Schedule “A”: PROJECT CHARTER – [CONDENSED] PROJECT NAME: RNAO Nurse Peer Leader Project: Advancing Clinical e-Functions & Patient e-Services

Prepared By: Rita Wilson, RN, MN, MEd. Date: September 16, 2015

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TABLE OF CONTENTS

PROJECT GENERAL INFORMATION ................................................................................................................ 3

DEFINITIONS .................................................................................................................................................. 3

REVISION HISTORY ........................................................................................................................................ 3

PROJECT BACKGROUND ................................................................................................................................ 4

VISION & GOALS .................................................................................................................................................. 4

OBJECTIVES & KEY DELIVERABLES ................................................................................................................. 5

TARGETED ENGAGEMENT & ADOPTION/UTILIZATION OUTCOMES ............................................................. 6

BENEFITS EVALUATION METRICS (PERFORMANCE INDICATORS) ................................................................. 8

PROJECT SCOPE ........................................................................................................................................... 10

PRIVACY IMPACT ASSESSMENT ................................................................................................................... 10

ASSUMPTIONS ............................................................................................................................................. 11

COMMUNICATION PLAN ............................................................................................................................. 11

EDUCATION/TRAINING PLAN ...................................................................................................................... 11

SUSTAINABILITY PLAN ................................................................................................................................. 12

NURSE PEER LEADER RESOURCES ............................................................................................................... 12

PROJECT TIMELINES .................................................................................................................................... 13

DISPUTE RESOLUTION ................................................................................................................................ 14

RNAO PROJECT (WORKING) TEAM .............................................................................................................. 14

PROJECT RESOURCES/KEY STAKEHOLDERS ................................................................................................. 14

PROJECT APPROVALS .................................................................................................................................. 15

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PROJECT GENERAL INFORMATION

Project Sponsor:

Irmajean Bajnok RN, MScN, PhD Director, International Affairs and Best Practice Guidelines Centre Co-Director, Nursing Best Practice Research Unit Registered Nurses' Association of Ontario

Target Project Duration Date:

23 months

Funding Source:

Canada Health Infoway

Start Date: August 2015

End Date: June 2017

Project Manager:

Rita Wilson, RN, MN, MEd.

Date:

Nov 10, 2015

Version No.

V 5.0

DEFINITIONS Terms, abbreviations and acronyms used in this document.

TERM DEFINITION

BPG Best Practice Guideline

CHI Canada Health Infoway

ICNP® International Classification for Nursing Practice® MOHLTC Ministry of Health and Long Term Care NPL Nurse Peer Leader NOS Nursing Order Set NQuIRE® Nursing Quality Indicators for Reporting and Evaluation®

REVISION HISTORY

Version # and Date Author/Reviewer Description

v1.0 September 16, 2015 Rita Wilson Initial Draft

v2.0 September 21, 2015 Rita Wilson Updated in accordance with SOW template

V3.0 October 19, 2015 Rita Wilson Revised deliverable dates and added Table 1

V4.0 Nov 2, 2015 Lucia DiPasquale Revision to the title of the document Remove Section 14 Add Terry Moore as document approver

V5.0 Nov 10, 2015 Rita Wilson Revised targets in Section 4.0 & Table 1

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1.0 PROJECT BACKGROUND

The cost of wound care to Canadians is astronomical. For instance, the treatment of foot ulcers among Canadians living with diabetes is approximately $150 million annually and growing. The prevalence of pressure ulcers is also relatively high in the Canadian healthcare system where approximately 1 in 50 home care clients, 1 in 8 patients in acute care hospitals and 1 in 11 nursing home residents, experience this condition. On average, patients with nosocomial pressure ulcers cost the healthcare

system an additional $13,500. In Ontario, the estimated cost of wound care is reported to be $1.5 billion annually. This is considered

a conservative estimate as detailed statistics for wounds (e.g. pressure ulcers, lower extremity ulcers)

are rarely collected. Given these facts, the management of chronic wounds is a priority for the Ontario MOHLTC.

