Background: The widespread implementation of the electronic health record (EHR) systems and utilization of connected health information technologies in both the military and private-sector health systems are catalyzing greater demands for a trained and proficient health informatics workforce, particularly within nursing informatics (NI). While academic graduate NI programs provide a solid foundation in clinical nursing informatics knowledge to answer this increased demand, there is a lack of relevant military health system (MHS) practical experience to support army NI graduates who have difficulty executing their newly acquired skills while attempting to navigate through complex MHS systems and processes. As NI graduate programs migrate away from the traditional classroom instruction to an all virtual/online experience, this limits opportunities for prospective army nurses to gain valuable practical experiences.

Purpose: To evaluate a pilot program allowing selected army nurses to partner with an established Department of Defense Accreditation Council for Graduate Medical Education (ACGME)-certified clinical informatics program for critical hands-on informatics experience. Specific aims include: 1) compare practical experiences between nurses who participate in this pilot vs. a traditional NI program and 2) examine interprofessional educational suggestions.

Description: Army-funded NI graduate students accepted into an online informatics master's program will "audit" ACGME-certified clinical informatics program located at Madigan Army Medical Center. The NI student will attend lectures given by the faculty and rotate throughout the different departments.

Evaluation: The army-developed informatics role-based target proficiency level (TPL) survey will be used to examine the levels of performance for each competency. The survey will be administered at baseline, 6-month and 12-month post-graduation intervals. By using an interprofessional education approach, an enriched experience will benefit future army informatics nurses.

Falls and injuries from falls continue to challenge healthcare organizations throughout the continuum of care. Organizations have implemented technology and bedside devices as well as sitter programs in the prevention of falls. The complexity of patient falls and the variability of identifying the need for a patient safety attendant led to the development of a systematic process outlining key indicators for patient falls with guidelines for clinicians that assisted in decreasing falls as well as decreasing the financial impact of falls.

The patient safety attendant assessment yool (PSAAT) was imbedded via a power form and IVIEW documentation from the emergency department and throughout the inpatient care areas within the electronic healthcare system at UMC El Paso. An interdisciplinary approach with quality management, information management, educators, process improvement clinicians, clinical bedside nurses and administration, nursing informatics, risk management, physician teams, and other essential healthcare teams utilizing PDSA and change management theory moved the organization toward decreasing falls and identifying patients that needed a safety attendant at the bedside.

Risk factors with a total score for requiring a patient safety attendant were implemented utilizing evidence based practice and the Agency for Healthcare Research and Quality guidelines on decreasing falls. Testing and retesting along with data aggregation of the impact the tool made in changing practice to include decreasing falls and decreasing the financial impact of falls proved positive.

One fall is one too many falls for any patient and family. The implications of implementing fall prevention programs focused on creating safer environments and improving on current prevention strategies continues to foster continuous improvement plans with sharing of information and data. UMC El Paso showed a decrease in falls in several departments and improvement in the utilization of the PSAAT throughout the continuum of care. Data from the utilization of PSAAT as well as data based on national benchmarks on patient falls continues to guide clinical practice at UMC El Paso toward improved outcomes.

The COVID-19 pandemic has propelled healthcare professionals to innovate care delivery without compromising the quality and integrity of patient-provider relationships. Telehealth tools have assisted in bridging the gap in fostering connectedness with real-time information, education, and individualized care planning for patients and their families. In an effort to empower patients and support clinicians in the care of expectant parents through education and advocacy, this project looks to facilitate health promotion through an integrated, interactive, and dynamic electronic care plan application for the obstetric patient from pre-conception to delivery. Enhancing the clinician digital experience, this feature also provides clinicians a workflow that is standardized, efficient, and customizable based on patient needs. Transforming the patient digital experience, the aim of this initiative was to provide user-friendly guidance and resources through accessible technology. The presenters evaluate the use and engagement of an innovative, patient communications platform.

