Supporting Best Practice Guideline Initiatives at the Local Unit Level

Supporting Best Practice Guideline Initiatives At The Local Unit Level Manager’s Information Booklet Nursing Practice and Education 2018/19 Supporting Best Practice Guideline Initiatives at the Local Unit Level

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Table of Contents

Introduction .............................................................................................................. 1 Best Practice Guideline Funding Process ................................................................ 2 Identifying a BPG Nurse Champion ......................................................................... 4 Identifying a Unit Mentor .......................................................................................... 4 Roles & Responsibilities ........................................................................................... 4 St. Michael’s Hospital Best Practice Spotlight Organization Team Contact Information ............................................................................................................... 7 Quality Improvement & Change Management Resources ....................................... 7 Appendices .............................................................................................................. 7 References ............................................................................................................. 16

Supporting Best Practice Guideline Initiatives at the Local Unit Level

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Introduction This booklet is an information resource for Clinical Leader Managers (CLMs) who are dedicated to providing support and leadership at the local unit level for building evidence based nursing practice through the implementation, evaluation, spread and sustainability of Best Practice Guidelines (BPGs). The booklet provides background and overview regarding St. Michael’s Hospital Best Practice Spotlight Organization designation and the Registered Nurses’ Association of Ontario (RNAO) BPGs. It also provides information on the backfill funding process, identifying a BPG Nurse Champion and Unit Mentor and, roles and responsibilities.

Best Practice Spotlight Organization BPSO refers to Best Practice Spotlight Organization, the designation awarded by the RNAO upon successful implementation, evaluation and knowledge translation of established nursing BPGs. The association created its BPG program to provide nurses and healthcare teams with the most up-to-date, comprehensive, best evidence-based patient-care and healthy work environment recommendations. RNAO BPG’s are recognized provincially, nationally and internationally. (RNAO, 2012) St. Michael’s Hospital launched its three-year BPSO candidacy journey during Nursing Week 2009 and achieved designation in spring 2012. The hospital joins hundreds of national and international healthcare organizations and academic settings who have achieved BPSO designation.

St. Michael’s is committed to maintaining our BPSO designation by actively engaging staff nurses to take the lead in contributing to the hospital’s evidence-based nursing culture. Backfill funding opportunities provide BPG Nurse Champions at the local unit level dedicated time to engage in quality improvement, develop leadership skills and build capacity while facilitating practice improvements and sustaining changes that enhance quality patient care.

Best Practice Guidelines RNAO BPGs are comprehensive evidence based documents that provide tools, resources and recommendations relevant to a specific topic. Clinical BPGs have been developed for older persons, adults, adolescents and children and, are focused on health promotion, disease prevention and curative topics. Healthy Work Environment (HWE) BPGs have also been developed for topics relevant to supporting healthy work environments. (RNAO, 2012) BPGs are implemented based on the specific needs of the organization, practice setting and/or patient/family population. The implementation of a BPG should address one or more of the following objectives (RNAO, 2012): • To deliver effective care based on current evidence • To resolve a concern in the clinical setting (e.g. improved pain management) Supporting Best Practice Guideline Initiatives at the Local Unit Level 1

• • • •

To achieve excellence in care delivery by meeting or exceeding quality assurance standards To introduce an innovation (e.g. a new test or treatment) To eliminate use of interventions not recognized as best practice To create healthy work environments that enable clinical excellence

When identifying a BPG and recommendations to implement, evaluate and sustain, Manager/teams should consider the following: • Needs of the local unit identified by staff surveys and/or other forums • Patient and family surveys and/or other forums • Current local and corporate priorities including but not limited to, St. Michael’s Corporate Strategic Plan, Interprofessional Strategic Plan (ISP), Quality Improvement Plan (QIP) and Senior Friendly Hospital Strategic Plan

Best Practice Guideline Funding Process Backfill Funding When funding is available, backfill opportunities may be available for Managers to identity a staff nurse to step away from direct patient care for a select number of days to enter into a temporary leadership role of BPG Nurse Champion. The BPG Nurse Champion leads local unit implementation, evaluation, spread and sustainability of RNAO BPGs. This may include: • Implementing a new BPG • Evaluating the impact of a previously implemented BPG • Sustaining a previously implemented BPG • Spreading a previously implemented BPG in a local unit to another unit within the same department/program Backfill funding is allocated from the Ministry of Health and Long Term Care (MOH-LTC) Nursing Graduate Guarantee (NGG) Initiative and is subject to vary in amount from year to year. MOH-LTC guidelines stipulate that this funding can only be utilized to replace a staff nurse (BPG Nurse Champion) in direct patient care with another staff nurse, allowing them dedicated time to work on a BPG initiative. Funding cannot be used for other purposes.

