ANIA 2023 Annual Conference

P01 - Population Health Informatics and Technology Certificate Program: An Academic Nursing Initiative to Meet Nursing Education and Workforce Needs

Robin Austin, PhD, DNP, NI-BC, Assistant Professor, University of Minnesota

Tags: nursing informatics training public health

Updated: 04/03/23

Learning objective: Summarize a population health informatics certificate program to address current and future workforce needs.

Background/introduction: A midwestern university won a competitive grant (~8 million) as part of HHS/ONC Public Health Informatics and Technology (PHIT) workforce development program. The PHIT program aims to build the informatics workforce in public health driven by COVID-19 pandemic needs. It has an emphasis on diversifying the PHIT workforce along with real-world learning opportunities through stipend-supported practicums. The pandemic underscored the collaboration between governmental public health and healthcare delivery settings along with numerous stakeholders emphasizing the need for a population health perspectives in informatics. Along with being a lead partner in the grant, the nursing school also has major emphasis/efforts to update its nursing curriculum to meet the new AACN Essentials and tap into the alignment with both informatics and population health. One of the objectives was to create a population health informatics and technology (PHIT) certificate program which will meet the needs of the workforce grant and AACN competency needs.

Methods: The development of the certificate involved two schools (nursing and public health) in the academic health center (AHC), along with collaboration from an AHC informatics institute. This post-baccalaureate certificate was adapted from an existing graduate-level nursing program and expanded on the interprofessional approach. Existing graduate level courses are being updated, and new courses will be created to meet grant/competency requirements.

Results: The PHIT certificate was approved by the board of regents at the University and will prepare trainees to harness the power of data for improving public and population health. Content focuses on information systems in public health, electronic data exchanges, and tools for consumer engagement, along with the utility of data for health equity and better population health. The certificate is set at 12 credits and all courses are offered fully online. The intent is to accommodate needs of working professionals and provide an option for training next generation of nurses in informatics. The training includes real-world practicum experience in a variety of settings: public health, non-profit care settings, HIT/EHR vendors, and associations/consultancies involved in HIT work. The PHIT certificate is designed to be inter-professional to appeal across health-related disciplines (public health, nursing, medicine, pharmacy). Through the PHIT workforce grant, the application fee will be waived, along with stipend-supported practicums. Innovative partnerships with various entities serving minority populations (Black Nurses Rock, Hmong Nurses Association, IndigiData, tribal public health) are being discussed.

Limitations: The need for aligning PHIT certificate with overall curricular revisions for AACN Essentials led to a delay in launch, but courses are being offered from Fall 2022. There will demands on faculty time for constant updates to courses given the dynamic/fast-paced field.

Conclusions/implications for practice: The PHIT certificate program is an effort to meet DEI needs as the workforce grant prioritizes under-represented individuals for practicum stipends. This also presents an innovative career development opportunity in nursing informatics. Given the recent Future of Nursing report and AACN Essentials, initiatives such as this are needed in academic nursing.

Learning Objective:

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.

P02 - Identifying Opportunities to Reduce Override Alerts and Increase Use of Infusion Pump Drug Library - A Clinical Informatics Optimization Project

Julieta Esguerra, MS, BSN, RN, CAHIMS, CPHIMS | Editha Tuazon-Reyes, MSN, RN

Tags: smart pump safety drug library

Updated: 04/08/23

Purpose: The innovation of clinical technologies such as smart infusion pumps enables healthcare systems to further improve safety and efficiency of patient care. The defined smart pump parameters that include high-alert medications, soft and hard dosage limits, and a customized library for specific patient care areas provide safeguards when administering medications and fluids. This project was implemented to foster the improvement of safe and efficient patient care surrounding infusion administration in two mid-size acute care hospitals for a period of 10 months. Project goals were to identify library infusions triggering the highest alerts, reduce override alerts to < 5%, increase nursing adoption of the use of the infusion pump drug library to > 95%, and avoid workarounds.

