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Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs
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Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden workforce in eMMs

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Barbara Lennon delivered this presentation at the 3rd Annual Electronic Medication Management Conference 2014. This conference is the nation’s only event to look solely at electronic prescribing and …

Barbara Lennon delivered this presentation at the 3rd Annual Electronic Medication Management Conference 2014. This conference is the nation’s only event to look solely at electronic prescribing and electronic medication management systems.

For more information, please visit http://www.healthcareconferences.com.au/emed14

Published in: Health & Medicine
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  • 1. Agency Staff on the Agenda – Training the Hidden Workforce in eMMs
  • 2. Austin Health Major tertiary health provider in northeast Melbourne Three campuses – The Austin Hospital – Heidelberg Repatriation Hospital – Royal Talbot Rehabilitation Centre Major services – Liver & Gastro-intestinal transplantation – Spinal Cord Injuries – Oncology – Vic Respiratory Services – ONJ Centre – MH – External sites – Dialysis – external sites
  • 3. 2011 Radiology orders Pathology orders e-Prescribing Discharge Summaries Results & Results Endorsement 2012-13 Inpatient medications MAR Fluid balance chart 724 Access 2014 Clinical Documentation First Net ? Oncology system ? Surgi Net The Austin Health EMR Journey Clinical System Chosen:
  • 4. Organisational Statistics Measure 2011 – 2012 Year Staff (EFT) Medical 647 Nursing 2,098 Allied 471 IT / Informatics 50 Total 5184
  • 5. June 2011 • ‘Big Bang’ implementation of some Cerner modules across 3 campuses. • Had more effect on the workflows of medical staff.
  • 6. Implementation Comprised of: • Alerts & Allergy recording • Diagnosis, problem and past history recording • Results Review • Pathology and radiology ordering • Ordering Discharge Prescriptions • Discharge Summaries
  • 7. Training • All staff to be trained as per job role • EFT differs from actual numbers of staff = large numbers • Some specialities wanted to be trained separately • Nurse Bank staff contacted and offered training – minimal uptake
  • 8. Training The Cerner training team trained 6 days a week from 0800 to 2200 Monday – Saturday for 4 months
  • 9. Training Stats •Nursing staff – 2344 •Bank Nurses – 291 •Medical – 892 •Clerical – 354 •Allied Health - 423 Grand Total: 4304
  • 10. Austin Health Nurses trained in: - Documenting Allergies - Recording Patient weights - Checking results - Documenting when they had successfully collected a pathology specimen
  • 11. Superuser Training •160 SuperUsers were trained across the 3 campuses. •2 x 8 hour training sessions •Regular updates on any changes made pre implementation •Post Implementation support 24/7
  • 12. Decisions for Agency Nurses • Meetings with Senior Nursing staff and Nursing Workforce Administrators • Decision made – Agency nurses not required to be trained in the use of Cerner WHY??
  • 13. Decisions re Agency Nurses The changes to nursing workflows were not significant enough to warrant the training of numerous agency staff Austin nurses were satisfied with this decision
  • 14. Planning for eMM Implementation After a very successful go live of phase 1, plans were being made for the introduction of a fully electronic medication chart on Cerner. The medication component would be rolled out in a phased approach. As paper medication charts would no longer be available at the bedside, all nurses would be required to be trained in administering medications from an electronic chart.
  • 15. Planning for eMM Implementation in Rehabilitation/Continuing Care Wards– June 2012 • Electronic Drug charts to be implemented in 4 Rehabilitation/Continuing Care Wards(Repatriation Campus) • 2 weeks 24/7 support from Clinical Informatics Team • ‘On the job’ training given to agency staff
  • 16. Planning for eMM Implementation in Rehabilitation/Continuing Care Wards– June 2012 • 30 Superusers trained for the 4 wards. • 2 X 8 hour training sessions • Superusers would cover 3 shifts (morning, evening and night) for a 2 week period • 24/7 support from the Clinical Informatics Team would be given for a period of 2 weeks – reduced after 1 week due to confidence in using the system
