The use of an appropriate mode of communication among the multidisciplinary care team members regarding coordination of care is an extremely complicated yet important patient safety initiative. Effective communication among the team members (nursing staff, medical staff, respiratory therapists, rehabilitation therapists, patient-family services team, etc.) becomes essential to develop a culture of trust and collaboration to deliver the highest quality care to patients are their families.
The inpatient post-acute pediatrics, where children and their caregivers come for continuity of care, is no exception to the increasing use of text messages as a means to communication among clinicians. One such platform is the Vocera Communications (Vocera Smart Mobile App called Vocera Edge) that allows the teams to use the application and share sensitive patient information through an encrypted platform using IOS company-provided shared and assigned mobile devices. This poster discusses the quality initiative of implementing the transition from Vocera Smartbage to Vocera Edge Mobile App, technology advantage, using case expansion and lessons learned about a secure alternative modality that allows sending and receiving secure text messages in a pediatric post-acute setting using an IOS device.
This implementation process included all direct care staff, ancillary teams, and administrative teams on the clinical units. Our institution launched this transition from voice prompted hands-free Vocera Smartbage to Vocera Edge mobile-based app for secure care team texting using a big bang approach during the first PDSA cycle. The pre- and post-implementation data was gathered using a qualitative survey of about 500 multidisciplinary team members to determine the ease of use of the application and its efficiency in care coordination. The technology was further expanded in its use by implementing clinical alerts and alarms notification using middleware integration with patient monitoring (Masimo) and life safety (nurse call) systems. Additional use of the smart mobile iPhone use include pushing out apps like Lexicomp and Up to Date to have it readily available for users for evident-based practice in medication and disease management.
A secure texting option using a mobile device is a safe and efficient mode for care team communication and collaboration using technology in real time. This allows for the settings like post-acute pediatric care areas to be in line with the widespread use of mobile apps and technology our mainstream healthcare. The results show an overall number of non-actionable alarms on the clinical units decreased over a 4-month period. We noticed an increased collaboration among medicine, nursing, and respiratory therapy. Successful implementation of the communication system occurred in a shared and assigned model with all of the multidisciplinary teams in our pediatric post-acute setting. In just a 3-month period post implementation, we noticed a 14% increase in from 7,993 messages in 6 days in December 2020, to 9,116 messages in March 2021. This confirmed that all clinical and non-clinical teams were using this mode of communication for coordinating the care for their patients. System generated data analytics used in addition to the pre- and post implementation staff survey for process evaluation.
Purpose: A systematic literature review was conducted to describe features of wearables used for monitoring cardiometabolic health and identify usability and impacts of using wearables on cardiometabolic health indicators.
Background/significance: Cardiometabolic disorders (CMDs) represent a cluster of interrelated risk factors, including elevated blood glucose, obesity, hypertension, and dyslipidemia. CMDs are the leading causes of mortality and a significant public health burden in the United States and worldwide.1 With advances in wireless technology, wearable devices (e.g., smartwatches, wristbands) have become popular for monitoring healthy behaviors and risk factors. Approximately 30 % of US adults use wearable devices.2 It is important for nurses and nurse informaticists to understand how these wearables might be utilized in health promotion strategies, particularly with populations at risk for CMDs.
Methods: The wearables were limited to having sensors for blood pressure (BP), heart rate (HR), electrocardiogram (ECG), glucose, and cholesterol, which have been known as the American Heart Association’s cardiovascular risk indicators. A systematic search was performed through PubMed, CINAHL, Academic Search Complete, and Science and Technology Collection databases, using keywords related to the selected CMD risk indicators and wearable(s). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies: 1) were published from 2016 to 2021 in English, 2) focused on wearables external to the body, and 3) examined wearable use by individuals in daily life (not by healthcare providers). We excluded protocol, technical, and non-empirical studies. The search yielded 572 studies; after the abstract screening, 53 articles were selected and critically reviewed regarding wearables' features, usability, and impacts on the cardiometabolic health indicators.
