing the Quality Chasm: A New Health System for the 21st Century” 2011)

“Cultural competence is the delivery of health services that acknowledges and understands cultural diversity in the clinical setting and respects individuals' health beliefs, values, and behaviors.” (HasnainWynia Romana 2006)


Aspects of PCC

Individual based Collaboration & respect

Art of practice Caring

Clinician experience, attitude and creativity


Criticism of PCC

Tokenism Hospital hotel

Focus on e-health

Can’t be resourced

How do we combine the principles of evidence based care with

patient centered care

Start with yourself

Who owns the

health concern

How do I respond

when the patient

rejects my advice

What are my

personal biases or

prejudices How creative am I

Establish a collaborative relationship with the patient

What does the

patient want

What is the

patients motivation

How is the patient

getting their

information &

support

What resources

does the patient

have available

Where is the best location for the care ?

Travel time: 20 mins Wait time: 15 mins Consult time: 10 mins

Referral time: 2 wks Travel time: 30 mins Wait time: 20 mins Consult time: 20 mins


Referral time: 4 weeks Travel time: 30 mins Wait time: 30 mins Consult time: 20 mins

An example – Centre of care

Dear Dr

I have a saw

leg

Response time: 2 hrs E-Consult time: 30 mins


Response time: 3 hours Travel time: 0 mins Wait time: 0 mins Consult time: 10 mins

3D printing time: 3 hrs Travel time: 0 mins Wait time: 2 days Consult time: 0 mins

E-technology options

EWMA/AWMA position paper


Alternative care locations

Culture of the care setting

“You did what with the #@* bandage”

Clinician attitude

“I can’t get rid of her. She just wants to talk”

“Please sit still Ethel so I get the best image”

“Waste of my time seeing another obvious

venous ulcer”


Managing Wounds as a Team -2014


The team


(Modified from Dorahy & Hamilton 2009)

Decision making

Setting the expectations

Consider informal care contracts

What the health care

agency will provide

What the patient will

provide

Expected outcomes Time lines

My clinic

I will make every effort to replicate Jenifer

Hawking's legs by:

Reduce the fluid in your leg

Prevent infection of your leg ulcer

Minimize the pain

Help stop the leak and the stink

Me

I will make every effort to

Keep my leg dry

Wear the support bandages

Let Bill know if I am concerned

Be cheerful and humorous

The Patient

The stinking leg ulcer will heal and be out of my life, Dear

Outcome

No longer than 12 weeks to heal

Timeframe

One Fredo frog (flavor determined by the complainant if complaint upheld)

Penalty for non performance

Ethel contract

Monthly

Review

Home weekly and clinic monthly, unless I need to see Bill for entertainment

Care location

Achieving the outcomes collaboratively

Involve the patients in monitoring

Phone photos

Compare with other

patients Leg club©

Social media

Diaries

Pain

Food Teach other patients

Provide feedback as motivation

Be flexible

Open to new ideas

Alternative service

options

Learn from other

clinicians

Let peer support

resolve some

problems

Coach more than a clinician


Some warnings

• You are a registered health professional

• Bound by code of ethics

• Governed by criminal, common and statute law

• Patient center approach should only involved

• Approved devices or products

• Systems that maintains the personal safety of the clinician

• Are legal

• Comply with your personal and professional ethics

So how do we involve the patient in and EBP environment?

Your knowledge of the

evidence and

experience

Patient expectations

& motivation

Creative

re-engineering of care

Legal Professional and Ethical Framework

Passionate &

Persistent &

Creative

World peace &

global warming

Thank you

latrobe.edu.au CRICOS Provider 00115M

…and how

has the

pain been?

Documents

Title of presentation How to include the patient ideas but still deliver