Nurses in Informatics - Transforming Healthcare

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Susan K. Newbold, PhD, RN-BC, FAAN, FHIMSS
Consultant in Healthcare Informatics working
to advance healthcare information technology
(Friday, 3.45, Keynote)

Harnessing the contribution of the nursing workforce is critical for effective health informatics for present and future endeavors. An overview of the historical efforts of nursing informatics pioneers will lead to a
discussion on how to promote future health informatics to transform healthcare.

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  • Thank you to the HINZ Organising Committee for inviting me to speak.Thrilled to be here after 11 years. Last event was NI2000 right at this Centre.PhD prepared nurse – emphasis on Nursing Informatics from the University of Maryland, Baltimore in the USRN-BC is not RN before computers!FAAN and FHIMSSMost recently Vanderbilt University, Nashville, TN then a 164 hospital chain as EHR education leadYou notice that I attempted to wear “All Black!” Congratulations.Earlier this month I was in Boston, Massachusetts, where Harvard Research shows women who ware makeup are perceived to be more competent.
  • My brief presentation will include these topics with a chance to discuss the promotion of health care informatics.
  • First focus on history to help direct the futureI got involved in the Nursing Informatics History Committee due to Dr Werley – nursing minimum data set, pictured on the left – also first editor of the Nursing Research journal
  • You may recognize some of these faces:Dr Marion Ball – mentor to many, formerly IMIA presidentKaren S Martin – developer and keeper of the Omaha system which I know is used in NZ
  • Monitored Hourly RoundingThe practice of hourly rounding on 3 Tower, a 36-bed adult medical nursing unit, was initially documented by the nursing staff using a paper form placed in each patient’s room. Kyla Slagter, BSN, RN, Clinical Nurse Leader (CNL) student working on 3 Tower, wanted to identify an innovative way to use technology to track and document nursing presence in a patient room, instead of using the current paper documentation method. Ms. Slagter contacted the Carolinas Medical Center (CMC) Information Services Department to inquire if the current systems for ASCOM (hand held) phones and the existing call bell system could be enhanced/expanded to track and record nursing presence. She found out that indeed it was possible; The purpose of Ms. Slagter’s project was to (through innovative use of technology) improve hourly rounding and subsequently reduce patient call frequency and improve patient outcomes for falls, and satisfaction. Patient satisfaction and security depends largely on the patient’s perception of nursing presence. When patient needs are anticipated and addressed through the use of hourly rounds, call light usage and fall rates may be reduced, and patient satisfaction scores may be increased (Meade, Bursell, & Ketelsen, 2006; Woodard, 2009).Approximately 65 staff members from 3 Tower including RNs, LPNs, Patient Care Leaders (PCLs – CNL students), Nursing Assistants (NAs), and Unit Secretaries (US) were involved in this EBP project. In addition to Kyla and the key nurses previously mentioned, the following people were instrumental in the implementation and support of this project: Ann Gaylord, BSN, RN; Latasha Harmon, BSN, RN; and Christian Harrocks, BS, IS Engineer.
  • Patient SatisfactionPatient Satisfaction is defined as the patient satisfaction scores provided by Professional Research Consultants (PRC) that are specific only to 3T. Patient satisfaction scores reported by PRC included scores related to Overall Quality of Nursing Care, Nursing Promptness, and Overall Safety. Data is shown for 2009 (pre-intervention) and 2010. The 2010 data trends upwards, demonstrating positive outcomes related to the new Hourly Rounding Process that began in June 2010. Year end data for 2011 is pending at this time.
  • Call Light FrequencyCall Light Frequency was measured using the call light reporting system. This reporting system provides information that records/displays the patient’s room number, event type (ie. RN presence, NA presence), services (ie. assist, bathroom, pain), start times (when presence indicator is pressed or call light activated), and elapsed times (the time nursing presence begins and ends or the time taken to address the call light). Call Light Frequency and data related to the specific duty assignment for the call (i.e. assist, bathroom, etc.) was retrieved using the Nurse Call System Report to identify trends. One of the goals of the Monitored Hourly Rounding was to decrease the frequency of call light usage. The graphs below demonstrate the overall monthly number of calls and number of calls specific for assistance and patient needing assistance to the bathroom.