Results: The types of wearables used in the reviewed studies were smartwatches (45.3%), patches (34%), chest straps (22.6%), wristbands (13.2%), and others (9.4%). HR (58.5%), ECG (26.4%), and glucose (28.3%) were the predominant indicators captured. No studies tracked BP and cholesterol. Additional features of the wearables included physical activity, respiration, sleep, diet, and symptoms monitoring. Various usability measurements were used across studies by assessing user satisfaction, monitoring satisfaction, ease of use, comfort, wearability, attractiveness, privacy, etc. Most usability studies reported positive outcomes. Monitoring HR or ECG via wearables was effective in detecting atrial fibrillation, stress response, and myocardial infarction. Glucose monitoring wearables were supportive for reducing time-in-hypoglycemia or hyperglycemia, emotional, and behavioral burden in patients with diabetes.
Conclusions/implications: Wearables have great potential for individuals to easily self-monitor cardiometabolic health. Wearables will enable nurses and nurse informaticists to track data and develop health-promoting interventions for people at risk for CMDs.
Learning outcomes: The audience will be able to identify various capabilities, usability, and impacts of wearables for individuals and nurses/nurse informaticists to monitor cardiometabolic health.
1) National Center for Chronic Disease Prevention and Health Promotion (2021). Health and economic costs of chronic diseases. https://www.cdc.gov/chronicdisease/about/costs/index.htm
2) Chandrasekaran, R., Katthula, V., & Moustakas, E. (2020). Patterns of Use and Key Predictors for the Use of Wearable Health Care Devices by US Adults: Insights from a National Survey. Journal of medical Internet research, 22(10), e22443. https://doi.org/10.2196/22443
Central line-associated bloodstream infections (CLABSIs) contribute to thousands of deaths annually as well as increase the costs for healthcare. CLABSIs are preventable and nurses play an important role in prevention through implementation of evidence-based interventions defined in policy and guidelines. In the electronic health record (EHR), these interventions are not documented in the same place, so it was challenging for nurses to easily tell if an intervention was due or had already been completed. Nurses requested a way to be able to see the overall status of central line interventions so they could see what needed to be done.
A CLABSI dashboard was created in the EHR to display information about central line interventions from existing nursing documentation. Rules for each intervention were created so that only those interventions that were overdue or needed to be done appeared on the dashboard. The dashboard displayed information individually for the different types of central lines, in the event that a patient had more than one central line. Once an intervention was completed, it disappeared from the dashboard. If all interventions were completed, the central line appeared in green so that the nurse could easily tell that nothing more needed to be done. The dashboard was configured to appear for all nurses in their summary reports, so there was no change to their existing workflow and it was easy for them to find the information.
Nurses were very happy with the dashboard and appreciated that there was no change to their documentation or workflows. They felt that the dashboard provided an easy way to tell if an intervention needed to be done. Nurses like to see green on dashboards and checklists and were motivated to ensure that all interventions were completed. The CLABSI Committee believes that the dashboard helped contribute to a decrease in CLABSI numbers. The catheter-associated urinary tract infection (CAUTI) committee has requested a similar dashboard for interventions to prevent these infections.
Dashboards are useful tools for nurses to see patient information in one place. Creating them takes time to understand the requirements, how it will be used, where documentation is done, and the nursing workflows. Thorough testing of the content is necessary to account for variations in nursing documentation practices. Nursing informatics involvement is key to ensure the successful creation and implementation of a dashboard.
Massachusetts mandated that all healthcare organizations need to present an operational plan as to how patients with dementia and/or delirium are assessed and treated. The operational plan must address six issues, namely the environment in the hospital, PMH and screening/assessment tools, management of treatment in the hospital, transitions of care, and advanced care planning. These standards highlighted an area of opportunity for the system as there was no harmonization between providers, nursing, and ancillary departments in the treatment of these patient populations. There was also a lack of communication between the inpatient and ambulatory care settings. The current care provided was not standardized and did not differentiate between treatment for dementia and delirium.
A core group comprised of system quality, clinical informatics, and geriatric-focused nurse practitioners was formed. A gap analysis was completed and a multidisciplinary steering committee convened. Changes made would improve and coordinate care across the academic medical center, community hospitals, and ambulatory care practices.
