January 2016
Clinical Informatics Council
Cancer Center
University of New Mexico Hospitals
Albuquerque
,
NM
United States
The DAISY Team Award is designed to honor collaboration by two or more people, led by a nurse, who identify and meet patient and/or patient family needs by going above and beyond the traditional role of Nursing. Our Clinical Informatics Team (CIT) is the epitome of this intent. Most nurses will tell you that the transition to the electronic health record was not easy, some will say the computer became its own kind of patient! At the University of New Mexico Hospitals, our CIT has been a leader nationally in helping put our computers back in their place. The team has done this by creating online forms that work and talk to each other, creating synergy and reducing redundancy. This allows the nursing staff to do what they love most: spending time with their patients!
Patients are admitted to a hospital for nursing care, and with that, the patient plan of care is managed by nursing. The plan of care at UNMH is really the entire patient record, and within it, the Nursing Process of Assessment, Diagnosis/Goal Setting, Interventions, and Re-evaluation is essential to helping patients achieve their maximal outcomes! Our plan of care is called the MSOC. Our CIT has facilitated the multidisciplinary summary of care (MSOC) by listening to the team and, in a thoughtful progression, creating a plan that helps nurses give the best care.
Additionally, the team has assessed the 5,000+ cells (fields in the electronic health record) and trimmed cells that are rarely used, coordinated where each particular data item is documented, and alleviated bulk and redundancy that didn't add to our patient outcomes. The MSOC is a single place where each discipline: nursing, respiratory therapy, physical therapy/occupational therapy/speech, dietary, pain management service, pastoral care, pharmacy, and the providers can all quickly see the last notes by each discipline. The summary section is a place to note the most pertinent patient-centric activities/actions/outcomes of the shift. We cannot speak highly enough of all of the CIT members who bring their computer skills, clinical acumen, and nifty ideas to our caregivers each and every day. The work that they have done in properly documenting food allergies, to the daily print-out of patients who still need a flu shot, have facilitated our care, given us more time with our patients, and amplified the care we provide. We are hearing about new and exciting processes that the team has in store for us! The team is led by Dr. Kim McKinley, a DNP, an acute care nurse practitioner, and certified in informatics. Kim was among the first fellows in the Academy of Nursing Informatics. Thank-you for having the innovative idea to recognize Health Care teams with your wonderful DAISY program!
***
When it comes to clinical information systems, the philosophy of the University of New Mexico Hospitals (UNMH), is that the people who do the work should be instrumental in the way that the work gets done, and, in the case of the electronic health record, documented. That places the power squarely on the shoulders of the bedside nurses. Nurses from all areas of the hospitals and clinics participate in the Clinical Informatics Team (CIT). They contribute their time to improve the care of our patients. Any nurse or healthcare member can bring a problem or concern to the CIT. The team members will brainstorm solutions and then form a task force to work on the issue. They perform a literature search, consult stakeholders, complete a workflow analysis, and then design the change.
Nurses in Information Technology then build it into the EHR. The CIT recognizes that it has a responsibility to the hospital's mission of safe patient care and to the nursing students we teach. They use several design principles to accomplish these goals. First, the EHR must be simple and direct, with a minimal number of screens and/or clicks to reach the fields. Second, equipment needs to be interoperable so that repetitive information is auto-charted by the system. Third, the design has to guide the novice nurse to do the right thing by using clinical decision support, reference texts, and alerts. Fourth, the system has to support evidence-based care. Fifth, the system has to support testing of new nursing care to prove effectiveness. There are several examples of design changes that support patient care.
The first change was the addition of an alert. The nurses started noticing that ventilated patients were developing oral erosions from the endotracheal tube. They instituted a reminder alert to move the tube every two hours. We will then run a report to determine compliance and a change in the number of these erosions before and after the addition of the alert.
Another addition to the EHR is the Pediatric Early Warning Score (PEWS). Pediatrics is using this to predict if a child is deteriorating. Lastly, they noted a major design flaw in the documentation of skin care and wounds. Three departments document wounds: Nursing, Burn and Wound Team, and Physical Therapy. Each used their own documentation tool. It is common for our patients to have multiple wounds. Each discipline, or even each practitioner, could name the wound something different, leading to confusion between all of the disciplines. It also had legal ramifications in child abuse or elder abuse when the documentation conflicted. The CIT re-designed the wound care documentation so that all disciplines can chart in the same place and label the wounds appropriately. This is a huge improvement in patient safety. Here at UNMH, we are extremely proud of the work done by our Clinical Informatics Team. It is a model we have found to be highly effective and gratifying to the nursing staff.
