nursing perceptions related to technology enhancements in ...€¦ · pre survey results access was...
TRANSCRIPT
Nursing Perceptions Related to Technology Enhancements in the Clinical Practice Environment
Deborah Brennan, BS, MSN, RN, RNC, NE-BC
Theresa Shaver BSN, RN
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
DMC Huron Valley Sinai-Hospital
• Located in suburb of Detroit
• Tenet Health System
• 153 bed community hospital in Michigan
• Part of the Detroit Medical Center
• Affiliated with Wayne State University
• Full range of services
• 33,800 ED visits and 9,295 admissions.
• 2,452 inpatient and 5,171 outpatient surgeries.
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
DMC Huron Valley-Sinai Hospital
US News Best Hospitals
‘Top Performer on Key Quality Measures™’ Recognition from The Joint
Commission
Certified by The Joint Commission - a
national leader in healthcare accreditation
"A" Hospital Safety ScoreSM by The Leapfrog Group Magnet Designation by the
American Nurse Credentialing
Center Second Designation
Breast Imaging Center of Excellence by the American College of Radiology (ACR)
Center of Excellence in Minimally
Invasive Gynecology (COEMIG)
Quality Oncology Practice
Initiative (QOPI®) Certification
Rated High Performing
NICHE (Nurses Improving Care for
Health system Elders) Exemplar
Status
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
EMR and Technology Overview
Leading academic health center in Michigan
Mission of excellence in the use of advanced technology in patient care
Since 2006, using Cerner’s Power Chart as its primary source of documenting patient care
Device Integration Committee that works with the hospital system and vendors to insure that the equipment purchased, and used, is integrated in to the electronic medical record (EMR)
Clinical Informatics (CI) team works as a liaison between Information Services and staff to provide staff input to those who build the systems
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Speaker Information
• Deb Brennan
• Interim Manager of Patient Services
• Magnet Program Director
• NICHE Site Coordinator
• Nursing Quality
• Theresa Shaver
• Director of Clinical Informatics Huron Valley Sinai Hospital
• Director of Clinical Informatics DMC Ambulatory EMR Implementation
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
History
• History of adoption into technology
Teletracking
Raulands Call System
EMR
2006 Cerner Power Chart
2008 Cerner SurgiNet (Real time surgical documentation solution)
2015 Cerner Power Chart Maternity (OB and Women's health solution)
Vocera
Welch Allyn – Connex® Vital Signs Monitor (CVSM)
Get Well Network – Integrated Patient Education nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Study Objective
• Gain insight into nursing perceptions related to technology
• Why?
• Gain a better understanding of the current nursing perceptions related to technology.
• Understand the nursing perception related to the use of technology in the clinical practice environment.
• Improve the educational content and delivery for future technology integration.
• Design a plan for future technology enhancement integration and successful long term implementation.
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Framework
Kurt Lewin’s Change Theory
• Unfreezing, Transition, Freezing
Technology Acceptance Model
• Provides a framework to understand barriers
• Examines perceived usefulness and perceived ease of usefulness
• Aids technology integration, job performance, and care delivery
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Method
• Pre and post survey methods
• Survey based upon Stronge-Brondt Nurses Attitudes toward Computers Questionnaire
• Perceived usefulness and perceived ease of usefulness questions
• Demographic data
• Likert Scale range of 1- 5 (strongly disagree to strongly agree range)
• Open ended questions and opportunity to add additional feedback - optional
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Nursing Perceived Ease of Usefulness
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Protocol
• Pre-survey and analysis of survey results
• Creation of an education and technology integration plan based upon the pre-survey results
• Education and technology integrated into the clinical practice environment design
• Adoption and optimization of the process with further refinements as needed
• Post survey analysis and evaluation of effectiveness
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Pre and Post Survey
• Pre-survey for analysis of current state of technology integration
• Identification of barriers related to current and past technology integration
• Gaps identified and plans close the gaps
• Improved plan based upon feedback
• Identification of post survey result for action planning for a further reductions in specified areas
• Identification of post survey improvements and best practice for future use.
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Survey Elements
Survey delivered via email utilizing the Survey Monkey tool
Announcements to staff to participate in the survey.