Reporting data include, but are not limited to: 1) data models for obstetric outpatient care with respect to care plan and program enrollment and attrition rates; 2) patient-task generation, reinforcing pregnancy-related screening, testing, vaccinations, newborn care education, and access to location-specific hospital and community resources; 3) survey results of patient experience, ease-of-use with the feature, and satisfaction with the desired information; 4) patient engagement (i.e., task completion and education understanding attestation); 5) clinician decision support design and logic configuration for suggesting care plans and educational content based on gestational age range; 5) workflow and build; 6) content acquisition processes; 7) implementation strategy; 8) opportunities for improvements to better understand trending (i.e. increasing adoption and engagement over time).

Background: At a large academic medical center with over 80 clinics, variations in documentation procedures can inadvertently lead to clinical staff working outside of their role boundaries. In one such instance, providers in a procedural clinic were attempting to delegate verbal orders to nurses via a third-party clinical staff member. To ensure that nurses operated within their appropriate scope in this and similar circumstances, a work group was developed to review variations in documentation for procedural medications. Nurses reported to the work group that they felt uncomfortable placing medication orders and documenting the administration for the surgeons despite not witnessing the procedure. The nurses identified that this was not best practice, being that the athletic trainers were the ones assisting with the procedure. Therefore, the work group was tasked with empowering the athletic trainers with the appropriate tools to document the medication administration while still operating within their scope of service.

Objective/purpose: Procedure narrator tool would allow the athletic trainer to document real-time medication ordering and administration. This would prevent the nurse from being asked to place an order or document an administration that they did not witness.

Design/methods: A multidisciplinary work group was created consisting of members from the billing department, information resources, nursing operations, and pharmacy. Information was gathered regarding medications, procedure workflows, and documentation requirements. A demonstration was presented to clinic leadership, provider champion, and athletic trainers. Training consisted of an in-service, tip sheets, and access to the training environment to preview the tool and solicit feedback prior to go-live.

Results/summary: A post implementation survey was sent to the impacted staff members, namely nurses, and athletic trainers. Using a five-point Likert scale, the target respondents were asked: 1) Prior to procedure narrator: Best practice was being followed when the nurse placed the ortho medication order. 2) Prior to procedure narrator: Best practice was being followed when the nurse documented the medication administration with use of the ortho medication handoff form. 3) Post-procedure narrator go-live: Best practice is being applied when the athletic trainer documents the one-step med for the provider. 4) Post-procedure narrator go-live: Best practice is being applied when the athletic trainer documents in the MAR (medication administration record) for the provider while in the room. 5) On a scale from 1-5, how likely are you to recommend the procedure narrator tool?
Overall feedback reviewed was positive, respondents overwhelmingly agreed that they would recommend the procedure narrator tool.

Lessons learned: Respondents were also given the option to provide comments. Comments were mostly neutral; however based on the answers, workflow enhancements were implemented to include items such as billing details and administration site documentation.

Conclusion/outcome: After successful implementation at the procedural clinic, the work group is identifying other clinics that could benefit from the procedure narrator that also have variations in documentation of procedures.

Background: Orientation to a new role can be a challenging undertaking. Pre-COVID 19 pandemic, processes often saw orientation programs occur in a face-to-face environment. In a post-pandemic state, many organizations have moved to virtual orientation processes. Concerns such as a loss of connection, lack of rapport, a sense of disconnection and feeling overwhelmed were identified with virtual orientation in an informatics department at a large, multi-site healthcare organization.

Purpose: As a result of the overwhelming amount of information being presented during the virtual orientation process and a perceived lack of connection to a team, two newly hired informaticists identified an opportunity to partner to share learnings and experiences.

Methods: Informal, virtual touchpoints began on a weekly basis between two newly hired informaticists to share learnings and resources. Additionally, this time allowed for a “safe space” to ask questions without fear of judgement from more experienced colleagues. These touchpoints also provided opportunities to work though never-experienced tasks together in a low-stress environment. With the support of departmental leadership, informal touchpoints evolved into scheduled weekly meetings and other newly hired informaticists from across the organization were added. This resulted in an institution-wide orientation support group for new informaticists. The newly formed orientation support group identified pertinent topics, sought subject matter experts to present on desired topics, and developed a central location to house learning materials.