Patients are admitted to a hospital for nursing care, and with that, the patient plan of care is managed by nursing. The plan of care at UNMH is really the entire patient record, and within it, the Nursing Process of Assessment, Diagnosis/Goal Setting, Interventions, and Re-evaluation is essential to helping patients achieve their maximal outcomes! Our plan of care is called the MSOC. Our CIT has facilitated the multidisciplinary summary of care (MSOC) by listening to the team and, in a thoughtful progression, creating a plan that helps nurses give the best care.
Additionally, the team has assessed the 5,000+ cells (fields in the electronic health record) and trimmed cells that are rarely used, coordinated where each particular data item is documented, and alleviated bulk and redundancy that didn't add to our patient outcomes. The MSOC is a single place where each discipline: nursing, respiratory therapy, physical therapy/occupational therapy/speech, dietary, pain management service, pastoral care, pharmacy, and the providers can all quickly see the last notes by each discipline. The summary section is a place to note the most pertinent patient-centric activities/actions/outcomes of the shift. We cannot speak highly enough of all of the CIT members who bring their computer skills, clinical acumen, and nifty ideas to our caregivers each and every day. The work that they have done in properly documenting food allergies, to the daily print-out of patients who still need a flu shot, have facilitated our care, given us more time with our patients, and amplified the care we provide. We are hearing about new and exciting processes that the team has in store for us! The team is led by Dr. Kim McKinley, a DNP, an acute care nurse practitioner, and certified in informatics. Kim was among the first fellows in the Academy of Nursing Informatics. Thank-you for having the innovative idea to recognize Health Care teams with your wonderful DAISY program!
***
When it comes to clinical information systems, the philosophy of the University of New Mexico Hospitals (UNMH), is that the people who do the work should be instrumental in the way that the work gets done, and, in the case of the electronic health record, documented. That places the power squarely on the shoulders of the bedside nurses. Nurses from all areas of the hospitals and clinics participate in the Clinical Informatics Team (CIT). They contribute their time to improve the care of our patients. Any nurse or healthcare member can bring a problem or concern to the CIT. The team members will brainstorm solutions and then form a task force to work on the issue. They perform a literature search, consult stakeholders, complete a workflow analysis, and then design the change.
Nurses in Information Technology then build it into the EHR. The CIT recognizes that it has a responsibility to the hospital's mission of safe patient care and to the nursing students we teach. They use several design principles to accomplish these goals. First, the EHR must be simple and direct, with a minimal number of screens and/or clicks to reach the fields. Second, equipment needs to be interoperable so that repetitive information is auto-charted by the system. Third, the design has to guide the novice nurse to do the right thing by using clinical decision support, reference texts, and alerts. Fourth, the system has to support evidence-based care. Fifth, the system has to support testing of new nursing care to prove effectiveness. There are several examples of design changes that support patient care.
The first change was the addition of an alert. The nurses started noticing that ventilated patients were developing oral erosions from the endotracheal tube. They instituted a reminder alert to move the tube every two hours. We will then run a report to determine compliance and a change in the number of these erosions before and after the addition of the alert.
Another addition to the EHR is the Pediatric Early Warning Score (PEWS). Pediatrics is using this to predict if a child is deteriorating. Lastly, they noted a major design flaw in the documentation of skin care and wounds. Three departments document wounds: Nursing, Burn and Wound Team, and Physical Therapy. Each used their own documentation tool. It is common for our patients to have multiple wounds. Each discipline, or even each practitioner, could name the wound something different, leading to confusion between all of the disciplines. It also had legal ramifications in child abuse or elder abuse when the documentation conflicted. The CIT re-designed the wound care documentation so that all disciplines can chart in the same place and label the wounds appropriately. This is a huge improvement in patient safety. Here at UNMH, we are extremely proud of the work done by our Clinical Informatics Team. It is a model we have found to be highly effective and gratifying to the nursing staff.