Learning outcome: By the end of this poster presentation, participants will be able to effectively implement a workflow-integrated, problem-based approach to provider documentation to improve quality and accuracy, thereby enhancing patient handoffs and overall patient safety.

Purpose: This project explores the implementation of a workflow-integrated, problem-based approach to improve progress note documentation quality and problem list accuracy in the neonatal intensive care unit (NICU).

Design: In this quality improvement project, a convenience sample of 17 neonatal nurse practitioners (NNPs) was evaluated. For time efficiency and problem list documentation, performance was observed over a three-month period pre-intervention from August 1 through October 31, 2023, and post-intervention from December 6 through March 6, 2024. For note quality, two notes pre-intervention and two notes post-intervention were compared.

Methods: Data retrieved from the EHR through reporting and manually with the PDQI-9 tool was analyzed using a Wilcoxon test with SPSS.

Findings: The use of the workflow-integrated, problem-based approach to progress notes improved total PDQI-9 scores from 40.5588 to 44.0588. The average total number of problems added to the problem list increased from 4.451 to 21.157.

Conclusions: Using the workflow-integrated, problem-based progress note in the NICU led to improved note quality scores and more active clinical problems added to the problem list. While time efficiency did not show an improvement, it is anticipated to improve over a longer period as providers become more proficient in the EHR changes.

The effective use of data is critical to driving operational efficiency, improving patient outcomes, and enhancing financial performance in healthcare settings. This presentation discusses the implementation of the Data, Measurement, and Analytics Program (DataMAP), designed to leverage clinical, administrative, and financial data through real-time dashboards to support informed day-to-day decision-making in a healthcare facility.

DataMAP was developed to address the challenge of siloed data and delayed access to actionable insights. The program integrates data from multiple sources, including electronic health records (EHR), billing systems, and human resources platforms, into user-friendly dashboards. These dashboards provide clinical leaders, administrative staff, and financial teams with real-time access to key performance indicators (KPIs) such as patient outcomes, staffing levels, resource utilization, revenue cycles, and operational efficiency metrics.

Key components of DataMAP include:

• Customizable dashboards: Tailored to the needs of different departments, enabling leaders to track metrics relevant to their goals and make data-driven adjustments.

• Real-time data integration: Allows for timely interventions, such as staffing adjustments, cost control, and patient care improvements.

• Predictive analytics: Provides insights into trends, patient acuity, and financial projections, empowering proactive decision-making.

This poster will cover the implementation process, from system integration to staff training, and emphasize the importance of data governance and stakeholder engagement in ensuring accurate, reliable data. Additionally, it will highlight the role of leadership in fostering a data-driven culture and ensuring that insights are translated into actionable strategies. Early results from the DataMAP implementation demonstrate improvements in operational efficiency, patient care delivery, and financial performance. The program also reduced decision-making time and enhanced collaboration across clinical and administrative teams. This presentation will provide practical insights and lessons learned for healthcare organizations looking to implement similar data-driven programs.

Introduction: Wrong blood in tube (WBIT) events are defined as blood specimens in containers labeled with another patient’s information. These events present a substantial risk to the patient, as transfusion of an ABO incompatible product can result in significant patient harm or death. Despite interventions aimed at decreasing WBIT events such as dual-nurse signoff of patient identification and enhanced education, these events persist. Passwater et. al. (2022) reported that manual patient identification of blood samples led to a WBIT error rate of 0.61%, while electronic identification of the patient yielded an error rate of 0.045%. Stakeholders at an academic, community Magnet®-designated hospital identified an opportunity to modify the existing workflow to reduce the incidence of WBIT events, thus decreasing the risk to patients. This presentation summarizes the strategies used to implement an organizational change in practice affecting bedside clinicians, blood bank technicians, and technology stakeholders.

Methods/approach: The clinical informaticist led the effort to complete a comprehensive workflow evaluation, including a survey of bedside nursing clinicians, to best identify challenges in the current confirmatory specimen collection process. This information was synthesized for themes and presented to operational and technology stakeholders. The clinical informaticist assisted in breaking down legacy barriers for ordering the confirmatory specimen, identified access requirements for lab colleagues, and provided education to bedside clinicians.

One such barrier was the lack of a confirmatory specimen order in the electronic health record (EHR), when all other specimen orders were available in the EHR to print specimen labels at the bedside. While blood bank technicians were the personnel who identified if a patient required a confirmatory specimen, they did not have access to the EHR. The workflow was redesigned to allow confirmatory specimen orders to be placed in the EHR by blood bank technicians and cosigned by the transfusionist. This allowed for the specimen label to be printed at the bedside by collecting clinicians and leveraged barcode scanning of both the patient wristband and specimen container at the time of collection.