Methods/interventions: Infusion pump drug library data set reports were used for two acute care hospitals from September 2019 to July 2020. Analysis of both concurrent and retrospective pump drug library data was performed to identify trends with drug library use and override alerts. Observation of end user practice with use of the pump drug library was completed for educational opportunities. Collaboration was achieved with the pharmacy team to identify issues and implement changes to the pump drug library. Additionally, a crosswalk of the drug library alongside providers’ order sets for consistency was performed.

Findings/opportunities: The most common overridden alerts and inconsistent practice trends for maintenance infusion fluids and blood transfusions were identified. No specific KVO rate was defined in the admission order set. A single pump setting was noted for all blood product types at 75ml/hr, which does not allow infusion within 4 hours. Some variance was noted for the titratable drips dexmedetomidine and dobutamine in comparison to the order sets along with inconsistent policies throughout the organization. Moreover, educational opportunities were realized for nursing to reduce errors when using the pump drug library, avoid overriding alerts, and dissuade deviation from standard nursing practice.

Actions implemented and outcomes: In December 2020, changes were made in the pump drug library to blood products labels, removal of generic antibiotic labels, and upper limit modification to dexmedetomidine. A lower soft limit of 20 ml/hr was added for the KVO option and policies changed for blood products transfusion and KVO fluid rate. Modification to system order set builds were requested for dexmedetomidine and dobutamine in accordance with the pump drug library. Face-to-face education was also provided to staff and no adverse drug event was recorded during the project. Overrides for blood products decreased from 85.0% to 35.0%. Overall override alerts decreased from 5.8% to 3.4%. Use of the infusion pump drug library increased from 94.0% to 99.8 %.

Implications for practice: Adjustments to the infusion pump drug library alongside system order sets and policies improved alignment with clinical practice. Enhanced nursing education increased the adoption of the pump drug library use, decreased override alerts, and endorsed standard practice. Overall, these transformations reduced dosing errors and promoted patient safety and benefits for the organization.

Learning Objective:

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.

P03 - Optimizing CDS to Decrease Alert Fatigue & Enhance Nursing Workflow

Kathleen Klimpel, PhD, CNS, ACHIP, Senior Clinical Informaticist, Rady Children's Hospital

Tags: nursing alarm fatigue BPA alert best practice

Updated: 04/03/23

Purpose: Clinical decision support (CDS) enhances health care by utilizing knowledge and available patient-specific data aids in decision-making at the most appropriate time in a clinical workflow. Best practice advisories/alerts (BPA) are one type of CDS. BPAs are used to notify healthcare professionals when there are tasks to be completed for a specific patient. Development of CDS is based on the principles of the five rights: information, people, format, channel, and time. This optimization used the five rights as a guide in optimizing the use of BPAs. For nurses at this institution, BPAs have a standard format and can be presented via several different channels. The BPAs that pop up often disrupt a nursing workflow. Nurses often experience alarm fatigue and frustration when exposed to an extreme number of medical alarms/alerts which leads to desensitization. This project’s goal was to increase the timely completion of required tasks and decrease the number of workflow disruption via pop-up BPAs.

Description: An area of the EHR at this institution is called the storyboard. It acts as a home base for clinicians. It appears on the left side of the screen whenever a patient chart is opened and is the location of much information about that patient (i.e., name, age, admission date, isolation). The storyboard was identified as a different channel to present BPAs as a response to the concerns of the nurses. A storyboard BPA is non-intrusive, stays available on the left panel of a patient chart, and is colorized to increase visibility. Pop-up BPAs will occur to notify the nurse of an action needed, but the nurse can defer it knowing they can return to the required tasks on the storyboard at a time that is appropriate in their workflow. For this project, an inventory of BPAs was obtained and reviewed, and revisions were made guided by the five rights of CDS. Lockout times for pop-up BPAs to reappear have been increased from 1 to 4 hours to reduce the number of BPAs popping up. Lastly, storyboard BPAs were created to supplement pop-up BPAs and provide a place where nurses can address the actions needed at an appropriate time in their workflow.