Scheduling a BPG Nurse Champion: Guidelines BPG Nurse Champions must be scheduled to work on a local unit BPG initiative for a minimum of 4 hours and a maximum of 12 hours per scheduled day. The BPG Nurse Champion released from direct patient care to work on their BPG initiative for less than 4 hours, will not receive backfill funding for those hours. BPG Nurse Champions should not be working on a BPG initiative during unpaid hours (outside of scheduled BPG initiative days). A staff nurse in a BPG Nurse Champion role should not be scheduled to Supporting Best Practice Guideline Initiatives at the Local Unit Level 2

work on a BPG initiative on top of working full-time hours. The total number of days dedicated for the BPG Nurse Champion to work on their BPG initiative is dependent on the total amount of funding that was requested and approved by Nursing Professional Practice. Other than the Communities’ of Practice scheduled dates, Nursing Professional Practice will not decide when the BPG Nurse Champion should be scheduled to work on their BPG initiative. The Manager and BPG Nurse Champions will choose dates that meet the needs of the local unit, BPG Nurse Champion’s schedule and scope of BPG initiative.

When scheduling the BPG Nurse Champion to work on their BPG initiative consider the following: •

•

•

Schedule the BPG Nurse Champion to work on their BPG initiative once a week or every other week for either 8 hours or 12 hours, depending on the total amount of funding approved. BPG Nurse Champions may prefer to be scheduled 12 hours if 12 hour days are their normal work day. Discuss this with the BPG Nurse Champion Schedule the BPG Nurse Champion to work on their BPG initiative on the same day as when key stakeholder groups are scheduled to meet or are available (i.e. unit based councils, staff meetings, etc.) to allow the BPG Nurse Champion the opportunity to engage with these groups as needed Schedule the BPG Nurse Champion to work on their BPG initiative immediately following the scheduled Communities’ of Practice to allow the BPG Nurse Champion apply any learnings in a timely manner

Receiving Funding A five (5) step funding process has been established to support the application and reimbursement of backfill funding from Nursing Professional Practice to local units.

1. Managers will be requested to submit a BPG Funding Proposal (Appendix A) to Nursing Professional Practice by an established deadline 2. Approvals will be communicated by Nursing Professional Practice to Managers after the BPG Funding Proposal has been reviewed 3. Managers will be requested to submit preliminary midterm RN/BPG Champion Timesheet (Appendix B) to Nursing Professional Practice by an established deadline 4. Managers will be requested to complete the bottom half of the approved BPG Funding Proposal and submit a final RN/BPG Champion Timesheet to Nursing Professional Practice by an established deadline 5. Prior to the end of fiscal year, Nursing Professional Practice will reimburse the local unit cost center identified on the BPG Funding Proposal in the amount of eligible hours listed on the RN/BPG Champion Timesheet Note: If at any time a Manager determines that they will not utilize the total amount of funds approved, please inform Nursing Professional Practice by contacting Marta Sliz Supporting Best Practice Guideline Initiatives at the Local Unit Level 3

(slizm@smh.ca) immediately to allow the reallocation of funds to another area that has identified a need.

Identifying a BPG Nurse Champion A BPG Nurse Champion is selected to lead, facilitate and inspire the BPG implementation and evaluation process. A BPG Nurse Champion must be a registered nurse (RN) employed on a full time or part time basis. When identifying a local unit BPG Nurse Champion, consider the following: • Does the individual demonstrate initiative and commitment to best practices in their current role?

• Is the individual passionate about the topic, patient population and the potential outcomes that can be achieved?

• Does the individual have the ability to lead, coordinate and facilitate an initiative/project?

• Does the individual role model positive clinical leadership?

A Manager may choose to use a formal application process to recruit a nurse to be a BPG Nurse Champion in their local unit. The ‘Call’ for Best Practice (BPG) Nurse Champion Applications template can be modified to meet the needs of the local unit (Appendix D).

