barbara lennon, clinical informatics education manager, austin health - agency staff on the agenda:...
DESCRIPTION
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/emed14TRANSCRIPT
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Agency Staff on the Agenda –
Training the Hidden Workforce in
eMMs
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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
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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:
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Organisational Statistics
Measure 2011 – 2012 Year
Staff (EFT)
Medical 647
Nursing 2,098
Allied 471
IT / Informatics 50
Total 5184
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June 2011
• ‘Big Bang’ implementation of
some Cerner modules
across 3 campuses.
• Had more effect on the
workflows of medical staff.
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Implementation Comprised of:
• Alerts & Allergy recording
• Diagnosis, problem and past history recording
• Results Review
• Pathology and radiology ordering
• Ordering Discharge Prescriptions
• Discharge Summaries
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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
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Training
The Cerner training team trained 6 days a
week from 0800 to 2200 Monday –
Saturday for 4 months
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Training Stats
•Nursing staff – 2344
•Bank Nurses – 291
•Medical – 892
•Clerical – 354
•Allied Health - 423
Grand
Total:
4304
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Austin Health Nurses trained in:
- Documenting Allergies
- Recording Patient weights
- Checking results
- Documenting when they had
successfully collected a pathology
specimen
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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
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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??
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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
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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.
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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
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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
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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.
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Post Sub Acute Implementation
After extended support ended – training of
agency staff was given by a nominated
Superuser from the ward.
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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
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Acute Care Implementation – Nov 12
•11 acute wards
•Did not include:
- ICU
- ED
- Mental Health
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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)
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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.
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Concerns re Agency Staff
• ? Compromise patient safety
• ? Increase workload for permanent nursing
staff
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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.
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Required Agency Information
• Meetings with Director of Nursing, Nursing
Work Admin Personnel and Nurse Unit
Managers
• How many agencies?
• How many agency nurses?
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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
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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
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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
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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
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15 x 2 hour training sessions booked
Capacity to train 245 agency nurses
87 nurses attended
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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
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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
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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
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Continuity Plan
• Business plan drawn up
• Budget agreed
• Presentations given by 4 companies
• Quotes requested and received
Decision…
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…
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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?
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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…
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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
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Roadblocks – Account Creation
Account Creation Process
• Nurse applies for job
• Nurse gets job
• Nurse receives paperwork from HR
• Nurse fills in paperwork
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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
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Agency Nurses are not Austin Health
Employees!!!
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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
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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
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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!!!
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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
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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
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The Creation of an LMS
• The screen captures were taken over a 2 day
period.
• 2 week turnaround period for review, recapture
and publication.
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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.
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Agencies Invited Back to Austin
•Agencies were shown the LMS and how
to access it
•Explanation of compulsory vs optional
modules
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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
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Accessing the LMS
www.austin.org.au
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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
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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
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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
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Policy
No training = No access = No
shifts at Austin Health
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Lessons are separated as per job
title:
• Nurse
• Agency Nurse
• Medical Officer
• Clerk
• Medical Student
• Allied Health
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Stats
•The LMS first became available on 7th
November 2012
•To date, there have been 20152 ‘hits’ on
it
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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
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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
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Questions?