  • 17. EMM: Electronic Medication Management Systems ‘A Guide To Safe Implementation’ 2nd Edition 2012 Australian sites that have already implemented EMM systems found that it is not always possible to fully train agency and locum staff before they use the EMM system. Recognising that these staff may only work on a single occasion at the hospital, shortened training should be tailored to reflect their needs and access to EMM experts on the ward should be made available.
  • 18. Post Sub Acute Implementation After extended support ended – training of agency staff was given by a nominated Superuser from the ward.
  • 19. 2nd Rehabilitation/Continuing Care Implementation - August 2012 • Electronic Medication Charts implemented in another 2 Rehabilitation/Continuing Care Implementation wards (Talbot campus) • Same training/support model used for Talbot
  • 20. Acute Care Implementation – Nov 12 •11 acute wards •Did not include: - ICU - ED - Mental Health
  • 21. Training for the Implementation of an Electronic Drug Chart in Acute Care •All nursing, medical and clerical staff trained (classroom) 6 days per week until 10pm over a 4 week period •719 nurses •45 doctors •31 clerks •130 superusers (plus 2 medical superusers)
  • 22. Concerns As Austin Health utilises Agency Nurses to cover any shortfalls in the clinical areas, many nursing staff voiced their concerns that there was a need to train agency nurses, especially prior to a shift within the hospital.
  • 23. Concerns re Agency Staff • ? Compromise patient safety • ? Increase workload for permanent nursing staff
  • 24. Concerns re Bank Staff •Many Bank nurses did not regard training as a priority so refused to attend. •Wanted trained at a time suitable to them, not what we could offer.
  • 25. Required Agency Information • Meetings with Director of Nursing, Nursing Work Admin Personnel and Nurse Unit Managers • How many agencies? • How many agency nurses?
  • 26. Common Agreement •Agreement that Superusers would not train Agency nurses on the job as this was a strain on resources and there was no guarantee that a Superuser would be available on each shift •Agreement that agency administration staff would need to be involved in the planning and continuation of training
  • 27. Initial Agency Meetings • 23 agencies utilised by Austin Health were invited. • 19 responded • 14 accepted, 5 declined • 10 attended The agencies who failed to attend, no longer have a contract with Austin Health
  • 28. Agency Admin Meeting • An overview of the system was shown and its complexities • An explanation of the necessity for training • The concerns of Austin Health nursing staff raised • The need to maintain a good relationship with hospital and agency
  • 29. Agreements • 2 hour training session offered to agency nurses by the Clinical Informatics training team onsite at Austin Health • Austin Health would not be responsible for the payment of these 2 hours • Responsibility of the agency nurse to attend in their own time • A short term measure – more planning required
  • 30. 15 x 2 hour training sessions booked Capacity to train 245 agency nurses 87 nurses attended
  • 31. Bank Staff •At the same time, numerous sessions for Bank staff were created. •463 staff were booked in •357 attended •106 failed to attend = 77.11% attendance rate Bank Staff were paid to attend
  • 32. Continuity Plan • Throughout this time it was recognised that this model could not continue • Another form of training had to be made available • Contact with Education Manager in Peninsula Health, Victoria re Learning Management System (LMS) • Close relationship between 2 Health Services
  • 33. Continuity Plan •Austin Health and Peninsula Health share the same usernames for Cerner due to a shared domain (Statewide domain) •Austin Health and Peninsula Health also use some same agencies •Access given to view Peninsula Health’s LMS
  • 34. Continuity Plan • Business plan drawn up • Budget agreed • Presentations given by 4 companies • Quotes requested and received Decision…
  • 35.
  • 36. Where would the LMS be Hosted? •Would the LMS be hosted on the Intranet or the Internet? •If it was hosted internally, how would the external staff access it? •If it was hosted externally, how would it be kept out of view?
  • 37. Overcoming Obstacles • Agency staff are not employees of Austin Health therefore cannot log on externally to the Clinical Portal • ? Administrators becoming honouree employees – NO!! Discussion with legal department and IT…
