Agency Staff on the Agenda –
Training the Hidden Workforce in
eMMs
Austin Health
Major tertiary health provider in northeast
Melbourne
Three campuses
– The Austin Hospital
– Heidelberg Repa...
2011
Radiology orders
Pathology orders
e-Prescribing
Discharge Summaries
Results & Results Endorsement
2012-13
Inpatient m...
Organisational Statistics
Measure 2011 – 2012 Year
Staff (EFT)
Medical 647
Nursing 2,098
Allied 471
IT / Informatics 50
To...
June 2011
• ‘Big Bang’ implementation of
some Cerner modules
across 3 campuses.
• Had more effect on the
workflows of medi...
Implementation Comprised of:
• Alerts & Allergy recording
• Diagnosis, problem and past history recording
• Results Review...
Training
• All staff to be trained as per job role
• EFT differs from actual numbers of staff =
large numbers
• Some speci...
Training
The Cerner training team trained 6 days a
week from 0800 to 2200 Monday –
Saturday for 4 months
Training Stats
•Nursing staff – 2344
•Bank Nurses – 291
•Medical – 892
•Clerical – 354
•Allied Health - 423
Grand
Total:
4...
Austin Health Nurses trained in:
- Documenting Allergies
- Recording Patient weights
- Checking results
- Documenting when...
Superuser Training
•160 SuperUsers were trained
across the 3 campuses.
•2 x 8 hour training sessions
•Regular updates on a...
Decisions for Agency Nurses
• Meetings with Senior Nursing staff and
Nursing Workforce Administrators
• Decision made – Ag...
Decisions re Agency Nurses
The changes to nursing workflows were
not significant enough to warrant the
training of numerou...
Planning for eMM Implementation
After a very successful go live of phase 1,
plans were being made for the introduction of
...
Planning for eMM Implementation in
Rehabilitation/Continuing Care Wards– June 2012
• Electronic Drug charts to be
implemen...
Planning for eMM Implementation in
Rehabilitation/Continuing Care Wards– June 2012
• 30 Superusers trained for the 4 wards...
EMM: Electronic Medication Management Systems
‘A Guide To Safe Implementation’ 2nd Edition 2012
Australian sites that have...
Post Sub Acute Implementation
After extended support ended – training of
agency staff was given by a nominated
Superuser f...
2nd Rehabilitation/Continuing Care
Implementation - August 2012
• Electronic Medication Charts
implemented in another 2
Re...
Acute Care Implementation – Nov 12
•11 acute wards
•Did not include:
- ICU
- ED
- Mental Health
Training for the Implementation of an Electronic
Drug Chart in Acute Care
•All nursing, medical and clerical staff
trained...
Concerns
As Austin Health utilises Agency Nurses
to cover any shortfalls in the clinical
areas, many nursing staff voiced ...
Concerns re Agency Staff
• ? Compromise patient safety
• ? Increase workload for permanent nursing
staff
Concerns re Bank Staff
•Many Bank nurses did not regard
training as a priority so refused to attend.
•Wanted trained at a ...
Required Agency Information
• Meetings with Director of Nursing, Nursing
Work Admin Personnel and Nurse Unit
Managers
• Ho...
Common Agreement
•Agreement that Superusers would not
train Agency nurses on the job as this
was a strain on resources and...
Initial Agency Meetings
• 23 agencies utilised by Austin Health were
invited.
• 19 responded
• 14 accepted, 5 declined
• 1...
Agency Admin Meeting
• An overview of the system was shown and its
complexities
• An explanation of the necessity for trai...
Agreements
• 2 hour training session offered to agency
nurses by the Clinical Informatics training team
onsite at Austin H...
15 x 2 hour training sessions booked
Capacity to train 245 agency nurses
87 nurses attended
Bank Staff
•At the same time, numerous sessions for
Bank staff were created.
•463 staff were booked in
•357 attended
•106 ...
Continuity Plan
• Throughout this time it was recognised that
this model could not continue
• Another form of training had...
Continuity Plan
•Austin Health and Peninsula Health
share the same usernames for Cerner
due to a shared domain (Statewide
...
Continuity Plan
• Business plan drawn up
• Budget agreed
• Presentations given by 4 companies
• Quotes requested and recei...
…
Where would the LMS be Hosted?
•Would the LMS be hosted on the Intranet
or the Internet?
•If it was hosted internally, how...
Overcoming Obstacles
• Agency staff are not employees of Austin
Health therefore cannot log on externally to
the Clinical ...
Solutions…
• No patient identifiers on LMS – no
patient confidentiality compromised
• LMS could be hosted (but hidden) on
...
Roadblocks – Account Creation
Account Creation Process
• Nurse applies for job
• Nurse gets job
• Nurse receives paperwork...
Account Creation
• Nurse makes appointment with HR
• Nurse visits HR and completes ‘sign on’
process
• Nurses details ente...
Agency Nurses are not Austin Health
Employees!!!
Initial Agency Account Creation Process
• Agencies were sending through their nurses
details to me and accounts were being...
Pre Go Live
•Most agencies wanted all their
nurses to have Cerner
accounts…just in case = huge
numbers
•Prior to go live, ...
Requested IT Input
• IT expertise sought.
• IT created a template which requested specific
information regarding the agenc...
Bulk Upload Template
•This allowed the creation of multiple
accounts.
•Same template can be used by multiple
departments t...
Process Change
• Template completed by agencies with required
information
• Emailed through to Austin Health IT Service De...
The Creation of an LMS
• The screen captures were taken over a 2 day
period.
• 2 week turnaround period for review, recapt...
The Creation of an LMS
•20 lessons for nursing staff
•13 compulsory for agency nurses
Why only 13???
Training for first im...
Agencies Invited Back to Austin
•Agencies were shown the LMS and how
to access it
•Explanation of compulsory vs optional
m...
Agency Responsibilities and
Agreements
• Each agency responsible for ensuring and
checking their nurses were trained onlin...
Accessing the LMS
www.austin.org.au
Reports
• Each agency has their own unique code
• Each agency has named administrators with
Reporting access
• Agencies gi...
Account Details
•If an agency nurse cannot get their log in
details from their agency, they can either
contact Austin Heal...
Account Details
Austin Health’s IT Service Desk team,
the entire Clinical Informatics Unit and all
the After Hours Site Ma...
Policy
No training = No access = No
shifts at Austin Health
Lessons are separated as per job
title:
• Nurse
• Agency Nurse
• Medical Officer
• Clerk
• Medical Student
• Allied Health
Stats
•The LMS first became available on 7th
November 2012
•To date, there have been 20152 ‘hits’ on
it
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...
Post Go Live
•Due to budget restraints, many agency
staff have opted to join Nurse Bank as
they receive more regular shift...
Questions?
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden wo...
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden wo...
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden wo...
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden wo...
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden wo...
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden wo...
Barbara Lennon, Clinical Informatics Education Manager, Austin Health - Agency Staff on the Agenda: Training the hidden wo...
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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 electronic medication management systems.

