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Enter CPD Activity DetailsSubmission InstructionsLog into to My MainProNavigate to enter CPD ActivityCategory: AssessmentCertifiedActivity Type: Practice Audit/Quality AssuranceCut and paste your audit information onto the form and submit.Name Current Cycle:START OVER* Indicates Required Field/QuestionOnce you have completed the form in its entirety, click “SUBMIT”. You can save the information you have entered on this form at any time by scrolling to the bottom of the page and clicking on “SEND TO HOLDING AREA”. The editable, saved form will be accessible from your Holding Area and will require further action.7810502982595Category : Certification Type:* Certified Non-CertifiedActivity Type: * Practice Audits/Quality Assurance ProgramsSubmission form for Certified Assessment MAINPRO+TM credits. This form documents how you use your experience in a practice audit or a quality assurance program to critically reflect on some aspect of your practice and/or work. You can do this even if the audit or QA program involved others’ practices as long as you consider the impact on your own practice and/or work.Each completed exercise is eligible for 6 Certified Assessment credits. If this activity is multi-faceted, you can submit multiple forms as long as each one is based on a distinctly different question. Once you have completed the form in its entirety, click “SUBMIT”. You can save the information you have entered on this form at any time by scrolling to the bottom of the page and clicking on “SEND TO HOLDING AREA”. The editable, saved form will be accessible from your Holding Area and will require further action.-4253081324Describe the nature of the practice to which this audit/program applies. State whether it is our own practice or that of others. *00Describe the nature of the practice to which this audit/program applies. State whether it is our own practice or that of others. *1781810160655This is a family practice providing comprehensive care to patients of all ages and genders. I did a practice audit to improve my breast cancer screening.00This is a family practice providing comprehensive care to patients of all ages and genders. I did a practice audit to improve my breast cancer screening.178181015938500Program/Activity ID Planning Organization * 2057400-800100Who was involved?Myself, Admin, Nursing, Allied Health Care professionals, Regional Cancer Program, Hamilton Family Health Team, Cancer Care Ontario What was my role?Identify breast cancer screening as a priority and identify a champion in the office. Identify key staff members to bring EMR up to date and keep it up to date. Provide support so staff are up to date on guidelines Lead my office team through the audit questions.Sign up for and learn to use the Screening Activity ReportReview best practices module for my EMRStaff meetings (1 hour), Literature review (1 hours), Data cleaning (3 hours) 00Who was involved?Myself, Admin, Nursing, Allied Health Care professionals, Regional Cancer Program, Hamilton Family Health Team, Cancer Care Ontario What was my role?Identify breast cancer screening as a priority and identify a champion in the office. Identify key staff members to bring EMR up to date and keep it up to date. Provide support so staff are up to date on guidelines Lead my office team through the audit questions.Sign up for and learn to use the Screening Activity ReportReview best practices module for my EMRStaff meetings (1 hour), Literature review (1 hours), Data cleaning (3 hours) 1945005-381000Start Date: * Open the calendar pop up.194844514334700End Date: * Open the calendar pop up.Credits Requested: * 6 Indicate your role for this activity: * Assessment of Self Assessment of Practice Assessment of Other(s) Assessment of Material(s) 3912235184150024135918373Select00SelectYou may attach one or more files here: Step 1: Formulate your practice question(s)What was the origin of, or reason of, the audit/program? *Screening reduces mortality and morbidity from breast cancer, and in some cases incidence.In 2015, there were an estimated 1,900 deaths from breast cancer.The mortality rate from female breast cancer has been declining since the mid-1980s and is likely due to the combination of increased mammography screening and use of more effective therapies following breast cancer surgery.Screening effectiveness is based on multiple screenings over time. CCO currently recommends mammograms for average risk women every two years from age 50 to 74.By having an office-based protocol, this will increase my patients’ participation in the Ontario Breast Screening Program (along with the High Risk Program) and will sustain these programs’ usefulness on an ongoing basisFor the purpose of this exercise, what specific questions and/or learning objective did you formulate for your own practice?: * During my Audit I considered the following questions Q1 Do I use my EMR optimally for breast cancer screening so each patient’s inclusion and exclusions are accurate?Q2 What is my plan to update the accuracy of my EMR once I decide where each piece of data should be entered? How will I keep it up to date?Q3 Who offers and books mammograms in my office when patients come in? Q4 Do I want to do regular audits to find overdue patients? Who will do this? Do I know how to use my EMR to find these names or will I use the SAR? How often? How will I reach out to patients?Q5 What is my current breast cancer screening rate and do I know how to calculate this?Q6 What tools exist that I can use to improve my breast cancer screening rates? Q7 Who will champion breast cancer screening in my office?Step 2 Describe the auditBriefly describe the audit/program. How