Evaluation/outcome: In a 2-month period prior to this project, 283,196 BPAs fired for inpatient registered nurses at this institution. Post-implementation comparison data is pending. The number of BPA firings, number of active BPAs, and time from initial BPA to resolution of actions will be compared pre- and post-implementation. We will also gather nurses’ feedback on the BPA optimization process and outcome.

Learning Objective:

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.

P04 - Implementation of Cancer Genetic Surveillance in Rural Primary Care Clinics: The Role of the Nurse Informaticist

Laurie Riemann, BSN, RN

Tags: nurse informaticist cancer risk surveillance primary care genetic testing mutation

Updated: 04/08/23

Purpose: This project explored the impact of genetic risk testing services and surveillance within the electronic health record (EHR) on rural and urban primary care clinics’ operational workflow and patient outcomes. The roles of the nurse informaticist (NI) and interprofessional team are discussed to leverage a scaled, phased implementation approach to optimize the EHR infrastructure and support the early identification of patient cancer risk, genetic surveillance, and primary care support.
Background/significance: Genetic testing is instrumental in identifying individuals with cancer risk and guiding them through treatment and surveillance strategies. Yet, few health systems have developed the EHR infrastructure necessary to support the effective adoption of genomic healthcare within primary care clinics. Furthermore, primary care providers (PCPs) are often ill-equipped to address genetic risk, testing, and counseling and lack necessary EHR support for successful implementation within clinic workflow. Additionally, implementation of genetic testing services in primary care clinics requires interprofessional collaboration, genetic knowledge, and coordination of care—a mission nurse informaticists are well-positioned to lead.
Method: Implementation of EHR infrastructure and genetic testing services in primary care clinics occurred over three phases between April 2021 and December 2022 as part of the Early Detection of GEnetic Risk (EDGE) study. The interprofessional study team, led by the NI, met weekly to refine EHR formats and clinical workflow within three urban and three rural primary care clinics from a fully integrated healthcare organization in the rural Northwest.

Result: Since study launch, numerous new features over three phases have been deployed and optimized within the EHR. In phase 1, the NI led an interprofessional team (i.e., health information management, genetic counselors, chief medical information officers, pathologists, and PCPs) to improve EHR infrastructure to store genetic testing results and the surveillance plan for positive results. In phase 2, the advent of a folder naming convention required electronic authentication by PCPs, resulting in the automatic entry of genetic test results to both the EHR genetic folder and the patient’s healthcare portal. An electronic message script was implemented within the EHR for individualized genetic mutation result notifications to PCPs. Notifications included ICD-10 diagnosis codes, information to guide PCPs with patient follow-up, National Comprehensive Cancer Network (NCCN) guidelines, and the procedure to request genetic counselor referral within the healthcare system. In phase 3, the study team created personalized previvor reports containing known genetic mutation information, personal and family history information, frequently asked questions for patients and families, and cancer resources. The genetic counselor mailed these reports to the patient.

Conclusions/implications: NIs are well-equipped to facilitate implementation of genetic cancer risk test results and surveillance across the care continuum from patient testing to genetic counseling. Tangible steps were identified and implemented to improve electronic and patient communication for genetic testing results, resulting in timely and comprehensible genetic information for PCPs, genetic counselors, and patients. The next step is evaluating the process with the NI and key stakeholders in primary care and genetic counseling for implementation of genetic cancer risk surveillance and testing as the standard of care.

Learning Objective:

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.

P05 - Documentation for Quality Improvement

Melinda Jenkins, PhD, FNP

Tags: interoperability quality improvement Nursing Documentation Standardized Terminology

Updated: 04/03/23

Objectives: 1) Spotlight the value of the US Core Data for Interoperability (USCDI) to analyze nurses’ work. 2) Identify nursing decision support that includes interoperable core data. 3) Discuss teaching strategies to move nurses from narrative to structured documentation.

