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Childhood fracture management Project overview

Childhood fracture management Project overview. Victorian Paediatric Orthopaedic Network. What this presentation covers. Project background Guidelines Education module Implementing the guidelines. Background. Misdiagnosis is a common occurrence

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Childhood fracture management Project overview

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  1. Childhood fracture managementProject overview

  2. Victorian Paediatric Orthopaedic Network

  3. What this presentation covers • Project background • Guidelines • Education module • Implementing the guidelines

  4. Background • Misdiagnosis is a common occurrence • Residents unable to determine if paediatric fracture present or not in 20% of cases (Ryan et al 2004) • Management incorrect in > 50% of cases (Ryan et al 2004) • Audit of plaster casts in a Victorian tertiary hospital • only 35% were deemed adequate

  5. Background • Aim of project • Improve and standardise quality of paediatric fracture care • Developed by • ED physicians • Paediatric orthopaedic surgeons

  6. Childhood fracture management RCH Clinical Practice Guidelines website www.rch.org.au/clinicalguide/fractures • Guidelines • Education module • Fact sheets • Casting videos

  7. Clinical guidelines for ED • Easy to read format • X-rays to order • When to refer to ortho • Management in ED • Follow-up • Summary Radius/ulna shaft guidelines link

  8. Education module • Bone anatomy • Fracture patterns • Principles of evaluation and management • Animations • Quiz Paediatric education module link

  9. Family resources • Fact sheets • Clavicle • Buckle injury • Supracondylar • Wrist • Plaster care www.rch.org.au/clinicalguide/fractures/#family

  10. Steps to implementing guidelines • Becoming motivated to change • Baseline audit • Raise awareness • Changing what needs to be changed • Identify barriers and tailor approach • Monitor progress • Making the change permanent • Sustain progress Source: Stroke and TIA care bundle. NICS 2009.

  11. Barriers to uptake of guidelines Knowledge Beliefs Behaviour “I didn’t know there were guidelines” “It’s all good in theory, but practice is different” “It takes time – time which I don’t have” “I know what’s best for my patients” “I haven’t read the guidelines” Adapted from Cabana MD et al. JAMA 1999; 282:14581465

  12. Overcoming barriers Source: Modified from How to change practice. NICE. Dec 2007

  13. Overcoming barriers Source: Modified from How to change practice. NICE. Dec 2007

  14. Further informationMichelle VuProject Managermichelle.vu@rch.org.au

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