  • Key project staff:Project Lead: Beth Wathen, MSN, RN – Clinical Practice Specialist, PICUQuality Specialist: Diane Redmond, MSN, RN – Nursing Specialist for Accreditation and PolicyInformatics Specialist: Maggie Swietlik, MSN, RN, CPHIMS – Manager, Clinical Decision SupportOrgan Procurement: Diane Bacino, BSN, RN – Organ Procurement CoordinatorSocial Work: Amanda Rosengren, MSWPhysician Champion: Emily Dobyns, MD – Attending Physician, PICUPrior to 2009, notification to Children’s Hospital Colorado’s OPO required initiation by the medical provider and often occurred shortly before patient death. This frequently resulted in missed opportunities for organ donation due to a lack of timely notification. In addition, Children’s Colorado did not utilize clinical triggers to notify the OPO when admitted patients first met clinical criteria for donation. Also, the intensive care unit (ICU) staff nurses were reluctant to notify the OPO, verbalizing that it felt like they were giving up on the patients too soon. In order to improve timely notification to the OPO, the Clinical Practice Specialist for the ICU, along with the unit Medical Director proposed a trial using automated clinical decision support (CDS) triggers within the electronic health record (EHR) (Epic® Madison, WI) to identify patients meeting donor criteria. The CDS triggers are based off inclusion and exclusion criteria embedded in the EHR that are evaluated each time values are filed in the nursing flowsheets. When clinical criteria is satisfied, the nurse caring for the patient receives a pop-up advisory indicating that the patient “may be eligible” for organ donation. The patient criteria includes: ventilated patient with Glasgow Coma Scale (GCS) score of 5 or less, normothermia and is not receiving sedation or paralytics. The advisory provides a hyperlink for the nurses that when clicked will return them to the documentation flowsheets to complete additional assessment questions pertaining to the patient’s donor status.
  • In 2009, only 5.2 % of patients eligible to donate organs became organ donors. Often this was due to delays in notification of the OPO. Only 55% of patients meeting the clinical criteria were referred to the OPO within the one-hour notification window. This delay often resulted in rendering patients ineligible for donation. The automated clinical triggers were implemented in the electronic health record in July of 2010 and by the end of that year our timeliness of organ referral rate jumped to 86%. Eight patients (18.6%) donated organs and 26 total organs were donated. As of June 2011, our rate of timely notification stands at 93% and 14% (4) eligible patients have donated 14 organs. 
  • AbstractUWHC’s Director, Operational Integration & Nursing Informatics (Director, NI) has led an interdisciplinary team, the Patient Story Task Force (PSTF) in partnership with the EHR vendor to re-establish the patient story in the EHR. The Task Force’s goals include: To increase clinicians’ satisfaction with access to information about patients’ unique history and needs, and to help clinicians feel supported to deliver individualized patient-centered care. By challenging the vendor to utilize its applications creatively, the PSTF successfully developed a patient story homepage for all patients admitted to an inpatient bed. The patient story homepage was implemented house-wide effective September 10, 2011 and is now the first page all clinicians see when they access an inpatient record: All clinicians now begin on the ‘same page’ for patient care planning. UWHC, thanks to its Nursing leadership (and tenacity), is the first hospital in the country to effectively develop an interdisciplinary patient story homepage and re-establish the patient story in the EHR.In addition to the project committee membership, 432 inpatient staff nurses (24% of the total inpatient nursing population) were involved in the project through the Nursing Informatics and Practice Councils, unit pilots, workflow observations, focus groups, and interviews.
  • Specifically, the objectives/outcomes are:To increase the number of patients admitted to an inpatient unit with a completed EHR patient story by 100% by September 2011: Done! Delivered as a defaulted patient story home page triggered by patient admission to unit for 100% of patients effective September 10, 2011.To increase clinicians’ satisfaction with the ease to locate the patient story in the EHR by 60% by October 2011: Increased by 68.7%!
  • Specifically, the objectives/outcomes are:To increase the number of patients admitted to an inpatient unit with a completed EHR patient story by 100% by September 2011: Done! Delivered as a defaulted patient story home page triggered by patient admission to unit for 100% of patients effective September 10, 2011.To increase clinicians’ satisfaction with the ease to locate the patient story in the EHR by 60% by October 2011: Increased by 68.7%!
  • To increase clinicians’ overall satisfaction with the information available in the EHR patient story by 60% by October 2011: Increased by 36.2%.
  • Started out of an IOM sabbatical with Dr. Angela McBride
  • Thank you to the HINZ Organising Committee for inviting me to speak.Thrilled to be here after 11 years. Last event was NI2000 right at this Centre.You notice that I attempted to wear “All Black!” Congratulations.Earlier this month I was in Boston, Massachusetts, where Harvard Research shows women who ware makeup are perceived to be more competent.
  • Nurses in Informatics - Transforming Healthcare