2.0 VISION & GOALS

The Registered Nurses’ Association of Ontario (RNAO) will initiate the demonstration project, RNAO Nursing Peer Leader Network, as part of the Clinician Peer Network Program to support clinician and patient engagement in evidence-based wound care management. The Project goals are as follows:

1. Enhance clinician engagement and adoption of advanced clinical e-functions such as e-Clinical

decision support resources in the form of ICNP-encoded NOS.

2. Enhance clinician engagement and adoption of advanced clinical e-functions such as e-clinical analytics to monitor the impact of implementing the Guidelines through key indicators and to use the outcome data for continuous quality improvement.

3. Provide education to support clinicians’ effective use of patient e-services (i.e. e-views) to enhance the patients’ self-management and self-monitoring of their foot or pressure ulcers.

4. Increase clinicians’ awareness of strategies that promote advanced clinical e-functions and patient e-services both provincially and nationally.

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3.0 OBJECTIVES & KEY DELIVERABLES

Five Nurse Peer Leaders will be established in five Demonstration Sites in multiple health care sectors across the province of Ontario to achieve the following deliverables:

1. Advanced Clinical e-Functions:

a) Lead the implementation, adoption and evaluation of the following advanced clinical e-functions at their respective Demonstration Site:

i) e-Clinical decision support resources in the form of ICNP-encoded nursing order sets derived from the following RNAO BPGs: Assessment and Management of Foot Ulcers in People with Diabetes

Assessment and Management of Stage I-IV Pressure Ulcers

Strategies to Support Self-Management in Chronic Conditions: Collaboration with Clients

ii) e-Performance measurement that incorporates the use of ICNP to extract and aggregate anonymized data for subsequent analysis;

iii) e-Clinical analytics using RNAO’s NQuIRE data system to evaluate and monitor the impact of implementing the e-clinical decision support resources.

2. Patient e-Services:

a) Develop and implement a minimum of one educational resource for nurses to support the integration of patient e-services, such as e-viewing of care plans and pertinent health education resources, into their daily practice to enhance their patients’ self-management and self-monitoring of foot or pressure ulcers.

3. Project Evaluation:

b) Participate in the evaluation of the impact of the Project utilizing the key metrics identified, NQuIRE data and other data included in the evaluation strategy.

4. Peer Education/Dissemination:

a) Develop a Project Toolkit comprised of implementation guides, best practices and other related educational resources.

b) Develop and deliver webinars, workshops and presentations to share achievements, lessons learned and resources developed with the wider healthcare community locally, provincially and nationally.

c) Contribute articles to RNAO’s eHealth for Every Health eNewsletter and other relevant journals. d) Partner with RNAO to submit one manuscript for publication in a peer reviewed journal.

Implement one

only

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4.0 TARGETED ENGAGEMENT & ADOPTION/UTILIZATION OUTCOMES

Table 1 displays the targeted engagement for the RNAO Nurse Peer Leader Network demonstration project. The following benefits will also be realized for patients/clients/residents/caregivers, nurses, health care organizations and the health care system, in general:

Approximately 24 to 31% of persons in an acute or non-acute setting have a pressure ulcer and

34 to 37% of persons receiving community care have a chronic wound.1 Therefore, it is

estimated that through their active involvement in care planning and self-management/self-

monitoring 200-300 patients/clients/residents/ caregivers will experience greater satisfaction

with the quality of health care received and the health outcomes realized.

One hundred percent of the frontline healthcare providers in the long-term care and home and

community sectors are directly or indirectly involved in wound care management. Based on this

fact, it is estimated that 1000-2000 frontline nurses and other clinicians would be educated to

use some aspect of the evidence-based e-clinical decision support resources in the form of

nursing order sets that better support their practice and promote safe, high quality care for

patients/ clients/residents.

Nurses Peer Leaders will have the potential to reach approximately 1600 eHealth Champions

across the province and hundreds of nurses nationally to promote the use of advanced clinical

e-functions using a variety of forums including webinars, conference presentations and

publications.

