The adaptation of CPGs for VTE Prophylaxis using the ADAPTE Method. Part of the First VTE Prophylaxis Forum organized by QMD, KKUH, KSUMC in 2017

1. Venous Thromboembolism
(VTE) Prophylaxis: an
Adapted Evidence-Based
Clinical Practice Guideline
By
Dr. Yasser S. Amer
MBBCh, MPed, MHI, CPHQ, FISQua
CPG Methodologist, CPGs-QMD, KKUH
CPGs Steering Committee, KSUMC
eSiHi Physician (CPOE) Build Team

2. Statement of disclosure
23 May 2017 2
Dr. Yasser S. Amer
MBBCh, MPed, MHI, CPHQ, FISQua
I have no actual or potential,
commercial or academic conflict
of interest to declare in relation
to this presentation/ project
Adaptation of CPG for VTE Prophylaxis

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What makes a trustworthy CPG?
Adaptation of CPG for VTE Prophylaxis

4. Standards for high quality CPGs
IOM 2011 – G-I-N 2012 – AGREE 2013
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5. The CPG lifecycle at KSUMC:
CPG Adaptation Program
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6. CPG Adaptation Program
King Saud University Medical City
I. Research Chair for Evidence-Based
Health Care and Knowledge Translation
II. Quality Management Department
III. KSUMC-Wide CPG Steering Committee
and 20 CPG Departmental Committees
Collaborative!
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7. Guidelines International Network
(G-I-N)
www.g-i-n.net
EBHC-KT Research Chair, King Saud University
Organizational Member since 2009 (1st Member from GCC)
Founded in Nov. 2002
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8. CPG Adaptation Methodology
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9. MCW Policy & Procedure for
Synthesis of CPGS in KSUMC
(Updated 2016)
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10. CPG Authorship group
CPG CHAMPIONS!
Review Group:
Methodology
Review Group:
Clinical Content
Adaptation Group
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11. Set Up Phase: Team formation
This CPG Adaptation Project was
initiated by the Critical Care
Departmental CPG Committee!
Started Jan 2012 – Ended Feb 2013
Lifespan: 13 months!
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12. Set Up Phase: Team formation
CPG Adaptation Working Group
 Dr. Hadil Al-Otair, MD, ABIM, MRCP (UK)
 Dr. Mohammad Azfar, MD, MBBS, MRCP (UK)
 Dr. Rafat Taher, MD, FRCS(C)
 Mr. Maher Titi, RN, MSN, CPHQ, FISQua
 Mr. Mohammed Hussein, RN, MSN, CPHQ, CPPS, CPHRM
 Ms. Rawia Abdalla, RN, MSN, CPHQ, CPPS, CPHRM
 Ms. Mashael Alsheikh, B.C.P.S
 Dr. Yasser Amer, MBBCh, MPed, MHI, CPHQ, FISQua
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13. Set Up Phase: Topic Selection
VTE = PE & DVT
Rationale
• Preventable hospital complication
• Clinical care gap (E2P)
• Variation in practice
• Accreditation Standard (ROP)
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14. Health/ Clinical/ Key Questions
Patient (& disease characteristics)
Intervention(s)
Professionals (Target users)
Outcomes (purpose of the CPGs)
Healthcare settings (& context)
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CPG Scope: PIPOH Model
Adaptation of CPG for VTE Prophylaxis
Adaptation Phase

15. Inclusion / Exclusion Selection Criteria
Criterion Description
Methods of
Development
EB-CPGs: (Detailed Methodology of Development
Documented; NOT Consensus/Expert-based)
Authors Organization/ Specialized Society
(CPG development groups); NOT single authors.
Country International CPGs
Date of
Publication
2011 – 2013 (last 3 years; at the time of this project)
Language English CPGs
Status Original Source CPG (de novo developed)
NOT Adapted
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16. Search and Selection
of Source CPGs
• 8 CPGs DBs searched (NGC, GIN, NICE, SIGN,
ICSI, Ontario GAC, NZGC, Google Sch.)
• 9 Source CPGs retrieved
• 6 CPGs excluded based on PIPOH and
selection criteria
• 3 CPGs included for further appraisal by
AGREE II Instrument.
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19. Quality Assessment of the
Source CPGs
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20. AGREE II Domain Scores for the 3 source CPGs
ACCP-2012, ICSI-2011, ACP-2011
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21. Key recommendations
1. VTEP in Medical/Critically ill
Patients
2. VTEP in Non-Orthopedic Surgical
Patients
3. VTEP in Orthopedic Surgical
Patients
4. Anticoagulant dose adjustment
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22. Finalization Phase: Reviewers
Clinical Content
 Prof. Ahmad Abdulmomen,
MD, FCCM
 Dr. Mariam Al Ansari,
MD,FRCSI,FCC
 Mr. Hussam Muzain , RN
 Mr. Emerita Espanol, RN
Methodology
• Prof. Lubna A. Al-Ansary,
MBBS, MSc, MRCGP, FRCGP
• Dr. Hayfaa Abdelmageed
Ahmed Wahbi, PhD, FRCOG,
FRCS (Ed.), Mmed-Edu
• Dr. Manal Abou Elkheir, BSc,
Pharm D, BCPS
• Dr. Shaikh Iqbal, FRCPCH
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23. Dissemination &
Implementation
“Nothing could be more
frustrating than producing a
CPG that is then ignored by
not being disseminated nor
implemented nor updated!”
The concept of the ‘LIVING’
CPG23 May 2017 23Adaptation of CPG for VTE Prophylaxis

24. CPG implementation
strategies/ interventions
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25. CPG implementation
strategies
1) Dissemination Process. . .
2) Local Clinical Champions. . .
3) Education & Training. . .
4) Networking with existing projects. .
5) Regular M & E. . .
6) Patients as champions for change.
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26. Implementation Tools
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27. 1. Quick Reference Guide
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2. CPOE
with CDS
Adaptation of CPG for VTE Prophylaxis

29. 3. Performance Measures
(PM/ KPI)
TWO CPG-Based internationally
validated PMs/ KPIs
M & E!
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30. 4. Patient Education Guide
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31. How to access our CPGs?
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33. Desktop Shared
Folder
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36. What is your role as a HCP
in CPGs? “spread the word”
1. CPG implementers/ users.
“Your continuous feedback!”
2. CPG developers/ adapters.
3. Improvement research projects.
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