Purpose: Computers are no match for humans in understanding words. Narrative nursing notes in electronic health records (EHR) are quite limited in allowing data sharing about nursing problems and interventions. Standardized terminology in EHRs will facilitate data sharing for nursing quality improvement, and decision support. “Collect data once, use many times.”

The US Core Data for Interoperability (USCDI) identifies core data for nursing documentation with standardized, coded terminologies including: SNOMED CT, Systematized Nomenclature of Medicine Clinical Terms—used to capture clinical problems, interventions, and goals; LOINC, Logical Observation Identifiers Names and Codes—used to identify health measurements, observations, and documents; and RxNorm—used to identify medications. In addition, core data is useful for computerized problem-solving used in quality improvement and decision support to analyze large volumes of data from monitors and electronic health records.

Description: The goal for sharing nursing documentation is to teach students and practicing nurses how to replace narrative notes with interoperable standardized terminology. Terminologies approved by the American Nurses Association, mapped to SNOMED-CT, have familiar terms for nursing problems, interventions, and goals. For example, the clinical care classification (CCC) nursing terminology is currently used within the Hospital Corporation of America (HCA), Vanderbilt, and other health systems, for computer-readable nursing documentation to build reports that support patient safety and ANCC Magnet recognition. Documentation is streamlined and fit into nursing workflows.

Evaluation and implications for nursing: To practice documentation, Rutgers graduate students added structured terms to narrative SOAP (subjective-objective-assessment-plan) notes. CCC nursing diagnoses and expected outcomes were added to medical billing diagnoses in the Assessment. CCC nursing interventions were added to medical billing orders in the plan. For example, assessment with medical diagnosis ICD10 Z30.9 encounter for general counseling and advice on contraception would also include CCC K.25.5.1 infection risk, expected to improve.

Plan, with medical billing for intermediate encounter would include an order set for contraceptive prescription as well as CCC H 24.4.3 teach medication treatment, K 30.3.3 teach infection control, and CCC H24.4.2, manage medication treatment with return for BP check and refill in 6 months. With CCC documentation, nurses’ contribution to patient medication-taking and avoiding sexually transmitted disease will be visible. Quality metrics may be calculated. After the documentation assignment, the students that were surveyed agreed that structured data on nursing interventions is important for performance measurement and to uncover nursing’s contributions to patient outcomes.

Learning Objective:

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.

P06 - Factors Influencing the Mortality Rate of Patients Admitted with Chronic Disease in Urban Hospitals in DC Metropolitan Area: EHR Big Data Analysis

Priscilla Okunji, PhD, MS, FNP-BC, CRNP

Tags: electronic health record big data chronic disease mortality rate

Updated: 04/03/23

Background: Chronic disease is the leading cause of deaths worldwide. Lifestyle choices, such physical inactivity, poor nutrition, inadequate stress management, alcohol abuse, and tobacco smoking, are the major contributors for chronic disease development. Approximately 75% of Americans aged 65 or older suffer from more than one chronic disease, with the most prevalent combination being hypertension (HTN) with type 2 diabetes mellitus (T2DM) or cardiovascular disease (CVD). However, the inability to effectively use electronic health records (EHR) to garner large clinical data on the prevalence and the factor that affects chronic diseases and their associated outcomes have been reported. The difficulties in accessing hospital datasets for extraction continue to be challenging. We collaborated with a research institution located in the Washington, DC, metropolitan area to gain access to urban hospitals’ datasets to extract unidentified information with diabetes, myocardial infarction, and the associated independent variables (age, gender, race, and the lab results) with an outcome variable (mortality rate).

Methods: Secondary data from inpatients with diabetes and myocardial infarction were selected from 2014-2015 urban hospitals data warehouse. For diabetes, we used the ICD-9 codes 25000 (ICD-9: 25000) and myocardial infarction (MI) was 41000 (ICD-9: 41000), and the data extraction design was purposely selected accordingly. We also accessed factors that critically affected the outcome of the inpatients.