Five BPSOs will demonstrate the benefits of using a standardized methodology for BPG

implementation that incorporates the use of ICNP codes to increase data quality and facilitate

data extraction for e-clinical analytics to support continuous quality improvement.

Hundreds of healthcare organizations nationally and provincially will also benefit from nurses’

enhanced knowledge of advanced clinical e-functions that contribute to better design and

adoption of their electronic health information systems.

The health care system in general will benefit from the five organizations participating in the

project that would have used standardized terminology language such as ICNP® (which is

mapped to SNOMED CT) as it paves the way for future system interoperability and the sharing

of health information.

1 CAWC website: Prevalence of Chronic Wounds in Canada. GM Woodbury and PE Houghton

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Table 1: ENGAGEMENT - TARGETS FOR ENTIRE PROJECT

Physicians Nurses Pharmacists Clinic/ Support

Staff

Patients / Caregivers

Others if applicable (specify)

TOTAL COMMENTS

Targeted # Peer Leaders

5 Targeted # Colleagues/ Mentees engaged in direct mentoring activities (primary target audience, usually 1-to-1 or small groups; targeted workshops, on-site practice workflow redesign, etc.)

Targeted # colleagues/ mentees engaged in awareness/ educational activities (usually larger groups/ settings e.g. through conferences, webinars, etc.)

Targeted colleague/ mentee within the project scope (denominator)

1000

Targeted # Patients/

Mentees engaged in direct mentoring activities (primary target audience, usually 1-to-1 or small groups; targeted workshops, on-site practice workflow redesign)

Targeted # patients/mentees engaged in awareness/ educational activities (usually larger groups/ settings e.g. through conferences, webinars, etc.)

Total targeted patients 200

Targeted care settings e.g. acute care; primary care; home & community

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5.0 BENEFITS EVALUATION METRICS (PERFORMANCE INDICATORS)

Deliverables Metrics

Nurse Peer Leaders

Number of nurse peer leaders supporting the implementation and clinicians’ adoption of advanced clinical e-functions and patient e-services in 5 NPL Project Demonstration Sites.

Number of staff who received training per Demonstration Site on the use of advanced clinical e-functions and patient e-services

Percentage of staff who were trained, per Demonstration Site, who are using the advanced clinical e-functions and patient e-services at specific intervals

NPL Project Demonstration Sites

Number of NPL Project Demonstration Sites Number of sectors represented Number of NPL Project Demonstration Sites that have implemented the advanced

clinical e-functions and patient e-services.

Advanced Clinical e-Functions

Percentage of staff using the e-clinical decision support resources per Demonstration Site

Percentage of Demonstration Sites using e-performance measurement Percentage of Demonstration Site using RNAO’s NQuIRE system for e-clinical

analytics Level of satisfaction with the implementation strategy for the e-clinical decision

support resources Level of satisfaction with the e-clinical decision support resources Perceived ease of use of the e-performance measurement Level of satisfaction with the e-clinical analytics Incidence and cost of pressure and diabetic foot ulcer per NPL Project

Demonstration Site pre- and post- implementation Percentage of clients with pressure or diabetic foot ulcer with evidence of an

ulcer assessment pre- and post- implementation Percentage of patients assessed on admission for the risk of developing

pressure/diabetic foot ulcers or foot amputation using a structured, valid, and reliable tool pre- and post- implementation

Percentage of diabetic foot and stage II to IV pressure ulcers with evidence of healing after 2 – 4 weeks pre- and post- implementation

Percentage of clients with diabetic foot/stage II to IV pressure ulcerations that healed pre- and post- implementation

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5.0 BENEFITS EVALUATION METRICS (PERFORMANCE INDICATORS)

Deliverables Metrics

Patient e-Services Degree of usefulness of educational resources as communicated by clinicians Number of clinicians using patient e-services per Demonstration Site Number of patients/families/caregivers using patient e-services per

Demonstration Site Level of patients/families/caregivers satisfaction with patient e-services Impact of patient e-services on patients’ knowledge, confidence, comfort, skill

level and judgment about need for assistance.

Peer Education/ Dissemination

Total number of educational events (i.e. workshops, webinars) facilitated by the nurse peer leaders

Total number of participants at the educational events (i.e. workshops, webinars) facilitated by the nurse peer leaders

Total number of articles contributed by nurse peer leaders to the eHealth for Every Health eNewsletter and other relevant journals

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6.0 PROJECT SCOPE

The scope of this Project is defined as follows:

In Scope:

1. Establishment of five Nurse Peer Leaders at five Demonstration Sites in multiple health care sectors in the province of Ontario to lead the implementation, adoption and evaluation of the advanced clinical e-functions and patient e-services delineated in this Project Charter.

2. Implementation of two of the following RNAO BPGs at each Demonstration Sites using ICNP-encoded nursing order sets: Assessment and Management of Foot Ulcers in People with Diabetes

Assessment and Management of Stage I-IV Pressure Ulcers

Strategies to Support Self-Management in Chronic Conditions: Collaboration with Clients

3. Development and implementation of educational resource(s) to support nurses’ integration of patient e-services into their daily practice.

4. Develop and disseminate educational resources (including a Project Toolkit) to facilitate peer education among the wider healthcare community locally, provincially and nationally.

Out of Scope:

1. Other RNAO BPGs not included in this Project Charter 2. Other organizations not selected through the formal RFP process. 3. Development of a patient portal or App to support nurses’ integration of patient e-services into

their daily practice. 4. A Toolkit Project Charter is not required under the terms of this Agreement.

7.0 PRIVACY IMPACT ASSESSMENT

No individual patient data will be entered into the NQuIRE database during this Project. Consequently, no data submitted by the Demonstration Sites will contain “personal information” or “personal health information” as defined in the federal Personal Information Protection and Electronic Documents Act or the Ontario Personal Health Information Protection Act, 2004 (collectively, the “Legislation”), including disparate information with the NQuIRE data, that, taken together, could identify an individual.

Consequently, RNAO is not obligated to conduct a privacy impact assessment under the terms of this Agreement.

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8.0 ASSUMPTIONS

Timely response to the RFP by eligible health care organizations. Nurse Peer Leaders will have in-depth knowledge of their electronic health information systems or

have access to IT/technical support staff with this knowledge to facilitate the integration of the ICNP codes within the system and subsequent use of these codes for data extraction.

Consistent availability of NPL Project Implementation Team members. Demonstration Sites will have an active wound care committee in place. Appropriate business resources (e.g. office space and equipment) will be available for the

duration of the Project. Timely response by the relevant stakeholders to sign-off on deliverables when required. There will be adequate end user training and post-implementation support.

9.0 COMMUNICATION PLAN

Nurse Peer Leaders will work collaboratively with their respective Project Implementation Teams to design the communication plan and messaging for all staff that will be impacted by the deployment of the advanced clinical e-functions and patient e-Services.

10.0 EDUCATION/TRAINING PLAN

Nurse Peer Leaders will receive ongoing training in best practices for implementing the advanced clinical e-functions and patient e-Services required for this Project.

Nurse Peer Leaders will develop educational resources to support nurses’ integration of patient e-services in their daily practice.

Nurse Peer Leaders will work collaboratively with their respective Project Implementation Teams to design the education plan for all staff that will be impacted by the deployment of the advanced clinical e-functions and patient e-Services. The plan will leverage the expertise of existing RNAO BPG/eHealth Champions.

Nurse Peer Leaders will develop and deliver education strategies to increase clinicians’ awareness of effective strategies that promote the use of advanced clinical e-functions and patient e-services locally, provincially and nationally using a variety of forums including but not limited to: Webinars, workshops and other knowledge exchange events RNAO’s eHealth for Every Health eNewsletter

Nurse Peer Leaders will Partner with RNAO to submit one manuscript for publication in a peer reviewed journal.