Survey participant consents were obtained prior the participating in the survey
15 – 20 minute estimated time to complete the survey
For all nurses working at the bedside
Estimated greater than 50% participation rate based upon the number of bedside nurses
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Survey Demographics Percentages
6.8
37.86
50.49
3.88
0.97
0
10
20
30
40
50
60
Diploma AND BSN MSN DNP
Nursing Education
70.59
2.94
26.47
0
10
20
30
40
50
60
70
80
Days Afternoons Nights
Shift
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Survey Demographics Percentages
4.85
16.5
11.65
12.62
16.5
13.59 13.59
2.91
7.77
0
2
4
6
8
10
12
14
16
18
Years in Nursing
4.85
16.5
11.65
12.62
16.5
13.59 13.59
2.91
7.77
0
2
4
6
8
10
12
14
16
18
Years in Nursing
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Pre Survey Results
Access was not an issue – result of 90%
Greater than 80% considered themselves experienced computer users and confident using technology
25% of the nurses still charted on paper first
46% of the nurses felt their were redundant technologies
82% of the surveyed nurses did not report a decrease in workload due to technology
42% of nurses could not say technology improved the clinical practice environment
36% of the nurses stated they did not feel the hospital provided adequate training
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Nursing Perceptions Results and Comments
Common Themes
• Frustration with ‘slowness’ of the EMR system
• Overlapping or redundant charting and functionality
Technology Aspects
• 82% considered themselves as experienced technology users
• 58% felt technology assisted in care delivery
• Most nurses were neutral about the effects of technology on patient privacy
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Identified Barriers
Identified barriers
Optimization of technology potential
End User Adoption of new technology
Participation and understanding of education
Interface integrations
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
New Technology Integration
• The Welch Allyn CVSMs were implemented to capture vital signs and have that data transfer directly to the EMR.
• This required not only the purchase of the devices but the interface to the Power Chart system.
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Educational Plan Based onSurvey Results
Clinical Transformation Integration Committee which met and reviewed devices planned for integration.
Examined technology in relation to efficiency and reduction in the amount of duplicated work flow.
Super User format with unit super users as unit based resources.
Most nurses felt technology did not reduce workload. The team reviewed results and discussed interventions to decrease workload.
Education to occurred at the unit level where the staff worked verses group format or mandatory attendance during in-services
Technology application was designed to be integrated with the patient record in order to provide accurate documentation and decrease the amount of time the spent documenting.
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
• Education and training for Welch Allyn Connex® Vital Signs Machine
• Staff received a multi phase implementation of this device due to the interface and need for staff to understand both the hardware and the software components involved.
• Training included each unit designating “Super Users” to receive additional training to help support the day to day use of this technology in their units.
Adapted Education Plan
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Educational Plan –Phase One
• Phase one was the training to the use of the device itself. This training occurred in a classroom setting and allowed for staff to practice using the equipment.
• This initial training as to use of the device was provided by a team of individuals that included the Clinical Informatics Department, Patient Education and the Welch Allyn Educators.
• All departments sent representatives from each shift to be trained on the operation of the machine. The staff were educated on; Log in
Set up of details (cuff size, patient position etc.)
Machine Function
Saving Data
Clearing Data
Log Out nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Educational Plan – Phase Two
• Phase two was done after the devices were connected to the Power Chart through interface.
• Staff was educated and supported as to how use the device to and have data cross the chart without need for staff to manually enter this data. Staff was shown how to:
• Steps: Make sure that the connection was on Wi-Fi
Scan patient identification bracelet and verify correct patient
Capture Vital signs and data
Use machine to capture and save serial vitals in recovery
Save data to EMR
This saved time and prevent transcription error as well as allow staff time for other patient care needs.
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Educational Plan – Phase 3
Follow-up
• The clinical informatics team and the department super users maintain constant and rounds to ensure that the devices are functioning and staff is using them as designed.
• The follow up is ongoing and due to the change in staffing from time to time our team has deemed this a continuous support process.
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Outcome of the Educational Plan
• Assisted staff in learning how to best use technology to the greatest benefit in order to reduce workload and be of benefit.
• Unit based education and bedside care education at the point of delivery and application during clinical practice improved the overall outcomes.
• Improved interfacing with technology and education with staff improved staff understanding and application of the technology.
• Staff were able to use and apply technology integration to a higher level and found technology was more beneficial within the daily practice environment
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Post Survey Results in Percentages
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Post Survey Results in Percentages
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Post Survey Results in Percentages
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Results
The Welch Allyn machines were well received by staff due to the convenience of not having to login in a enter the data manually
User adoption continues to be a focus because although the devices work as designed some staff still are not comfortable “trusting” that the information has crossed in to the patient EMR
Continued education and support are the solution to optimization of this and all other past and future implementations of patient care technology.
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Results
This successful integration supported:
Improved nursing practice
Improved nurse satisfaction
Increased time with the patient
Improved patient satisfaction scores
Outcomes included:
Decreased patient falls
Enhanced documentation
High quality outcomes for Core Measures nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
What We Learned
Future Applications:
• Any integral part of technology integration and change in the continual engagement of the staff in the process.
• Increased in staff engagement and level of involvement of the staff leads to improved successful implementation out success.
• Remember to engage the staff during the evaluation process of equipment at the start of the evaluation process.
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Questions?
Thank you
Contact Information
• Theresa Shaver: [email protected]
• Deborah Brennan: [email protected]
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum