Clinical Best Practice Working Group

Purpose

The Clinical Best Practice Working Group was established to provide the opportunity for key expert clinicians to develop and coordinate the implementation of best practice, with the goal to reduce clinical practice variation within Intensive Care and High Dependency Units across NSW.

Responsibilities / functions

• Liaise with Performance working party in regards to sub-optimal patient outcomes (for example adverse events) and clinical practice variation
• Identify priorities for statewide guideline development
• Develop statewide clinical practice guidelines
• Function as the intensive care clinician review group for ACI network and guidelines

Frequency of meetings

Quarterly

Co-Chairs

• Sarah Jones, Clinical Nurse Consultant (CNC) St George ICU, South Eastern Sydney LHD
• Dr Nhi Nguyen, Senior Staff specialist, Nepean ICU, Nepean Blue Mountains LHD

Projects

The Clinical Best Practice working group have identified two practice priorities for 2014-2016.

Physical Activity and Movement guideline

As survival rates from a critical illness continue to improve, more information is becoming available about significant physical, psychological and cognitive deficits that many survivors experience during their recovery and subsequent hospital discharge. Some of these deficits can be attributed to muscle wasting as a result of critical illness, treatments and immobility while the patient was in the Intensive Care/High Dependency Unit (ICU/HDU). Studies have demonstrated that early physical activity and movement (PAM) programs are feasible, safe and effective in reducing some of these adverse effects. Additionally these programs can significantly reduce intensive care and high dependency length of stay with the effect of substantial cost savings and enhancing bed availability for planned and emergency admissions.

Project outputs

• Review implementation practices in NSW via survey to identify gaps in barriers to practice.
• Update of the ACI/ICNSW PAM guidelines including
  • systematic review of the literature from 2012 – present
  • practical safety checklist to assist with practical  implementation guidelines for the movement and mobilisation of critically Ill patients.

Appropriate blood tests

Patients in intensive care and hospitals as a whole, have many diagnostic and surveillance tests ordered. Some of these tests are necessary for the ongoing management of the patient. However there are also many tests which are repeated more often than clinically required, as they are considered as 'routine order set'. Further, some tests performed are not followed up especially if the patient has been transferred out of the intensive care unit.

Project outputs

• Development of definition of what routine testing includes in intensive care.
• Development of routine testing guidelines for intensive care (test order sheets), that meet the clinical needs of the patient.
• Publication of a point prevalence study post implementation of the routine testing guidelines.
• Report on cost benefits of the alteration in practice.

Membership