Outcomes: What started as informal touchpoints between two new informaticists, rapidly evolved into a formal group of over twenty new hires sharing similar circumstances. Participants verbally expressed significant improvements in joy and belonging and reported feeling more connected to the informatics team. This group also created a clinical informatics and practice support handbook which is housed in a centrally accessible location. The handbook contains pertinent, up-to-date references identified by new informaticists as necessary for successful completion of orientation. Due to the perceived value of this resource, all informaticists in this organization were granted access to the handbook.

Conclusions: Creation and development of the orientation support group has benefited many and continues to grow and develop. Additional evaluation is needed to explore effectiveness and identify ongoing opportunities for development.

Nurse educators need strategies to incorporate the theoretical foundation for the teaching of informatics/digital health and reflection/clinical judgment in their teaching approach, Using and combining various existing theoretical models to create a faculty guide in developing learning activities that integrate informatics/digital health and reflection/clinical judgment framework can serve as a tool in promoting and incorporating informatics and clinical judgment in nursing education.

Evidence-based practice
Purpose: Using this matrix, faculty can incorporate both informatics/digital health and reflection/clinical judgment in the development of the teaching and learning strategies in their program or course.

Method: Designing a framework of a multimodal combination of existing models that included informatics, reflective model, and clinical judgment is a strategy that can integrate informatics and promote clinical judgment in the learning environment. Several conceptual models were used to create a structural framework in the development of the matrix guide. Bloom’s taxonomy action verbs were added to serve as a guide in outlining the teaching and learning approach.

Results: The multimodal matrix specifies four conceptual models that can be applied to teaching practice that could generate a comprehensive guide of how educators develop learning activities and objectives that demonstrate structured, higher-order thinking skills, incorporate informatics, and exemplify reflection.

Conclusion/implications: The matrix can be used in developing a rubric in various courses. The application of this matrix can go beyond the classroom environment. Apply to simulation, clinical settings describing types of healthcare technologies used in care settings, processing of data and health information, thus influencing care outcomes. The matrix can be integrated in learning management system and used as a guide for course development. Contribute to new and unique outcome/outcome development. Easy matrix for new faculty teaching informatics/digital health and reflection/clinical judgment.

In today’s quality and data-driven healthcare environment, almost all large health systems have a formal nursing informatics department dedicated to the inpatient setting. In the ambulatory care arena, though, rarely does a formal nursing informatics position exist. In 2017, at one large academic medical system, the ambulatory care training and workflow group split into 2 different departments. The job description remained the same for both, leading to role ambiguity amongst the staff and the clients they served (clinical staff and leadership). By the beginning of 2019, the diverse workflow team, comprised of both licensed and non-licensed staff, experienced an 80% turnover in staff. Efforts were then turned to team education, training, team building, and retention for the remainder of 2019.

In the beginning of 2020, emphasis pivoted from team focused to an individualized focus. One-on-one discussions were implemented to gather appropriate feedback. Staff voiced concerns of not having a career path for advancement, no role distinction, and lack of a formal training plan to enhance skills. In February 2020, we engaged our human resource partners to redesign the job description, and develop an advancement program that would allow progression within the department and demonstrate leadership support for professional development.

In June 2020, a new staff engagement survey was adopted by the healthcare system. The targeted goal for overall engagement scores was set at 76 for the institution. The workflow team’s baseline score measured 67 in June 2020, and scores further decreased to 63 in June 2021. It was decided to perform skip level interviews amongst this team with their director. Skip level meetings have been shown to create a level of trust and open communication between leaders and employees (Yoho, 2016). These one-on-one conversations took place throughout the spring of 2021. By February 2022, scores jumped up to 68. With such tangible impacts on engagement, sustainment plans included continuing biannual skip level discussions. Additional tactics to maintain progress included honing in on one main theme that resurfaced during all discussions: internal career progression. Among the nursing industry, career development models have shown to directly impact engagement and retention (Bernard & Oster, 2018). In July 2021, we re-engaged our human resource team to continue the title change work effort from 2020. This work was completed and the job description and title change occurred on September 1, 2022. The October 2022 engagement scores increased to 78, exceeding benchmark for the first time.

In addition to increasing our engagement scores, our team of nine now includes three staff with a master's degree in nursing informatics and one with a bachelor's degree in health informatics. Four have achieved yellow belt lean six sigma. Three have advanced to a level II position on the team.