Solutions: For patients with a history of dementia or dementia on the problem list, two care plans automatically trigger for nursing – “fall injury risk” and “adult chronic confusion.” A banner stating “patient has a history of cognitive dysfunction” will appear in all clinical and non-clinical patient facing areas. Even though the language in the banner is standardized, each department/area determined where the banner would appear in Epic. For any patient over the age of 65, regardless of diagnosis, a CAM (confusion assessment method) triggers for nursing as part of the nursing admission assessment. A positive CAM causes a BPA to fire to the provider with a reminder to add “acute delirium” to the hospital problem list. Once acute delirium is added to the problem list, a banner stating “patient has acute delirium during this hospitalization” appears in the same areas as described for dementia. A positive CAM also auto triggers the “fall injury risk” and “IP delirium adult” care plans for nursing with associated care plan education. There are areas in which the CAM will not fire including peri-op, emergency department, behavioral health, and within 24 hours of anesthesia administration. The CAM will not re-fire if there was a positive CAM during the hospitalization. The banner stating that the patient has acute delirium during this hospitalization is deleted after discharge.
This organization is an academic and healthcare system with over 2,000 licensed beds and over 70,000 annual inpatient admissions. In 2018, executive nursing leadership set a strategic priority through fiscal year 2020: leverage technology to enhance communication, patient experience, care delivery and business processes.
This poster will delve into how a major multi-campus academic health system is innovatively utilizing geolocation technologies such as real-time locating system (RTLS) by integrating clinical applications such as Rauland nurse call with Epic and applying interoperability between these three applications to reduce the burden of nursing documentation in order to streamline clinical documentation and augment patient-centered care.
Furthermore there will be an overview of the health system's RTLS strategic priorities such as:
• Enhancing safety communications between nursing and security to optimize business operations related to workplace violence
• Augmenting perioperative business workflows
• Strengthening pediatric security safety protocols
A review of how these RTLS technologies are employed for the benefit of all hospital staff – including those beyond the clinical team -- across all hospital entities will be included as well.
Recent research indicates that for nurses, the burden of electronic documentation is a barrier to achieve the goal of clinical well-being, an improved patient experience, and efficiency. This presentation will discuss how the health system is utilizing geolocation technologies such as real-time locating system (RTLS) by integrating multiple clinical applications with Epic and applying interoperability between these systems to reduce the burden of nursing documentation in order to streamline clinical documentation and augment patient-centered care. After a successful four month pilot on one inpatient unit, the health system went live with automated badge rounding functionality hospital-wide at the smallest hospital within a multi-campus health system, a facility with
As a result of practice convergence and adoption of a unified EHR, numerous informatics departments across a Magnet recognized healthcare organization established a shared service framework with a universal purpose of providing a world-class healthcare experience. With over 100 informaticists, multiple needs were identified throughout the department. Informaticists voiced a desire for a shared decision-making model advocating for expression and management of higher level of professional autonomy. Shared decision-making had been well adopted in clinical settings throughout the organization, however, had been underutilized within the informatics division.
Thus, the informatics professional governance (IPG) council, a shared governance structure, was developed as a proposed solution to the departmental needs across the multi-campus, multi-state healthcare organization. As an extension of the leadership team, this model includes divisional assessment of departmental functions impacting roles and responsibilities and collaboration and efficiency of practice support through convergence of unique skillsets. To ensure adequate and diverse representation across the enterprise, the council incorporates core informaticists from each region, informatics management, and informatics administration. Shared governance offers a vehicle to engage staff and foster team collaboration as peers challenge each other to achieve a common goal.1
Skillful leadership and contributions from all staff members of the department is imperative to the success of the shared governance framework, as it allows everyone’s voice to be heard while exerting professional ownership and accountability. Empowerment involves recognizing the power already present in a role and allowing that power to be expressed legitimately.2 The IPG council provides structure, support, and transparency to peers across the department by encouragement of active voice and participation, healthy exchange of ideas, and solution-oriented decision making. The formal process of gathering input through utilization of a standardized form, frequent and transparent communication, and reporting back to divisional leadership improves professional practice and collaboration with leaders. Through team-building opportunities to foster constructive working relationships and a professional practice environment, the findings show council members and peers are empowered to serve as dedicated decision-makers positively impacting professional environment, while building interdepartmental rapport and improving workplace satisfaction.
