Provide one example, with supporting evidence, of an improvement in the nursing practice that resulted from clinical nurses' involvement with design and implementation of technology. Supporting evidence must be submitted in the form of a graph with a data table that clearly displays the data.
AND
Provide one example, with supporting evidence, of an improvement in the patient experience that resulted from clinical nurses' involvement with design and implementation of technology. Supporting evidence must be submitted in the form of a graph with a data table that clearly displays the data.
Example One
Improvement in the nursing practice that resulted from clinical nurses' involvement with design and implementation of technology
Background/Problem
In the first quarter of 2012, physician order sheets were used for screening patients for Pneumovax and influenza immunizations. The use of a paper system for tracking immunizations was inconsistent, and many patients left the hospital without being screened and ultimately without being vaccinated. The new CMS protocol implemented that all patients be screened for vaccines. In early 2012, FF Thompson Hospital was not meeting the CMS core measure standard of at least 91% of all patients be screened for vaccinations. We were below the national average at 90%.
Goal Statement
The improvement desired was to electronically track immunizations on all inpatients using the electronic immunization screening tool, and meet or exceed the CMS Core Measure percentage of 91% of all patients screened for immunizations within the first three months of implementation.
Following the Magnet definition of nursing practice, in which nursing practice encompasses autonomous and collaborative care of individual's in all settings and promoting a safe environment, it was identified that vaccination screening be captured in a new manner in order to meet CMS core standards. Upon the implementation of FF Thompson Hospital's new electronic medical record system in the second quarter of 2012,the process for screening patients for immunizations became automated. The Clinical Care Station (CCS) build team, which consisted of clinical nurses, pharmacists, infection control, and informatics nurses, created a detailed immunization tab within McKesson to help capture vaccination screening. The following are the measures that were put in place to show improvement:
Any item on the list with an “R” indicates there is reference data for the nurse to use while screening as needed. See below.
Data requirements:
Participants
Wendy Schultze, BSN, RN, Informatics Nurse Specialist, CCS Build Team, Nursing Administration, Patient Care Services Cathy Crosby, MSN,RN, CNL Diagnostic Imaging, CCS Build Team Laurie McFetridge, BSN,RN, CPN, 3 East Charge Nurse, CCS Build Team, Medical Surgical Unit, Department of Nursing Christine Casterline, RN, 3 West Clinical Nurse, CCS Build Team, Medical Surgical Unit, Department of Nursing Kathy Cooley, BSN, RN, CNOR Surgical Informatics Nurse, Perioperative Services, Department of Nursing Virginia Henry, RN, Ambulatory Procedures Unit, CCS Build Team, Perioperative Services, Department of Nursing Renee Thomas, RPh, Pharmacist, Pharmacy, Patient Care Services Sherrie Defayette, RN, ICU Clinical Nurse, CCS Build Team, Department of Nursing Diana Ellison, MSN RN, CNL, Clinical Nurse Leader, Nursing Administration, Patient Care Services Gloria Karr, MSN, RN-BC, CIC, Director of Infection Control and Emergency Preparedness, System Administration
While an initial increase in immunization screening took place, and projected the hospital well above the CMS core measure national average, we began to see a decrease in compliance, and in quarter two of 2013, we were at the CMS national average for compliance. The CCS team reevaluated the immunization screening process, and identified that during initial implementation, the team had made the decision to include the screening tool in the admission assessment only. This was an attempt to enforce the screening needed to be completed for each admission. On re-evaluation of the process in quarter three of 2013, it was determined a number of people fell into “Precaution” category and the electronic screening tool was not accessible because the admission assessment can only be used once. The CCS team then added the immunization screening tool to the "Daily Assessments" tab in the electronic record. This alerts the nurse that they need to follow up with the immunization screening on their patient if they were initially listed as a precaution and needed to be reevaluated.
Outcome
With the reevaluation in quarter three of 2013 and change in technology to provide the nursing staff with consistent information and automated processes to flag patients for immunization needs, FF Thompson Hospital has exceeded it's goal of meeting the CMS core standard of 91% for three quarters post reevaluation, and in quarter one of 2014, is at 96% with a trajectory of 99% by the end of quarter three of 2014.
Example Two
Midway through 2012, it was identified that inefficiencies in the admission process were delaying the transfer of patients from the Emergency Department to their Inpatient/Observation rooms causing a decrease in the patient experience during their stay in the Emergency Department. One specific area noted was the reporting process from the Emergency Department Nurse to the Medical/Surgical Nurse. This process consisted of the Emergency Department Nurse obtaining a bed assignment, calling the proper unit, and giving verbal report to the Medical/Surgical Nurse. Delays occurred if either the Emergency Department Nurse or the Medical/Surgical Nurse were unavailable caring for other patients to make or answer the telephone call at the time the bed assignment was made. By October 2012, the average time it took from the time a bed assignment to be made until a patient arrived to the Inpatient/Observation room was greater than 90 minutes.
The desired outcome was to decrease the amount of time it took for a patient to be transferred to their Inpatient/Observation room once a bed assignment was made using the technology if the Emergency Department electronic medical record, T-System, to make the process more efficient. This decrease in the amount of time would lead to an improvement in patient experience as identified by an increase in the Press Ganey Satisfaction Survey Emergency Department Overall Rating.
A team consisting of members from Emergency Department Nursing, Medical/Surgical Nursing, Nursing Informatics, and Information Technology met to discuss ways to meet the goals by using T-System to transfer information. This team discussed the admission process and developed a new protocol to use technology to make the process of transferring information more efficient. The following are the steps put in place to meet these goals:
Data Requirements
While the first graph shows the improvement in the patient experience related to timely admission to the floor, the second graph show a steady improvement in overall patient experience post intervention.
Elizabeth C. Alexander, MS, RN, CN-E, Director of Medical Surgical Nursing, Patient Care Services Virginia Hebda, MS, RN, CEN, Previous Director of Emergency Nursing, Patient Care Services Kathy Wethington, RN, CMSRN Clinical Nurse, 3 West, Medical Surgical Unit, Department of Nursing Megan Didas, BSN,RN Clinical Nurse Emergency Department, Department of Nursing
With the implementation of using the technology of T-System to print the medical record directly to the assigned Inpatient Unit, the goal of decreasing the amount of time from assignment to a bed resulting in an improvement in patient experience was met. The average time from bed assignment to being transferred into a room decreased from an average of 95 minutes to an average of 63 minutes and the Press Ganey ranking improved from the 43rd Percentile to the 73rd percentile.