were the criteria, standards, and/or interventions selected? How were the records selected? How was the data collected, recorded, and analyzed?: *Q1. Consistent EMR usage is key for breast cancer screening. I reviewed the screening guidelines including age (50-74), tests (mammogram and for high risk MRIs as well), follow up intervals (1-2 years depending on risk and results). I reviewed the risk factors (+FH, BRACA, chest radiation before age 30). I reviewed the exclusion factors (bilateral mastectomy, breast cancer). I then decided where to record all this information within my EMR so I have consistent data entry. Breast cancer screening is usually fit into office appointments when patients come in for other things so I need to be able to rely on the accuracy of my EMR as I do not have a lot of time to update it (search for last testing etc). I also reviewed the guidelines for trans women – start mammograms every 2 years at age 50 after at least 5 years of hormone therapy.Q2. To update my EMR, I used the Screening Activity Report. This report has the latest screening data for rostered patients. I also used my EMR to create a list of all patients age 50-74. I hired a nurse to work from home, accessing my EMR remotely, and she went into every chart and updated them according to our decisions from Q1Q3. Currently I was suggesting mammograms when I noticed they were due, while they were in office. Q4. Currently we were doing audits somewhat randomly every few years. We did not have a system to remind us to do this nor a person assigned to the task. We also did not trust our EMR records that we had all the mammograms inputted so could not do audit. We did not know how to generate a list from our EMRQ5. Breast Cancer up to date rate is 75% using my Screening Activity ReportQ6. I had access to my SAR but did not really use it regularly. Q7. I did not have a written protocol nor identified champion to keep cancer screening in the forefront Briefly describe the findings of the audit/program. * Q1. Here are some specific findings. I did not have a digital version of the High Risk Program referral form. I did not have a specific location in my EMR to document that I had referred a patient to the high risk program and if they were accepted to this program or not. I did not have a consistent location to document genetic findings. I found that I was recording positive breast cancer family hx but not negative so I had to ask each time. I now record negative family hx. I also try now to use the prevention module the same way for exclusions and include the reason why.Q2. When comparing the EMR to the SAR we were able to bring each eligible women’s records up to date with their past mammogram and next one was set due. We found many records where we did not have the last mammogram inputted. More specifically we found patients who were n referred to genetics for a high risk family history but did not show and did not get rebooked, a patient who had breast cancer but was not getting annual mammograms, patients who were supposed to get annual mammograms but had reverted to biannual. This process for my practice of 1500 patients took 4 hours. While in the chart we updated them for colorectal and cervix cancer screening. To keep my EMR up to date, I forward each mammogram result to my office staff who input it.And each month, the office staff open the Screening Activity Report and sort for the new screening and make sure they have been inputted. I find when there are locums or we are rushed, we forget to keep the EMR up to date so the SAR helps as a back up check.Q3. Breast cancer Screening is now offered in two ways in my office. Firstly: As patients that come in for screening, the EMR has a stop sign that the admin talks to the patient about and suggests they discuss it with their clinical team. The RN who brings the patient in then goes into the medical record and she can see who has a red flag in their prevention module. Often she deals with this and gives the patient the number for booking her own mammogram or offers to book it for them. She documents this at the beginning of the record eg Prev: UTD. When I come in, I check if she has reviewed preventions by looking for this documentation. If she has not, then I do it. Secondly: Twice a year we run an audit to see who is overdue for screening. We compare this to the Screening Activity Report for accuracy and we contact the patient. We are currently phoning them after hours but plan to email.Q 4. We decided to do an annual audit in January using a new search function of our EMR that we are now confident is accurate. We will do this is January of each year and will call overdue patients. We are working on an email notification as well. Q5 My current screening rate may be different when I use my own up to date EMR instead of the SAR as I can account for excluded patients. Q6 For this audit, I now have access and use the following tools/tips:-I use my EMR consistently with clear pathways for how to keep it up to date and where to put each inclusion, exclusion or high risk piece of data. I used the EMR for cancer screening best practices modules from the Hamilton Family Health Team Website-I always refer to the Ontario Breast Screening Program and steer patients to sites with accreditation from this program as it has a great quality component. -I have the High Risk Ontario Breast Screening Program referral as an eform-I recommend on line videos for my ESL patients who speak Arabic, Benagali or Mandarin relied heavily on CCO’s Screening Activity Report and reviewed the following aspects of its functionality One?ID for physician and ONE ID for delegate with delegate linked to SARDownload to Excel