Learning outcome: Empower clinical informatics peers to merge clinical expertise, collaborate, and converge on outcomes for issues resolution, promote team building to foster relationships, and improve the professional practice environment.
1) Shepherd, M. L., Harris, M. L., Chung, H., & Himes, E. M. (2014). Using the Awareness, Desire, Knowledge, Ability, Reinforcement Model to build a shared governance culture. Journal of Nursing Education and Practice, 4(6), 90.
2) Porter-O’Grady, Tim EdD, RN, FAAN Is Shared Governance Still Relevant?, JONA: The Journal of Nursing Administration: October 2001 - Volume 31 - Issue 10 - p 468-473
Purpose: Develop a conceptual model and determine the feasibility of identifying and documenting nursing research opportunities derived from the Nursys database.
Background/significance: Professionals in the library and information sciences and the archival sciences have long grappled with author disambiguation, particularly with monographic titles (i.e., books) or artistic works. To resolve conflicts and properly associate authors with similar names as well as authors with pseudonyms, librarians create what is known as an authority file. This file is comprised of all known spelling variations, pseudonyms, and brief biographical data to identify unique authors. Similar identifier systems such as ResearcherID (Web of Science) and the Open Researcher and Contributor ID (ORCID) are used to acknowledge scholarship and achievement in academia.
The unique nurse identifier (UNI) shares a similar parallel but a different scope. Advocates proclaim this as an ideal mechanism to provide evidence of nursing contributions to clinical care and patient outcomes. The UNI literature also mentions the potential research opportunities at the organizational level such as patient safety and institutional efficiency and effectiveness. This abstract proposes another possibility: one that connects the UNI to the nurse’s research contributions and evidence-based initiatives implemented at their organization. The data within the Nursys database provides a rich source of content which serves as a starting point for future nursing scholarship thereby improving healthcare outcomes and enriching the overall nursing research literature.
Methods: Davenport’s information ecology principles, culture, behavior, politics, and technology, served as the foundation for model development. The medical center’s strategic plan and nursing research agenda provided a systems level approach in which each principle was assessed to determine applicability. Key steps within the model were then identified along with their relationships and sequence.
Results: Upon evaluation, the team determined by consensus that the model depicted appropriate application of the UNI and the medical center’s information ecology. Future efforts will center around testing the model by developing use cases. Also, further mapping and development of APIs to capture publication data will be investigated. Local policies will be created to ensure importing of the final research and implementations to a database at the current employer. The local database should be capable of formatting the data to provide maximum flexibility and portability to other organizational database systems. In addition to understanding the available data, the investigators inquired if the subsequent scholarship could be imported to Nursys or another comparable database at the nurse’s organization.
Conclusion: Though the model was created according to our institution’s nursing research agenda, strategic plan, and information ecosystem, it has potential applicability across a variety of healthcare organizations. The unique nurse identifier is a perfect tool to monitor and manage nursing research opportunities which can change practice locally, nationally, or internationally. Future use cases should focus on the development of comprehensive nursing portfolios based upon research derived from Nursys data. This research will strengthen the utility of the UNI and the profession’s knowledge base thus increasing nursing’s impact on healthcare outcomes.
Background: Wounds are a major health problem that can be costly to both the patient and facility. The proper treatment of a wound is guided by the measurements of the wound that show progress, stagnation, or worsening. In order to appropriately monitor the healing process of a wound, it is necessary that accurate and consistent measurements are obtained. Providing clinicians with accurate wound measurements aid in treatment decisions that improve the care of patients with wounds. The traditional and most-often used practice of wound measuring is manually using disposable rulers to obtain the length, width, and depth of each wound. If a different person is performing the measurement, the results of each wound may vary due to the difference in technique used by each individual. In order to be clinically useful, wound measurements must be reliable, repeatable, and accurate.
Purpose: The purpose of this project is to make the process of assessing wounds more efficient by decreasing the time spent on photographing, measuring, and documenting wound assessments by implementing the use of 3D-wound imaging technology and software. Using 3D-wound imaging technology can also provide accurate and consistent wound measurements.