The Vanderbilt Nursing Informatics Committee (VNIC) is the shared governance forum for frontline nursing staff to glean thoughts, provide input, and make decisions about use of technology that impacts nursing practice. VNIC’s front-line staff function as expert liaisons and are called eStar representatives (eReps). They provide the bridge between the clinical areas, colleagues, healthIT, and nursing informatics. Since launching in 2017, yearly surveys and qualitative feedback revealed opportunities for improvements. The eStar representative role is subject to turnover, there can be limited engagement in VNIC, and there are often significant differences in eStar representative knowledge, skills, and performance across the organization. Problematically, some eStar representative positions across the organization remain unfilled or filled by leaders. 49% of eStar reps have less than 18 months of experience in the role, and orientation to the role has lacked standardization. This poster will share a successful approach and new perspectives on how to strengthen the role of staff, informatics, and shared governance.

Over a six-month period, Vanderbilt nursing informatics services (VNIS) refreshed the program using three clear objectives. The first objective was to identify the status of eRep positions for each clinical area (vacant vs. filled, leader vs. front-line staff, and attendance), and implement a standardized onboarding program; metrics from the orientation session surveys will be shared. The second objective was to improve resources to support the eRep including: an eStar representative newsletter, an MS TEAM communication hub for asynchronous communication, and onboarding materials.  The third objective was to enhance recognition and development activities. A change in perception was needed to reframe the eStar rep position as a path to enhance career satisfaction, improve knowledge and skills, and achieve advancement on the clinical ladder. Various strategies utilized will be shared. Two VNIS resources were dedicated to the work of developing this program.

After the six-month adoption period, the progression of the new eStar rep program was well underway, and a follow-up survey was conducted that identified increased satisfaction and proficiency in the eStar rep role. This poster will present data obtained at the one-year mark, including lessons learned. Having an organized and streamlined method to include, onboard, and educate front-line end-users can directly influence patient outcomes and can lead to better usability with the EHR and thus, better patient care.

Background: Beginning in 2021, the American Association of Colleges of Nursing (AACN) refocused educational standards using a competency-based approach for baccalaureate and master’s degree programs. The AACN Essentials outline necessary curriculum content and expected competencies for graduates, with a renewed emphasis on informatics, quality, and patient safety.

Although informatics and healthcare technologies competencies are one of 10 domains required by AACN for quality nursing education, few schools have a dedicated course for teaching these competencies for future nurses and nurse leaders. A small survey of nursing schools identified that 44% of BSN programs do not teach a separate course for informatics but thread it into curriculum, and 12% of programs reported that informatics was not covered at the BSN level. 24% of programs teach informatics as a standalone course, and 21% of courses combine informatics with another course (personal communication, July 26, 2022).

Use of information systems to evaluate healthcare quality, track and trend healthcare data, and understand healthcare policy related to informatics and technology (specifically HIPAA, HITECH and The Cures Act) have been hallmarks of Capital’s nursing informatics and tech Health courses at the graduate and undergraduate levels. The purpose of this poster is to identify essential nursing informatics competencies and highlight student-focused assignments to improve informatics and technology education for students at the BSN and MSN level.

Methods: The informatics courses are 3-credit hour courses that incorporate exams and project-based learning for student assessment. Classroom activities for student learning include projects related to 1) information literacy, 2) use of data and information in a spreadsheet, 3) quality analysis, and 4) technology usability. Each project builds student’s skills to support subsequent project completion. Pedagogy includes both online, synchronous, and asynchronous approaches. In the undergraduate course, students have a choice of taking an online or a classroom class.

Evaluation/results: Assessment of student learning used a mixed methods approach. Exams assess student learning in the undergraduate program and projects with rubrics provide a quantitative measure of student learning. Grading rubrics also allow for qualitative assessment of student learning. In addition, students complete a review of the course using quantitate and qualitative measurements.

Implications: The projects used in this course are innovative and will provide ideas for competency-based education using new AACN Essentials competencies. As education continues to prepare students for using informatics and technologies competencies for their future practice, practicing nurse informaticists will become familiar with required competency education. As a result, onboarding of new graduates will be enhanced and MSN graduates will be equipped to gather data, form information for decision-making, and support professionals as they expand knowledge and wisdom for practice.