Background and significance: Cardiovascular disease is the number one killer of men and women in the United States. According to the 2019 American Heart Association Heart Disease and Stroke Statistics, non-Hispanic, African-American men have higher rates of hypertension (HTN) and the highest rate of hypertension-related deaths of any racial, ethnic, or sex group in the United States. African-Americans often go undiagnosed for much longer than other populations, leading to the development of cardiovascular disease at a younger age and increased morbidity (heart disease, kidney disease, eye disease) and mortality.

To help reduce modifiable risk factors including hypertension in African-American men, health promotion interventions have been implemented in barbershops. Barbershops are often centers of the community and serve diverse populations. While this form of health outreach is becoming more common, no studies reported combining health promotion with the use of activity trackers, such as Fitbits®, as part of a barbershop initiative. A number of studies, however, have shown health improvement due to monitoring through activity trackers such as Fitbits®, although most have found that activity trackers are more often adopted by people who are white, non-Hispanic, women, and have incomes over $100,000. This study would involve a more diverse population focusing on low income, African-American men in an urban area.

Aims: Using a quantitative approach, this study will investigate the feasibility of an activity tracker intervention to measure heart rate, steps, and sleep in low income, African-American men to determine 1) if the use of these activity trackers impacts health behaviors and blood pressure, 2) the relationship among wearing patterns, steps, heart rate, sleep, and blood pressure, and 3) any technical or wearability issues with the Fitbits®.

Study design/methods: African-American male barbers will be given Fitbits® to wear for a month. Fitbits® will be purchased and registered to emails managed by the PI in order to collect heart rate, steps, and sleep data from participants. IRB approval and funding has been obtained, and data will be collected between July and September 2020. After signing a consent form, each participant will be assigned a study number and complete a survey about their basic demographics, history of hypertension, and any experience using an activity tracker. Participants will then have their blood pressure measured by the investigators using an automated blood pressure device. At the end of the month, participants will be asked (via survey and interviews) about their wearing patterns and any issues with wearing the device, as well as updated health information. Main comparisons of interest include: heart rate with pre- and post-blood pressure, steps, and sleep, as well as general wearing patterns.

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Proposed outcomes: Information about the feasibility of this population’s willingness to wear activity trackers, as well as issues with Fitbits® will be shared. Results will help investigators determine if this population can benefit from wearing these devices, if these devices can be distributed to a larger population in order to assess health outcomes and to generate more studies. 

Purpose: In this study, we leverage a user-centered design methodology of iterative cycles of user research to inform optimizations to the electronic health record (EHR) in order to best support nurses with timely documentation, data visualization (e.g. visualization of tasks due), and ease of navigation.

Description: Timely, accurate, accessible nursing documentation is critical to care quality and seamless continuity of patient care amongst the interdisciplinary care team. It also has important implications for accreditation, regulatory, research, legal, billing, and reimbursement. While EHR systems provide myriad positive impacts on healthcare delivery, perception of usability, and user-friendliness continues to remain an area with opportunity for improvement. High click counts and ease of navigation have been cited as major sources of dissatisfaction amongst clinicians.

Evaluation/outcome: At two-weeks post-go-live, preliminary end user feedback revealed themes of education, efficiency, and aesthetic. Semi-structured interviews further highlighted opportunities for optimizations and an improved communication strategy for socializing system changes. Some end users reported that the change in screen design was disorienting at first, but as they became acquainted with it, they found it to be more user-friendly. The theme of education was informed by an identified need amongst some staff for an improved socialization of changes to come prior to implementation. The theme of efficiency was evidenced by feedback that staff perceive fewer clicks and screen toggling to complete workflows. As an example, one registered nurse (RN) reported “I like that I’m able to view patient information and an overview of the patient’s upcoming procedures.” We will continue to capture qualitative data in addition to analysis of quantitative findings related to timeliness of task management.

Conclusions: Our preliminary findings suggest that when a system is optimized leveraging user-centered design methodologies with early and frequent end user feedback, both usability and adoption can be improved. Tracking staff completion of educational materials is one metric to consider for go-live readiness. A frequent cadence of communication that comes directly from leadership to their direct reports and from senior leadership to the front lines is critical for effective enterprise-wide information dissemination.

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Background: Surgery can be a heavily anxiety-producing event, not only in a patient’s healthcare journey, but for their family and significant others. For patients undergoing surgery, their caregivers and support members also experience anxiety due to the lack of information and consistent communication, particularly when there are changes in the phases of care. Anxiety translates to decreased satisfaction, increased frustration and stress (Muldoon et al., 2011). It is the fundamental responsibility of providers to deliver patient and family communication that is clear and consistent, in order to mitigate concerns during surgical wait times.