Results: For the 2014 data, females and African-Americans were admitted more than their male counterpart across the DM and MI only categories. For the 2015 data, females and African-Americans were also admitted more than their male counterparts for DM and MI only. However, it important to note that more males with DM±MI were admitted than in 2015, while more females were admitted for females in the same category. There was no statistically significant among African-Americans across the disease categories in both years. A reduction in mortality rate (4%) was also noted from 2014 to 2015. BMI, DBP, PP, glucose, and AIC levels were all statistically significant across the disease categories (p < 0.001) with HDL significant (p < 0.05) for only 2014 but (p > 0.253) for SBP in 2015.

Conclusion: Access to enhance the use of readily available EHR data in future clinical research is new and involving. It has been confirmed that similar studies could be encouraged, as such studies would lead into using the EHR data to determine the relationships between the prevalent of chronic diseases such as obesity, heart diseases, diabetes, and the factors that impact the outcomes of patients admitted with such diseases. This innovative research method would enable future biomedical investigators to have access to available data rather than years of waiting for bedside data collection for pilot or population research.

Learning Objective:

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.

P07 - Robots as Patient Sitters: Acceptability by Nursing Students

Emmaline Wuensch, BS | Nancy Zhang, BSN, RN

Tags: efficiency robots in healthcare acceptability

Updated: 04/03/23

Background/significance: Science continues to evolve related to the safe and effective use of robots in health care. Researchers have demonstrated that robots can support the role of nurses through accomplishment of tasks and improvement of effective communications and can free professional nurses for more important critical-thinking and caring roles. In nursing education events and circumstances in recent years, including the COVID-19 pandemic, have led to successful experimentation in the use of robots and artificial intelligence to support simulation and remote learning. Nursing students are an ideal population for which to test new and effective technologies, as they are just beginning to develop their attitudes towards, and comfort with, a variety of procedures and use of technology.

Purpose: In acute care settings, bedside sitters are often used for patients at high risk for falls, but they are expensive and their effectiveness is unclear. Thus, exploration of effective substitutes for human sitters is needed. The purpose of this study was to measure the acceptability, as perceived by nursing students, of the use of robots in a patient sitter scenario.

Methods: The study was framed by the technology acceptance model (TAM). The TAM instrument includes subscales to measure perceived usefulness (PU) and perceived ease of use (PEU) of the technology. The study was approved by the human subjects protection program of the university. The participants (n=24) were all undergraduate upper division and master's-entry accelerated second-degree students in the nursing program at a research 1 university. Students were recruited by in-class invitations from the research team. The students received credit for clinical/research hours for an undergraduate research course or capstone clinical course as compensation for participating in the experiments. Students signed informed consents upon enrollment. The adaptive robotic nursing assistant (ARNA) robot is a mobile manipulator that consists of an omnidirectional base with an instrumented handlebar, and a 7-DOF robotic arm. It is a service robot capable of providing physical assistance to a human user in pHRI, teleoperation, and autonomous operation modes

Results: Data indicate that students rated the technology’s usefulness at 3.77/5.00 with a standard deviation of 1.10 and the ease of use at 3.49/5.00 with a standard deviation of 1.12. This indicates a moderate to high acceptance of use of the ARNA robot in a sitter scenario. In terms of the relationship between perceived usefulness and ease of use, perceived usefulness had a 27.2% dependence on perceived ease of use (i.e. R2 = 0.272) with a p-value of 05.

Conclusions/implications: Fetching and retrieving items is just one of many possibilities for which robots can be programed. Nurses and engineers must continue to effectively collaborate to design and refine robots that meet the needs of health care facilities. Acceptability data should inform further development. Interestingly, an analysis of recent social media posts indicate public acceptance of the use of robots in health care which will potentially impact the openness of nurses and other health care workers to this labor-saving innovation.