  • 38. Solutions… • No patient identifiers on LMS – no patient confidentiality compromised • LMS could be hosted (but hidden) on Austin Health’s website • Password protected • Instructions on accessing the programme would be given to the agencies
  • 39. Roadblocks – Account Creation Account Creation Process • Nurse applies for job • Nurse gets job • Nurse receives paperwork from HR • Nurse fills in paperwork
  • 40. Account Creation • Nurse makes appointment with HR • Nurse visits HR and completes ‘sign on’ process • Nurses details entered onto the HR system • Nurses details are sent to Department of Health • Cerner account is created
  • 41. Agency Nurses are not Austin Health Employees!!!
  • 42. Initial Agency Account Creation Process • Agencies were sending through their nurses details to me and accounts were being created manually by me – time consuming and laborious • Not sustainable
  • 43. Pre Go Live •Most agencies wanted all their nurses to have Cerner accounts…just in case = huge numbers •Prior to go live, approx 400 accounts were created manually as requested by agencies. •Not sustainable
  • 44. Requested IT Input • IT expertise sought. • IT created a template which requested specific information regarding the agency nurse. • 1st trail failed • 2nd trial failed • 3rd trial successful!!!
  • 45. Bulk Upload Template •This allowed the creation of multiple accounts. •Same template can be used by multiple departments throughout the hospital •Template used for new medical and nursing staff in February rotations and for university students
  • 46. Process Change • Template completed by agencies with required information • Emailed through to Austin Health IT Service Desk • Bulk upload occurred. • Accounts created • Details emailed back to agencies • Logon details given to agency nurses on completion of online training
  • 47. The Creation of an LMS • The screen captures were taken over a 2 day period. • 2 week turnaround period for review, recapture and publication.
  • 48. The Creation of an LMS •20 lessons for nursing staff •13 compulsory for agency nurses Why only 13??? Training for first implementation not compulsory for agency staff therefore those modules made optional for agency nurses. Agency nurses only had to complete medication related modules.
  • 49. Agencies Invited Back to Austin •Agencies were shown the LMS and how to access it •Explanation of compulsory vs optional modules
  • 50. Agency Responsibilities and Agreements • Each agency responsible for ensuring and checking their nurses were trained online prior to accepting a shift at Austin. • Each agency is responsible for ensuring a Cerner account has been created prior to commencing a shift at Austin Health
  • 51. Accessing the LMS www.austin.org.au
  • 52. Reports • Each agency has their own unique code • Each agency has named administrators with Reporting access • Agencies given instructions on creating reports detailing who has completed training and which modules they completed • Agencies can only access their own reports
  • 53. Account Details •If an agency nurse cannot get their log in details from their agency, they can either contact Austin Health Service desk during office hours or the Clinical Informatics Unit Oncall person if it is out of hours. •Austin Health’s After Hours Site Managers have also been trained in searching for account details
  • 54. Account Details Austin Health’s IT Service Desk team, the entire Clinical Informatics Unit and all the After Hours Site Managers also have Reports Access on the LMS so they can check training records prior to giving out passwords
  • 55. Policy No training = No access = No shifts at Austin Health
  • 56. Lessons are separated as per job title: • Nurse • Agency Nurse • Medical Officer • Clerk • Medical Student • Allied Health
  • 57. Stats •The LMS first became available on 7th November 2012 •To date, there have been 20152 ‘hits’ on it
  • 58. No of Nurses Who Have Completed their Training per Agency 0 100 200 300 400 500 600 700 800 900 1000 1 Belmore C4U Collins & Brown HCI Malvern Mediserve Origin Swingshift VNS Workpac YNA
  • 59. Post Go Live •Due to budget restraints, many agency staff have opted to join Nurse Bank as they receive more regular shifts at Austin Health. •Since the acute go live in November 2012 a further 187 Bank nurses have received training
  • 60. Questions?

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