    1. 1. Nurses in Informatics Transforming Healthcare 25 NOVEMBER 2011SUSAN K NEWBOLD, PHD RN-BC FAAN FHIMSS
    2. 2. Topics Overview of historical efforts of Nursing Informatics pioneers Examples of current ways nurses use informatics to transform healthcare Tips on promoting healthcare informatics
    3. 3. NI History Project Dr. Harriett Werley Dr. Virginia Saba
    4. 4. Project Purpose and Funding
    5. 5. Pioneer Definition Innovator, trailblazer, or groundbreaker in some aspect of nursing informatics “First” in opening up a new area/aspect of nursing informatics, Shaped the thinking/direction of nursing informatics, and Demonstrated sustained leadership in nursing informatics AMIA Nursing History Committee, 2005
    6. 6. Videotaping 145 pioneers identified 33 videotaped (Chicago, Washington, Baltimore)  July 2005 – November 2007  Summer Institute in Nursing Informatics  AMIA Fall Meetings Selection  Earliest contributors to various aspects of nursing informatics  Availability & willingness to be interviewed  Limited resources
    7. 7. Nursing Informatics Pioneers Interviewed
    8. 8. Nursing Informatics Pioneers Interviewed
    9. 9. Common Themes• Nursing Informatics - what it is, present, future• The value of Informatics• Significant events that shaped the field of nursing informatics• Demographic of Pioneers• Pioneers path-career that lead up to involvement in (nursing) informatics • When they first considered themselves an informatics nurse.• Personal aspirations, accomplishments, vision, goals, collaborators• Pioneers first involvement - earliest events they recall. • Social and political environment the development of the field • Reactions of others • Level of difficulty in establishing discipline• Pioneers lessons learned that they would like to pass on.
    10. 10. Common Themes Example
    11. 11. Examples of Videos
    12. 12. Sample Transcription
    13. 13. Next Steps Adding a new section of other pioneers with bios Adding use cases for teaching and recruiting Qualitative analysis of themes Honoring Dr. Harriett Werley
    14. 14. NI Innovations Awards 2011 7th Year of the Award Initiated by Nurses for Nurses Sponsored by Health Data Management journal and ANIA-CARING Requirements –  Innovation in Healthcare that is Significant  Nursing Involvement  Metrics
    15. 15. NI Innovations Awards 2011 Carolinas Medical Center, Charlotte, North Carolina Children’s Hospital Colorado, Aurora, Colorado University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
    16. 16. Carolinas Medical Center, Charlotte, NC Monitored Hourly Rounding documented on paper Purpose of project:  improve hourly rounding, reduce patient call frequency, improve patient outcomes for falls and improve satisfaction Initiated by a nurse Nurse education to punch in and punch out on devices already in use Metrics - fall rates, patient satisfaction, and frequency of call light use
    17. 17. Hourly Rounding Project
    18. 18. Metrics for Rounding Project
    19. 19. Metrics for Rounding Project
    20. 20. Metrics for Rounding Project
    21. 21. Children’s Hospital Colorado, Aurora, Colorado Timely identification and early notification of potential organ donor candidates through clinical decision support Nurse involvement with social work and physician Metrics – increase in donations
    22. 22. Clinical Triggers and Donation 2009 2010 2011 (thru June 2011)Patients Meeting Clinical 58 43 28Triggers# Organ Donors 3 8 4% of patients meeting Clinical 5.2% 18.6% 14%Triggers that donated organs# Organs Donated 13 26 14
    23. 23. University of Wisconsin Hospitals and Clinics, Madison, Wisconsin EHR Patient Story In addition to the project committee membership, 432 inpatient staff nurses were involved in the project through the Nursing Informatics and Practice Councils, unit pilots, workflow observations, focus groups, and interviews. Metrics
    24. 24. University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
    25. 25. University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
    26. 26. University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
    27. 27. EHR Patient Story
    28. 28. TIGER Initiative Technology Informatics Guiding Educational Reform (TIGER) Integrate technology into all levels http://www.thetigerinitiative.org/
    29. 29. Questions
    30. 30. Nurses in Informatics Transforming Healthcare 25 NOVEMBER 2011SUSAN K NEWBOLD, PHD RN-BC FAAN FHIMSS

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