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11.0 SUSTAINABILITY PLAN During the planning phase of the project, each Demonstration Site will be requested to prepare and submit a sustainability plan that will include the following:

1. A list of factors in their organization that are enablers or barriers to sustaining patient-centered, evidence-based wound care management in their organization.

2. Strategies to remove or minimize any factors identified as a threat to sustainability.

3. Strategies to maintain or enhance any factors identified as enablers of sustainability.

4. Strategies for continuous quality improvement that leverage the quarterly NQuIRE reports.

5. Strategies to use the lessons learned to spread the adoption of advanced clinical e-functions and

enhanced patient engagement in self-management to other clinical areas within and/or beyond

the organization.

6. Future goals to implement and evaluate additional guidelines to address other service delivery

needs of the organization.

12.0 NURSE PEER LEADER RESOURCES

The following RNAO and CHI resources will be made available to the Nurse Peer Leaders throughout the Project:

CANADA HEALTH INFOWAY RESOURCES Peer Leader Resource Toolkit

RNAO RESOURCES ICNP-Encoded nursing order sets and NQuIRE indicators

A Guide for Implementing Nursing Order Sets and Supporting NQuIRE Data Collection and

Reporting in Meditech/Cerner

Toolkit: Implementation of Best Practice Guidelines

eHealth Toolkit

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Q3-Q4 FY15/16 Q1 FY16/17 Q2 FY16/17 Q3-Q4 FY16/17 – Q1 FY17/18

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15.0 RNAO PROJECT (WORKING) TEAM Staff who actively work on the project at some point during the Project Lifecycle

Resource Name Resource Project Role Estimated Time Commitment (Days/Week or FTE) Rita Wilson eHealth Program Manager 0.5 FTE

Tanya Costa Project Coordinator 0.5 FTE

Tanvi Sharma Nursing Research Associate 0.25 FTE

Tasha Penney Program Manager - NQuIRE 0.25 FTE

Meetings will occur weekly/bi-weekly or as needed to complete the work during the project lifecycle.

16.0 PROJECT RESOURCES /KEY STAKEHOLDERS Key stakeholders who provide support to the Project as needed

Resource Name Resource Project Role

Irmajean Bajnok Director, International Affairs and Best Practice Guidelines Centre Yaw O. Owusu Associate Director, Research and Evaluation

Rita Wilson eHealth Program Manager

Tanya Costa Project Coordinator - eHealth

Tanvi Sharma Nursing Research Associate

Tasha Penney Program Manager - NQuIRE

TBD Canada Health Infoway Clinical Adoption Team

Meetings will occur on a monthly basis as a form of communication for project status/updates, risks, issues, etc. Theses stakeholders may delegate another person to attend the meeting if they are unavailable for a specific update meeting.

14.0 DISPUTE RESOLUTION

For information on the dispute resolution process, refer to Section 1.6 in the Agreement.

For information on the issue escalation process, refer to Section 11.1 in the Agreement.

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17.0 PROJECT APPROVALS

The Project Charter must be approved & signed-off by all parties below prior to moving to the next phase. Once completed &

approved, the charter forms the foundation for detailed planning and future decision-making. Any changes to information

contained in the Charter must be documented using a formal Project Change Request process.

Canada Health Infoway

Sign-off by Canada Health Infoway signifies that there is a clear commitment to contribute the required financial resources to

complete the Project goals & objectives as outlined.

Name & Title Signature Date

Maureen Charlebois Clinical Adoption, Chief Nursing Executive & Group Director

Terry Moore Executive Regional Director, Ontario

Lucia DiPasquale Regional Project Manager, Ontario

RNAO

Sign-off by RNAO‘s Project Sponsor demonstrates a clear commitment to provide the required human, financial and material

resources to realize the Project’s goals and deliverables as outlined.

Name & Title Signature Date

Doris Grinspun Chief Executive Officer

Name & Title Signature Date

Irmajean Bajnok Director, International Affairs and Best Practice Guidelines Centre

Name & Title Signature Date

Rita Wilson Project Manager