How to ensure EMR accurate by comparing to SAR for each enrolled patientHow to Keep EMR up to date by sorting monthly SAR for most recent screens Find patients screened positive who are lost to follow-up List: Overdue patients by screening programList: Patients identified as “triple reds”Review limitations of SAR and meaning of colours-I have placed a poster for cancer screening in all exam rooms-I have cancer screening videos playing my waiting room HYPERLINK "" \t "_blank" use Q codes to track those who are excluded from routine breast cancer screening(Q 141 for exclusion) -I tell patients about MyCancerIQ follow a cancer screening blog for family docs /hnhbscreenforlife.ca/information-for-health-care-providers/blog/-I know how I will use the Preventive Care Target Population/Service Report My office manger will be the champion and now has a written protocol she follows to ensure we complete the entire above steps daily, monthly and yearly. Step 3: Consider the information What kind of information and/or evidence was used to support the interventions and how was it obtained? * Breast cancer screening has a sensitivity of 86% and a specificity of 93%. In a screening program, there is repeated testing over time. Therefore, while a single test’s sensitivity may be low, through repeated testing, it will increase.Effectiveness is shown through randomized controlled trials and with mammography these trials show a 21% reduction in breast cancer mortality with regular screening in 50 to 69-year-olds who are at average risk for breast cancer.What was your assessment of the quality of this information? Describe its validity (ie, is it based on appropriate scientific evidence?) and relevance (ie, is it applicable to the practice being assessed?). What approach or tools did you use to come to these conclusions? * Family doctors play a key role in identifying appropriate patients for breast cancer screening, providing education for informed choice, and following up on any abnormal results. Thus, this project is absolutely relevant for primary care. It is important to consider both benefits and harms of any interventions. Harms can include: Anxiety about the test, false-positive results, psychological harm, labelling due to negative association with disease, unnecessary follow-up tests, false-negative results, delayed treatment, over-diagnosis and over-treatment.A good tool for patients for shared decision making is from the Canadian Task force 4: Make a decision about your practiceBased on what you learned, what decisions have you made about your practice? * From this audit we have developed our own homegrown cancer-screening protocol for breast cancer screening for my office that is sustainable over time. We have leveraged the resources available to us and optimized our EMR use. We realized that our EMR should be the source of truth for up to date information about our patients and we need to ensure we have systems in place to keep it up to date (eg using external data sources as the SAR.) We also found some new functionality in our EMR that was very helpful. Also, we realized that cancer screening must be team based with the whole office engaged. What must you do to integrate these decisions into your practice? What kinds of barriers or difficulties do you foresee? * The barrier is always time, as our attention is divided between fighting the daily fires of patient demand and balancing this with a preventative focus. Having the three sets of ‘eyes’ on screening helps. The admin reminds the patient, the nurse discusses it and then I check to see if it was done. Even then, when a patient is in the office, screening can be forgotten when other more concerning issues take precedence or when we get behind.Step 5: Evaluate/Reflect on the impact of your decision Please describe your reflections on the impact this process has had on your practice and/or work.* Consider questions such as: ? What impact has this process had on your practice generally? ? How do you feel now about the decision(s) you made? ? How successful have you been in implementing them into your practice? What kinds of barriers have you confronted? ?What are you doing now that you didn’t do before? What has happened to your confidence in this area? ? What kind of feedback have you received from your patients, staff, or colleagues? ? What new information have you seen? How has this further modified your approach? What further changes do you intend to make? ? What further areas of practice change, reassessment, and/or intervention have you identified? What plans do you have to address these? Breast cancer screening is an office-based protocol that I would like to embed in my office procedures so it does not get lost in day-to-day patient care.?I will be able to measure the impact of this in a year when I recalculate my screening rates.?The barrier is always time and attention.?There are only so many initiatives one can take since primary care involves all aspects of health at all ages. Whatever we focus on, we do better at, but if we try to focus on everything, we get burnt out and end up not accomplishing anything.?It is really important when integrating new ideas into my practice that they be sustainable. Having team support for new ideas helps make them sustainable. Having the solution home grown in my office that respects our strengths and processes also makes sustainably more likely. ?Whenever the staff rally, meet and feel heard it is always good for office morale.?I don’t intend to try to do more. This is enough for now and is sustainable. I will be interested in how my breast cancer screening rates change. ................
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