a digital prescription for effective nursing practice · a digital prescription for effective...
TRANSCRIPT
A Digital Prescription for Effective Nursing Practice
Tricia Thomas, Chief Nursing Officer, Trinity Home Health
Frances Dare, Managing Director, Accenture
March 3, 2016
Conflict of Interest
Tricia Thomas, PhD, RN
Has no real or apparent conflicts of interest to report
Frances Dare, MBA
Has no real or apparent conflicts of interest to report
• Today’s Nurse Communication Challenges
• Technology’s Role with the Challenges
• Integrated Technology and Clinical Practice Examples
• Integrated Technology and Practice Vision
• Working Together
Agenda
• Discuss the primary communication challenges nurses face: frequent
interruptions, difficulties interacting with others, time loss locating other
team members and equipment, and barriers to communication with patient
families
• Explain effective communication methods and the best enabling
technologies
• Demonstrate how integrated communication technologies and mobile
devices can support efficient, effective clinical practice
• Identify ways IT leadership can collaborate with nursing leadership to
improve clinical practice, efficiency and quality enabled by information and
communication technologies
Learning Objectives
Question 1
TRUE OR FALSE:
More than half of the HCHAPS (Hospital Consumer Assessment of
Healthcare Providers and Systems) patient satisfaction questions
focus directly on nurse – patient communication or nursing practice
impacted by communication challenges.
Observation and 1:1 shadowing:
24 x 7
All shifts
Understanding The Situation
Wide range of units and services:
Emergency
Intensive Care
Medical-Surgical
Short Stay
Post Anesthesia Care
Three hospitals – two states:
Community and academic
Small and large
SATISFACTION • High stress for nurses
• Frustration for families S
Realizing Value . . . The Starting Point
TREATMENT / CLINICAL • 1 page every 2.5 minutes
T
ELECTRONIC SECURE DATA • Unencrypted text work arounds
E
SAVINGS • 19 lost minutes per hour
• 9 minutes to find receiving RN, complete handoff S
Sources: http://ihealthtran.com/wordpress/2013/07/infographic-realizing-the-value-of-health-it/
2.6m registered nurses in the US workforce
62% of nurses work in hospitals
4x as many registered nurses as physicians in the U.S
Why Nursing Communication Matters
Sources:
http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-fact-sheet
http://www.jointcommission.org/assets/1/18/Root_Causes_Event_Type_2004-2Q_2015.pdf
http://www.ncbi.nlm.nih.gov/pubmed/20812527 2010 Jul-Aug;55(4):265-81; discussion 281-2.
Communication top 3 cause of sentinel events
$12B waste annually in US hospitals due to inefficient
communication
Average 500 bed hospital loses approximately $4m
annually
A Day in the Life of a Nurse
15 interruptions 1 patient 1 hour
minute for transition
conversations
1
minutes between
overhead pages
3
minutes lost with
transfer delays
19+
Biggest time loss—
locating other clinicians
Frequency and variety of
interruptions
Need for communication
options with patients
and families
Technologies have
increased
communication
expectations
EHR potential for
streamlined
communication
not yet realized
Tension between best
quality and most
efficient communication
Communication Challenges Key Findings
Today’s Technology Avalanche
Trinity Initiative: “Doc Halo”
COMMUNICATION
NEED
• Secure, real time communication
between nurses and broader care
team
SOLUTION
• Secure text messages and images
• Mobile phone based
• Interruption management via phone
controls
IMPACT • Decreased interruptions
• Time savings
E
Trinity Initiative: “Clarvia” S
COMMUNICATION
NEED • Complete, timely acuity information
SOLUTION
• Application to determine nurse
staffing based upon clinical record
• Data from EHR nursing
documentation an interventions—
33,000 mapped items
• Partnership between CNO, CFO
and CIO
IMPACT
• Right number and types of staff
• Improved patient and staff
satisfaction
Trinity Initiative: Fetal Link
COMMUNICATION
NEED
• Simultaneous sharing of
information between nurses and
physicians
SOLUTION
• Fetal monitoring strips and some
nursing documentation shared
• Real-time viewing regardless of
location
• MD access via phone or tablet
IMPACT
• 14 fewer nurse-physician calls per
patient
• Improved patient safety and care
quality
S
Question 2
TRUE OR FALSE:
Hospitals should implement technologies that ensure nurses are
interrupted only as allowed within set clinical practice policies.
• One Device
– Integrated functionality
• Constant Visibility
– Patients
– Team members
• Control
– Availability
– Communication medium
• Rewards and Reinforcement
– Individual and team behaviors
– Fun
Technology Nurses Dream Of
The Mobile Prescription—A Technology Concept
15 interruptions 1 patient
A View of the Possible
Question 3
Which of the following is an important “best practice” for
technology teams to support more effective nursing
communication:
A. Customize technologies based upon requests from individual
departments or units
B. Establish end-of-life policies for legacy technologies
C. Follow a best-of-breed approach to identify and implement
communication and collaboration technologies
How Nursing and IT Can Work Together
• Essential to have partnership between nurses and IT
– Different vantage points
• Use of councils/committees
– Share purpose, common and shared language
• Enterprise approaches
– Collaborate on content, flow, function
• Address concerns related to safety, quality,
cost, and functionality
SATISFACTION • Easier workflows for nurses
• Improved patient satisfaction S
Realizing Value . . . Impact Achieved
TREATMENT / CLINICAL • Reduced interruptions
T
ELECTRONIC SECURE DATA • Increased data and image security
E
SAVINGS • 3 minutes saved per encounter
• 14 fewer calls to physicians per patient S
Sources: http://ihealthtran.com/wordpress/2013/07/infographic-realizing-the-value-of-health-it/
22
“This is a potential game changer.”
– Health System COO
An Executive-Level Imperative
Questions
Tricia Thomas PhD, RN
Chief Nursing Officer
Trinity Home Health
@francesdare
Frances Dare, MBA
Managing Director
Clinical and Health Management
Services