In an effort to provide safe and high-quality patient-and-family-centered care, patient satisfaction is a critical metric for hospital and provider performance, and a key component of reimbursement (Sacks et al., 2015). For surgical patients and members of their support network, perioperative communication and attentiveness to the patient and family members are the two of the most paramount determinants of patient satisfaction and ratings (Schmocker, 2015). Challenges to optimal perioperative communication pose a risk to perceived optimal experience and satisfaction (Minna et al., 2017).

Mobile communication technologies and service-level design of these technologies have emerged as an innovative strategy in healthcare to optimize real-time patient-to-provider communication. The use of the electronic health record (EHR) visit notification functionality may reduce anxiety and improve perioperative communication and overall experience of the surgical patient and their family.

Method: The study assesses the use and impact of a novel, nurse-driven communications platform that leverages families/significant others’ own mobile devices via a short message service (SMS). During preoperative check-in, families/significant others were asked to enroll in the messaging system known as visit notifications. Real-time communication was leveraged through standardized and timely preconfigured messages sent by the perioperative nurse via the EHR. A mixed-methods approach was used, consisting of qualitative and quantitative elements. After 6 months of implementation, internal surveys to family/significant others were administered regarding satisfaction, communication, and perception of benefit. Observers also compared Press Ganey (PG) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores between patients who did and did not receive the perioperative Visit Notifications.

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Results: Though research is on-going, reporting data include, but are not limited to:
• Survey results of family/significant others’ perioperative experience, ease-of-use with the feature, and satisfaction with the desired information during surgery
• Survey results of perioperative nurses’ perception of the impact on communication and ease-of-use of the feature
• Correlations with patient satisfaction surveys: Compared Press Ganey (PG) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores between patients who did and did not receive the perioperative Visit Notifications
• Rates of usage: users per day, number and type of messages generated, users by location (campus, specialty unit), month, day of the week, recipient (relationship to patient), type of surgery
• Workflow and build
• Opportunities for the mobile messing feature optimization in workflow and build

Introduction

Problem Statement: Increasing clinical data exchange, poor content, and policies create frustrations and patient care challenges.Technology innovations and health information exchange enhancements have increased accessibility of data while inadvertently accentuating data quality issues. Patients are now technology consumers with their medical devices that are now connected to their electronic health record (EHR). Nurses are the first to identify technology challenges with the patient as they explore the clinical portals and the potential confusion with external data. The EHR technology guides the clinician through data capture and generates the data exchange, whether fax or HL7 message. Nurses are now realizing that the data often shared has only a visual display, not discrete data elements for EHR entities to consume. Many challenges include patient portal functionality that is inconsistent across multiple platforms; interoperability of patient medical/mobile devices; time and effort required to educate the patient about data differences; and organizational policies for medical devices, data exchange, and data provenance.Nurse informaticists are positioned to make sense of real-time information and are rich sources of innovative ways to provide leadership that improves and enhances patient care.
Impactful leadership methods for nursing informatics: Embracing new ideas and methodologies will empower and support nurses ensuring clinical data integrity will enhance patient-centered care along the healthcare continuum through the following: development, engagement, and enforcement of policies, rules, and regulations related to data exchange; conduction of transparent data quality reviews followed by education; usability of analysis and results; collaboration with entire healthcare ecosystem to repair identified issues and poor data content; and discussion of change management methodology. Nurses can drive change management by participating in vendor user groups as advocate for high clinical data quality which will improve both clinician and patient satisfaction; providing input to establish evidence-based best practices; identifying data gaps and the development of action plans to improve interoperability; application of nursing clinical and institutional knowledge to develop healthcare policies that advocate for patients, consumers, nurses, and all involved in clinical care.
Empower clinical transformation: Transformation in a healthcare organization is possible through participation and empowerment of the entire staff population and establishing practices and policies that leverage technology, (artificial intelligence/analytics) to automate time consuming tasks that are prone to error, thus reducing manpower and operational cost; foster an environment of change and improvement through work groups that guide policy changes; create a community of trust between partners, vendors, and organizations that builds the value-added proposition; and advocate for policies and procedures that build patient/provider trust and data quality improvement.
Conclusion: To affect change across the patient experience, the entire healthcare ecosystem must embrace positive transformations of policy and technology while empowering those involved in direct clinical care. Working together they can create an environment of awareness to improve clinical data quality through engagement and thereby increase success in patient centered care and satisfaction.