Methods: Prior to the implementation of the 3D-wound technology, a baseline time of completing skin rounds assessments of wounds including imaging, measuring, and documentation was obtained. This baseline time was calculated by averaging the time it took to complete skin rounds in a 1-month period. After implementing the 3D-wound technology, average times to complete skin rounds were calculated at 1-, 2-, and 3-months.
Evaluation/results: Results are pending completion of the 3-month trial period.
Implications for practice: Streamlining the process of wound assessment and documentation by implementing the use of 3D-wound imaging technology can be rolled out to the entire hospital, including outpatient clinics. A more widespread use of the technology can lead to decreased manhours across the facility and therefore decreased costs.
Conclusion: Future studies can show how clinicians use the accurate data provided by the 3D-wound imaging device in making treatment decisions which can ultimately lead to faster healing and decreased hospital bed days.
Clinical deterioration in the inpatient setting happens rapidly and often results in adverse patient outcomes such as cardiac arrest and mortality. Patients who do not experience mortality may have a longer length of stay and incur increased cost when experiencing deterioration while admitted to the hospital. Predictive models embedded in the electronic health record (EHR) use discrete data to identify deterioration risk, often sooner than could be detected by human assessment alone, and can prompt clinician action, both actively through real-time alerts and passively by display of risk scores throughout the EHR. Predictive models support early detection of clinical deterioration, encourage timely intervention, and decrease negative patient outcomes.
A multidisciplinary taskforce, led by informatics nurses and including front-line clinicians, physicians, nursing leadership, advanced practice providers, nurse educators, and IT experts, was formed to evaluate system readiness and design a framework for model implementation using a combination of improvement science, adaptive leadership, and data analytics. A lookback validation utility was applied for identification of the threshold at which deterioration was most likely and patient populations for inclusion were selected based on this customized evaluation. An expected alert response workflow was finalized, merging predictive technology with human action. A predictive model dashboard was created to monitor performance outcomes.
A baseline median was calculated using the first four months of data following implementation, reflecting the period during the project when the active alert was turned on but comprehensive staff education had not been completed. A new baseline median was calculated using data from the 8 months following comprehensive, refocused education for comparison.
During the 8 months following intervention 2, an improvement in mortality for patients triggering an alert was observed (24.5%, n=242 to 18%, n= 480), confirmed by six consecutive data points below the median. Cardiac arrest mortality also decreased from 76.9% of all patients with a DI alert (n=87) to 72.9% (n=168). A similar shift in mortality was observed when the rapid response team proactively rounded on patients for an elevated DI score (16.4%, n=162 to 14.3%, n=337).
When comparing expected deaths (number of deaths expected per month at a baseline mortality rate of 24.5% using the first 4 months of data) with actual deaths per month by observed monthly mortality rate following intervention 2, a total of 123 lives were saved.
Taken together, findings suggest that predictive models, when coupled with an organized system response, can improve patient outcomes such as mortality and cardiac arrest.
Competencies to include nursing informatics leaders based on TIGER, ANIA, and ANA best practices is the focus for this abstract.
COVID-19 provided insight to continuing informatics leader competencies in an academic safety net community hospital. Current strategies for competency development for leadership roles in informatics have existed for many years. A consensus on core domains remains a challenge due to local and global changes within healthcare environments. The guiding question for this abstract is “What core domains will influence and strengthen leadership roles in informatics?” In addition, facilitating knowledge, research, innovation, and global reach in today’s dynamic, constantly changing healthcare environments needs consideration.
The objective of this abstract was to define and assess competencies for leadership roles within nursing informatics. A review of current best practice guidelines with the development of a leadership competency tool resulted in a fluid and dynamic tool focusing on user, modifier, and innovator domains with self-assessment and evaluation domains to encompass testing, verbal, demonstration, simulation, and interactive/virtual classroom methods of evaluation-based on novice to expert theory, while continuing to provide mentorship throughout the leaders’ growth within the organization. Innovation domains utilized TRIZ problem-solving theory for tool development. Additional research to include tool validity and reliability is necessary. An analysis of addressing leader needs identified in utilizing the tool with a structured process to address local and global impact is also a limitation. Further research and innovation in predictors for leadership also requires further inquiry.