Identifying a Unit Mentor Unit mentor candidate qualifications (potential candidate should meet at least one of the following): • Understands the nursing/patient care goals at the local unit level • Has/acquires knowledge of the BPG to be implemented • Has practical experience in implementing a BPG • Available to mentor the BPG Nurse Champion through BPG initiative A Unit Mentor may be a Manager, Clinical Nurse Educator, Resource Nurse, Clinical Nurse Specialist, Nurse Practitioner, a previous BPG Nurse Champion or a clinician in any role who meet the above criteria.

Roles & Responsibilities Manager Acts as the Clinical Leader and provides leadership at the local unit level for improving the quality of patient care by: • Developing a BPG Funding Proposal with input from staff and submitting to Nursing Professional Practice by an established deadline Supporting Best Practice Guideline Initiatives at the Local Unit Level 4

• • • • • •

Identifying a BPG Nurse Champion and a Unit Mentor to support the BPG Nurse Champion Providing leadership and support to local staff, BPG Nurse Champion and Unit Mentor Establishing regular communication with the BPG Nurse Champion to provide support, feedback and receive updates on initiative progress Coordinating BPG Nurse Champion to participate in capacity building activities including BPG Communities of Practice and Nursing Week BPG Sustainability Poster Gallery Walk Event (dates will be provided each year) Scheduling protected time for the BPG Nurse Champion to work on their BPG initiative following the scheduling guidelines mentioned above Assisting and supporting the BPG Nurse Champion to communicate the need, goal, initiative progress and engage staff on the local unit. (e.g., providing updates at staff meetings, team building/skill days, bulletin boards, email, posters, flyers, etc.)

BPG Nurse Champion Collaborates with Manager, Unit Mentor and Nursing Professional Practice Mentor to design/refine, implement and evaluate BPG at local unit level by: • Attending and contributing to BPG Communities of Practice • Utilizing leadership attributes at the local level to drive implementation and evaluation • Providing regular timely information to Manager on BPG initiative progress • Identifying challenges and offer strategies to overcome • Engaging unit colleagues to gain support for BPG implementation and evaluation plan and priorities • Monitoring change and communicate progress to Manager and colleagues using multi-model communication strategies (e.g. one on one meetings, staff meetings, bulletin boards, email, posters, etc.)

• Developing a sustainability plan with input from Manager, Unit Mentor, colleagues, Nursing Professional Practice Mentor, etc.

• Actively approach Manager, Unit Mentor and/or Nursing Professional Practice Mentor when assistance is required • Preparing a PowerPoint presentation using the template provided from Nursing Professional Practice to share initiative progress at BPG Communities of Practice (date will be provided) • Working with Manager to complete the bottom half of BPG Funding Proposal Template to submit to Nursing Professional Practice (date will be provided) • Tracking scheduled BPG initiative days/hours using the RN/BPG Champion Timesheet provided and submit to Nursing Professional Practice when requested (date will be provided) • Developing a poster to display during Nursing Week’s BPG Sustainability Gallery Walk event (date will be provided)

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Unit Mentor Act as a facilitator and supporter throughout BPG implementation at the local unit level by: • Supporting and championing the BPG initiative at the local unit level • Assisting the BPG Nurse Champion with elements of team building, initiative/project management and change progress • Guiding, coaching and supporting the BPG Nurse Champion to implement their BPG initiative at the local level • Facilitating communication and problem solving between BPG Nurse Champion, Manager, Nursing Professional Practice Mentor regarding any issues that may arise with the initiative • Scheduling routine ‘check-in’ meetings with BPG Nurse Champion to provide support, feedback and receive updates on initiative progress • Assisting and supporting the BPG Nurse Champion to communicate the need, goal and progress through staff engagement (e.g., standing item on staff meeting agenda, team building/skill days, bulletin boards, email, posters, flyers, etc.)

• Providing assistance if needed to the BPG Nurse Champion in preparing a PowerPoint presentation using the template provided from Nursing Professional Practice to share initiative progress at BPG Communities of Practice (date will be provided) • Providing assistance if needed to the BPG Nurse Champion in preparing a poster to display during Nursing Week’s BPG Sustainability Gallery Walk event (date will be provided) Nursing Professional Practice Mentor Act as a facilitator to BPG Nurse Champion throughout BPG implementation by: • Providing mentorship to BPG Nurse Champion through BPG Communities of Practice and scheduled one on one meetings as needed • Sharing knowledge and expertise in developing, planning, implementing and evaluating BPG initiative • Providing support, guidance and coaching to BPG Nurse Champion and when requested, to Manager, Unit Mentor, etc.

• Providing assistance if needed to BPG Nurse Champion in preparing a PowerPoint presentation using the template provided from Professional Practice to share initiative progress at BPG Communities of Practice • Providing assistance if needed to the BPG Nurse Champion in preparing a poster to display during Nursing Week’s BPG Sustainability Gallery Walk event

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St. Michael’s Hospital Best Practice Spotlight Organization Team Contact Information Murray Krock Director, Nursing Practice and Education E: krockm@smh.ca T: 416-864-6060 ext.5514 Ashley Skiffington Evidence Based Practice Nursing Manager E: skiffingtona@smh.ca T: 416-864-6060 ext.3831 Marta Sliz Administrative Coordinator, Professional Practice E: slizm@smh.ca T: 416-864-6060 ext. 4171

Quality Improvement & Change Management Resources 1. Jeffs, L., Indar, A., Harvey, B., McShane, J., Bookey-Bassett, S., Flintoft, V., & Maione, M. (2016). Enabling Role of Manager in Engaging Clinicians and Staff in Quality Improvement: Being Present and Flexible. Journal of nursing care quality.

2. Kotter, J. P. (1995). Leading change: Why transformation efforts fail. http://www.gsbcolorado.org/uploads/general/PreSessionReadingLeadingChange -John_Kotter.pdf 3. Health Quality Ontario [HQO]. (2012). Quality Improvement Guide http://www.hqontario.ca/portals/0/documents/qi/qi-quality-improve-guide-2012en.pdf 4. Registered Nurses’ Association of Ontario [RNAO]. (2012). Toolkit: Implementation of Best Practice Guidelines (Second Edition) http://rnao.ca/sites/rnao-ca/files/RNAO_ToolKit_2012_rev4_FA.pdf

Appendices A. 2018/19 Best Practice Guideline (BPG) Funding Proposal Template Supporting Best Practice Guideline Initiatives at the Local Unit Level 7

B. RN/BPG Champion Timesheet C. 2018/19 Best Practice Guideline (BPG) Communities of Practice Schedule D. ‘Call’ for Best Practice Guideline (BPG) Nurse Champion Applications

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Appendix A (page 1/3)

2018-19 Best Practice Guideline (BPG) Funding Proposal Template Please complete and send to Marta Sliz slizm@smh.ca by September 14th. You will receive notification of approval from Nursing Professional Practice by September 28th. Backfill hours must be documented on the RN/BPG Champion Timesheet provided below and funding must be utilized between October 25th – March 31st 2019. Please complete the bottom half of this form and send it to Marta Sliz along with the RN/BPG Champion Timesheet no later than February 15th 2019 to receive your funding.

1. Funding Request Date 2. Name of Clinical Department/Area 3. Name of Clinical Leader/Manager 4. Name of BPG Nurse Champion 5. Name of Unit Mentor 6. Title of BPG Initiative 7. Title of RNAO BPG (click here to access RNAO BPGs on the SMH intranet) 8. List RNAO BPG Recommendations Informing/Align with BPG Initiative (refer to BPG for list of recommendations) 9. Describe BPG Nurse Champion Activities 10. Identify process and/or outcome indicators (identify metrics that will be collected to measure the impact of the initiative on nursing practice and

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Appendix A (page 2/3)

patient care. Example of a process indicator: Clinical documentation compliance of the Falls Prevention SIMPLE tool; Example of an outcome indicator: Number of patient falls) 11. Expected Start and Completion Dates (months) 12. BPG Nurse Champion Pay Rate (per hour) 13. Number of BPG Nurse Champion Backfill Hours Required to Complete Initiative 14. Amount of Funding Approved ($)

To Be Completed By Nursing Professional Practice Upon Approval

15. Clinical Department/Area Cost Center Number (to be reimbursed by Nursing Professional Practice) Please complete the bottom half of this form and the RN/BPG Nurse Champion Timesheet below and send it to Marta Sliz slizm@smh.ca by February 15th 2019 to receive your backfill funding. Please forecast any hours that will be utilized beyond February 15th until March 31, 2019.