Learning Objective:

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.

P08 - Impact of Integrated, Automated, Traveling Cobot Assistance on Time and Motion of Nursing Care Delivery

Steven McPherson, BSN, RN

Tags: nurse cobot robot time waste

Updated: 04/03/23

Purpose: An innovation trial, turned into a grant from the American Nurses Foundation Reimaging Nursing Initiative, has placed highly intelligent robots next to nurses in a large Magnet-designated health care facility of over 1000 beds. The informatician who usually deals in pop-ups, required fields, intuitive flowsheets, and workflows now has a robotic arm, safety sensors, locking storage, several electronic motorized wheels, and artificial intelligence behind blinking eyes standing four feet off the ground.

Relevance: Studies have produced results shouting that nurses are spending only a third of their day performing direct patient care with between 15-35% of their time away from the patient completing activities labeled non-nursing, miscellaneous, or waste. These time and motion analytics, however, are not placing the nurses in a chair staring at a screen. They are placing the nurses in the supply room looking for a tube feeding pump, walking patient belongings to the stepdown unit, running a broken equipment down to clinical engineering, and walking to the front desk retrieving glasses just dropped off. Every second a provider spends clicking an order, a nurse spends half an hour gathering the supplies necessary to complete that task.

Strategy: When asked, nurses describe items such as sequential compression devices, patient-controlled analgesia pumps, cryotherapy pumps, tube-feeding delivery devices, insulin pens, large-volume specialized IV fluids, and other various items not kept on units undergo a telephone game of go-fish and then a subsequent period of waiting for these items to deliver care and treat patients. These items are brought to the nursing unit from staff juggling many other priorities and availability. Subsequently, nurses provided examples of item movement between nursing units and from smaller volume areas whose support hinged on the patient transportation department. Increasing the priority of this item movement would impact patient operations and transfer, thus leaving the sender and receiver waiting extensive periods of time for a simple item needed for nursing operations.

Evaluation: The ideal department energized to interface with a cobot can break up batch rounding workflows with more trips using a cobot to traverse the corridors. This evolution changes the delivery person into an air traffic controller, managing job creation software to manage multiple cobots from inside their department. The outcome is felt by nursing staff having what they need faster, and therefore the patient receives their medication or treatment quicker. Integration with the electronic medical record is becoming the highest priority in search of a remedy to buy back the nurse’s time. Removing the mental bandwidth and effort spent obtaining items is beyond time and motion. Acting independently of the nurse to recognize order entry and documentation to anticipate the nurse’s and patient’s needs is the cornerstone of getting the nurse back to the patient where positive outcomes follow.

Learning Objective:

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.

P09 - Using Microsoft Lists to Generate an Automated Work Queue for Immunomodulatory Drugs Refill Requests that Streamlines Interdisciplinary Communication between Registered Nurses and Advanced Practice Providers for a Large Multiple Myeloma Practice

Vanessa Tran, BA, BSN, RN, CCRN

Tags: nursing informatics automate lists coordination of care Microsoft lists medication refill work queue

Updated: 04/08/23

Significance/background: In an ambulatory care multiple myeloma clinic covering 10 physicians that sends approximately 4,000 immunomodulatory drugs (IMIDs) refills per year by a team of 8 advanced practice providers (APPs) and 10 registered nurses (RNs), communication alignment for refill requests was challenging due to high medication refill volume and multiple modalities of communication. Original workflow included a RN receiving medication refill notification via EPIC in-basket. The RN would add the refill request to a manually managed shared Excel sheet for APPs to review or send an email to all APPs. Historically, there were 1-3 patient complaints per month regarding missed IMID refills as a result of missed communication.

Purpose: To create a digitized and automated work queue to streamline interdisciplinary communication of IMID refill requests while simultaneously tracking and collecting data for auditing, analysis, administrative, and managerial purposes.