Purpose: Interoperability between smart pumps and the electronic medical record (EMR) closes the loop on medication safety, helping ensure the right patient, right medication, right dose, right route, right time, and right documentation. Infusion orders are auto-programmed into the pump, reducing the need for manual programming and associated risk of error, and infusion rates and volumes are auto-documented into the EMR. This clinical decision support system includes alert triggers for programming outside defined dosing limits, tracking software to identify practice trends, and visibility to infusions in real-time to monitor and improve patient safety. While alert limit triggers help safeguard infusion delivery, if they are not driven by hospital evidence, they can contribute to alert fatigue and drug library non-compliance. This project evaluated the impact of smart pump interoperability on clinical practice by measuring and evaluating drug library alerts, overrides and compliance rates at an acute care hospital.
Description:In Sept 2018, wireless infusion pumps were implemented with dose tracking software in an acute care hospital. Data were collected and analyzed on drug library compliance, alerts, and overrides using infusion management software. There were 3 data collection periods: baseline (October - December 2018), post-EMR integration (October - December 2019), and post-drug library intervention (APril - June 2020). Infusion data was sent via secure file transfer protocol to a secure central server protected by firewalls, HIPAA de-identified, under software licensing and data use agreement.
Baseline data showed drug library compliance of 96%, with an alert override response rate (alerts that resulted in an override) of 12% and override frequency (total overrides/total drug library deliveries) of 1.45%. EMR interoperability went live in August 2019 and included changes to the pump-based drug library limits to match the EMR formulary. Post-EMR integration, drug library compliance increased to 98%. However, the alert override response rate increased to 58% with an override frequency of 4.19%. Eighty percent of the overrides were associated with norepinephrine and phenylephrine due to the addition of soft minimum dosing limits to match the EMR. However, these infusions are commonly weaned off below soft limits, making these alerts excessive and clinically non-credible. Subsequently, the drug library was modified to eliminate these soft minimum limits, virtually eliminating overrides associated with these infusions. As a result, alert override response rate decreased to 9%, override frequency further decreased to 0.33%, and drug library compliance sustained at 97%.
Outcome: Smart pump interoperability was successful, achieving 91% auto-programming compliance in the ED and 77% hospital wide immediately after go-live. Evaluating data at routine intervals identified opportunities to optimize the drug library; reducing overrides 77% and reducing alert override response rate to a remarkably low 9%, compared to rates of 74%-76% reported by Marwitz et al. Minimizing overrides also helped sustain high levels of drug library compliance of 96-98%, versus 81% national average. Smart pump interoperability impacted patient safety; one year post integration (as of 10/28/20), there were no reported errors related to smart pumps. A limitation is that our outcomes cannot be extrapolated to other hospitals.

The pediatric transport team implemented electronic documentation to improve the safety, efficiency, timeliness, and quality of healthcare and promote interoperability of patient records. This new product allows transport team members to document based on patient conditions and customize documentation fields as needed. The electronic medium also gives the team members access to evidence-based guidelines and recommendations from other resources. In addition, this product integration receives real-time information and transport updates, then pushes all the data into the hospital's electronic health record (EHR).

Problem: Documentation on paper during the transfer of patients did not provide the dynamics to cover documentation for each type of transport and situation during the transport. Paper-based documentation lacked data and analytic capabilities and needed improved legibility and documentation completion rates.

Methodology: The project team went through several case-scenarios throughout the testing and user acceptance testing stages of the systems development life cycle (SDLC), focused on application, integrating, and user testing prior to implementation. Ideas for change included interviews and observations of stakeholders’ current workflows, obtaining stakeholders’ input and ideas for successful completion of the project and cause-and-effect diagrams to show improvements. Leveraging relationships with other transport agencies played a role in consideration of how to use the new product. The project started with the planning and designing of the new workflows and was followed by training, system development and design, end-user training, implementation, and ongoing education. The project team analyzed the current state/measures versus the future state of percentages of documentation completion on the forms, as well as illegibility. The system usability scale (SUS) survey was used to evaluate the customer's usability and perceived satisfaction of the new product pre- and post-implementation by 26 participants. The SUS surveys were scored using Jeff Sauro's (2011) online scoring guidelines as a reference from the usability.gov website.

Results: The legibility and form completion percentages had significant improvements from pre-implementation to post-implementation. The illegibility of transport records improved from 24% pre-implementation to 100% post-implementation; the incomplete forms documentation rate improved from 56% pre-implementation to 100% post-implementation. The SUS score means improved from 67.6 pre-implementation to 82.3 post-implementation. According to the United States General Services Administration (2020), SUS scores above 68 are considered above average; the transport team recognized their post-implementation score to be 14.3 points higher.

Conclusion: Not only does paper charting restrict ease of access, but it can also be illegible, incomplete, and easily lost or misplaced. This project continues to improve the quality of documentation, quality of care, and safety for patients. Having fully implemented phase II of the project, the project team members will soon start phase III, and continue to collect data to prove the project's success.