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

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

  1. 1. Agency Staff on the Agenda – Training the Hidden Workforce in eMMs
  2. 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. 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. 4. Organisational Statistics Measure 2011 – 2012 Year Staff (EFT) Medical 647 Nursing 2,098 Allied 471 IT / Informatics 50 Total 5184
  5. 5. June 2011 • ‘Big Bang’ implementation of some Cerner modules across 3 campuses. • Had more effect on the workflows of medical staff.
  6. 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. 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. 8. Training The Cerner training team trained 6 days a week from 0800 to 2200 Monday – Saturday for 4 months
  9. 9. Training Stats •Nursing staff – 2344 •Bank Nurses – 291 •Medical – 892 •Clerical – 354 •Allied Health - 423 Grand Total: 4304
  10. 10. Austin Health Nurses trained in: - Documenting Allergies - Recording Patient weights - Checking results - Documenting when they had successfully collected a pathology specimen
  11. 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. 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. 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. 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. 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. 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. 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. 18. Post Sub Acute Implementation After extended support ended – training of agency staff was given by a nominated Superuser from the ward.
  19. 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. 20. Acute Care Implementation – Nov 12 •11 acute wards •Did not include: - ICU - ED - Mental Health
  21. 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. 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. 23. Concerns re Agency Staff • ? Compromise patient safety • ? Increase workload for permanent nursing staff
  24. 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. 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. 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. 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. 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. 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. 30. 15 x 2 hour training sessions booked Capacity to train 245 agency nurses 87 nurses attended
  31. 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. 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. 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. 34. Continuity Plan • Business plan drawn up • Budget agreed • Presentations given by 4 companies • Quotes requested and received Decision…
  35. 35.
  36. 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. 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. 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. 39. Roadblocks – Account Creation Account Creation Process • Nurse applies for job • Nurse gets job • Nurse receives paperwork from HR • Nurse fills in paperwork
  40. 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. 41. Agency Nurses are not Austin Health Employees!!!
  42. 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. 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. 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. 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. 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. 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. 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. 49. Agencies Invited Back to Austin •Agencies were shown the LMS and how to access it •Explanation of compulsory vs optional modules
  50. 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. 51. Accessing the LMS www.austin.org.au
  52. 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. 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. 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. 55. Policy No training = No access = No shifts at Austin Health
  56. 56. Lessons are separated as per job title: • Nurse • Agency Nurse • Medical Officer • Clerk • Medical Student • Allied Health
  57. 57. Stats •The LMS first became available on 7th November 2012 •To date, there have been 20152 ‘hits’ on it
  58. 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. 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. 60. Questions?

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