Intervention: After initial process analysis, building rapport and buy-in with end-users, Microsoft Lists (a PHI-secure platform) was used to replicate previous Excel workflow with new automated features. The project was independent of an IT team. Design and implementation of the beta version was achieved in one day. Changes, updates, and full user integration were achieved in one week.

Evaluation: The platform tracks patient identifiers, physician, provider sending refill, medication, dose, quantity, direction, notes, authorization number, pharmacy, date added, date modified, and total medications sent, not approved or pending. Since implementation, data entry has been self-sustained by end users with 100% participation occurring on a daily basis. Patient complaints of missed refills have been at 0% post-implementation. The RNs and APPs using the platform will be surveyed on ease of usability at 6 months. Data captured will be used for administrative and management purposes.

Discussion: This medication refill platform was a no-cost, secure, quick, and effective implementation that improved workflow and streamlined communication between RNs and APPs. The platform tracks and collects data that can be used for additional research and process improvement initiatives. This platform can be replicated in other oncology practices.

Innovation: Innovative use of technology and informatics provided the opportunity for nurses to facilitate communication alignment between RNs and providers and improved coordination of patient care and track metrics for future analysis and process improvement, which can lead to improved patient medication adherence, decreased medication errors, and increased patient satisfaction.

Learning Objective:

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.

P10 - Down the Stretch - A Nursing Informatics Fellowship

Meg Furukawa, MN, RN-BC, CNS, Nursing Informaticist, UCLA Health | Yvonne Mugford, MSN, RN-BC

Tags: role development mentoring fellowship projects NI

Updated: 04/03/23

Nurse informaticists play a valuable role, serving as the liaison between clinical users and the build analysts. They are the workflow experts, using their clinical knowledge to ensure that technology is used to its fullest capability and lead efforts to continually optimize functionality while reducing the documentation burden.

Nursing informatics (NI) is the specialty that transforms data into needed information and leverages technologies to improve health and health care equity, safety quality, and outcomes. With the proliferation of electronic health records (EHRs) and use of technology in healthcare, the need for nurse informaticists has increased significantly. To meet this demand, there has been an increase in NI degree programs. In spite of this, opportunities for nurses to learn and experience the NI role outside of formal education are very rare. Many nurses are interested in learning more about the NI field but do not want to commit to an NI degree program without a better understanding of the role.

Our organization developed a year-long nursing informatics fellowship to provide nurses with an opportunity to learn about the NI role. The fellowship includes attending monthly classes, completing a project to optimize the EHR or a clinical workflow, and mentoring by a nurse informaticist. Fellows spend up to 8 hours a month attending classes and working on their project.

Fellows identified an idea for system or workflow optimization as part of the application process. The nurse informaticists work with the fellows to identify a project that each can successfully complete within the length of the program. Priority is given to projects that interested the fellow and aligned with their clinical expertise and operational/strategic goals. The fellows worked with their mentors and nursing leadership to determine the scope of their project and develop metrics for success. They completed the system development life cycle for their projects.

Fellows worked with build analysts to identify potential solutions and went through established governance committees for approval. They developed and implemented education and communication and provided support for their projects. Examples of projects include flowsheet optimization, implementation of barcoded blood administration for ambulatory care clinics, streamlining checklists, and reducing the burden of documentation.

At the end of their tenure, each fellow presented their projects and outcomes to the nursing department at a symposium. The presentation included the background and problem statement of their project, baseline data, goals, solutions, results and outcomes, lessons learned, and next steps.

Four cohorts have completed the NI fellowship to date. Fellows report that the program helped them grow professionally and gain insightful leadership and informatics experience. Each fellow completed a project benefiting the organization by optimizing the EHR and workflows, positively impacting patient care and improving clinician satisfaction. Creating a NI fellowship is an effective strategy to create meaningful change, accomplish more optimization project, and mentor future informaticists. The fellowship can be replicated in other organizations to help maximize use of technology and improve nursing interaction with the EHR, allowing them to provide efficient, high-quality, and safe patient care.

Learning Objective:

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.