16. Total Number of Backfill Hours Utilized (please ensure the RN/BPG Champion Timesheet is accurate)

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Appendix A (page 3/3)

17. Initiative Deliverables (up until February 15th 2019) 18. List Initiative Outcomes (refer to Question 10) 19. List Sustainability Strategies 20. Reference and Attach Materials Developed (e.g., nurse and/or patient education materials, nursing practice tools)

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Appendix B RN/BPG Champion Timesheet Name of Clinical Department/Area Name of Clinical Leader/Manager Name of BPG Nurse Champion Title of BPG Initiative Date of Activity

Description of Activity

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Time (specify hours/minutes)

Appendix C

2018/19 Best Practice Guideline (BPG) Communities of Practice Schedule Date

Room

Thursday October 25th, 2018

136 LKS

Thursday November 22nd, 2018

136 LKS

Time 0800-1015 1030-1200

Introduction to BPSO, Quality Improvement Model for Improvement (MIF) PDSA (Potato Head Exercise) Utilizing Process Mapping to Promote Change

0800-1015

Update from Champions

1030-1115

Quality Improvement and Research: Pathways to External Dissemination Sustainability

1115-1200 Thursday December 20th 2018

136 LKS

Agenda Items

0800-1015

Update from Champions

1015-1100

Presenting PowerPoint and Poster Templates

1100-1200

Developing and Delivering Education to Support Change

0800-1015

Update from Champions

1030-1200

Change Management: How To Minimize Resistance to Change and Maximize Uptake that is Sustainable

Thursday January 31st , 2019

136 LKS

Thursday February 28th, 2019

136 LKS

0800-1200

Champion Presentations*

Thursday March 28th, 2019

136 LKS

0800-1015

Update from Champions

1030-1200

How to Develop a Poster

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Appendix D

‘Call’ for Best Practice Guideline (BPG) Nurse Champion Applications Nurses deliver knowledgeable care through best practice guidelines

The role of BPG Nurse Champion is to lead, facilitate and inspire the implementation of evidence based best practices in their local unit.

This is an exciting opportunity for nurses to put evidence based practice in action, engage in continuous learning, expand leadership skills & further their professional development through the application of BPGs.

Eligibility • Employed as a registered nurse on a full time or part time basis at St. Michael’s • Passionate about a BPG, patient population and the potential outcomes that can be achieved • Demonstrates initiative and commitment to best practices in their current role • Has the ability to lead, coordinate and facilitate an initiative/project • Role models positive clinical leadership This opportunity supports St. Michael’s Hospital Best Practice Spotlight Organization (BPSO) designation and the hospital’s corporate strategic directions focusing on quality, integration and innovation.

Start Date: October 25th 2018 Length (months): October – March 2019 Total Number of Days: TBD Interested in becoming a BPG Nurse Champion?

• Speak to your Clinical Leader Manager [insert name and contact information here]

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Appendix D

BPG Nurse Champion Application Form Applications are due: [insert date here]

Date of Application: ______________________________________ Applicant’s Name: _______________________________________ Highest Level of Education Attained: Diploma____ BScN ____ MN or MScN____ Other____ Numbers of Years at St. Michael’s Hospital: _________________ Full-Time: ________Part-Time: ________ Please List: Contributions to St. Michael’s Hospital (i.e. unit based council, nursing rounds, nursing council, function as preceptor for new graduate nurses or nursing students)

Please include the following with your application: • Name and a brief description of why your interested in becoming a BPG Nurse Champion • Brief description of any relevant previous experience and/or education • Current Curriculum Vitae Please submit your completed application to your Clinical Leader Manager [insert name and location] Please Note: All candidates will be advised by email within [insert time frame here] of the application closing.

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References Registered Nurses’ Association of Ontario [RNAO]. (2012). Toolkit: Implementation of Best Practice Guidelines (Second Edition). Toronto, ON: Registered Nurses’ Association of Ontario. Retrieved August 11, 2017, from http://rnao.ca/sites/rnaoca/files/RNAO_ToolKit_2012_rev4_FA.pdf

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