Results: Post-intervention, WBIT events were decreased from an average of 3.75 occurrences per month to an average of 2.5 occurrences per month. This was calculated by evaluating WBIT events reported in the 12 months pre- and post-intervention. Improved compliance with the workflow was also noted, evidenced by the decrease in number of confirmatory specimens that went uncollected when comparing data from six months pre-intervention to six months post-intervention.

Implications for practice: Clinical informatics was instrumental in pushing through barriers to enhance patient safety after evaluating multiple interventions to improve practice. By keeping patient safety at the center of the conversation, the team was able to collaborate to identify a solution that has positively impacted patient care. Information gained during this presentation can be incorporated within a variety of settings to improve collaboration between operational and technology stakeholders to improve patient care through safe ABO collection processes. This work also emphasizes the benefit of technology applications at the bedside to enhance patient safety.

As the need for new, innovative nurse care models grows, a virtual nurse (VN) pilot was initiated to better support bedside nurses and improve patient throughput as a quality improvement initiative. This project evaluated the feasibility and impact of a VN pilot on patient progression, nurse helpfulness, and discharge times on a 26-bed adult general medicine unit at a large academic medical center.

Virtual nursing utilizes telehealth technology to support inpatient nursing. Institutions who have implemented care models that use VNs as part of the care team have reported improved patient experience scores, patient discharge times, and nurse mentorship. One way to optimize technology in the transition from hospital to home is by incorporating a VN into the care team. VNs bolster the discharge process by conducting discharge planning sessions and providing patient and caregiver education on post-discharge care instructions, allowing patient questions and concerns to be promptly addressed.

VNs delivered discharge education from a remote location within the hospital, providing eight-hour day-shift coverage, Monday through Friday. Three front-line nurses from the pilot unit were tasked with initiating this project along with a telehealth engineer and a public health statistician. Each bedside was equipped with a Cisco room kit mini initially deployed for isolation communication management (ISOCOMM) during the COVID-19 pandemic. These devices connect to a long-standing and existing infrastructure operated by telemedicine. The VN reviewed and reconciled the discharge instructions with the primary medical team, reviewed the discharge paperwork with the patient, coordinated transportation home, and completed nursing discharge documentation. Total discharge time was collected for each patient. This metric was compared to patients who had been cared for on this unit in the three months prior to the pilot and patients who were not discharged by a VN (synchronous controls). Additionally, a survey was created for nurses to rate the helpfulness of their experience utilizing a VN to conduct the discharge.

Over five months, 117 patients were virtually discharged, compared to the 164 patients in the pre-intervention group, and 112 synchronous controls. The mean discharge times, defined as the time the discharge order was placed to the time the patient left the unit, were 2 hours 25 minutes, 2 hours 29 minutes, and 2 hours 30 minutes respectively. Statistical analysis (ANOVA and Kruskal-Wallis tests) found no significant differences either in mean or median times. However, the median time virtual nurses spent on each patient discharge was 45 minutes, representing time the given back to the primary nurse to focus care on other patients. Of the 24 surveys completed, 91% of nurses reported VN discharge as “very helpful.”

This pilot established feasibility and helpfulness of a VN discharge program on our acute care inpatient medicine unit. Longer-term patient outcomes, such as readmissions within 90 days, ED visits within 30 days, and adherence to follow-up outpatient appointments, are currently being tracked. Although total discharge time was not significantly different, helpfulness reported by inpatient nurses support the continuation of this pilot. Our task force is currently developing the next phases.

The field of nursing informatics is growing at a rapid rate to keep pace with the explosion of healthcare information technology. Nursing organizations such as the American Association of Colleges of Nursing (AACN) have recognized the importance of informatics in nursing by adding healthcare and informatics competencies to the newly published Essentials (2021). Nurse educators are tasked with ensuring that graduating nurses have the informatics competencies necessary for safe patient outcomes. Since the development of Stagger’s nursing informatics competencies in 2002, nurse researchers have developed tools for measuring nursing informatics competencies; however, it is important to review and revise tools to reflect current standards and trends.

A research team of eight nurse educators examined the SANICS-18 tool by Yoon et al. (2015) and compared the competencies assessed to the 2021 AACN Essentials, the Healthcare Information and Management Systems Society TIGER Competencies (2021), and current trends in healthcare information technology. Using an iterative process, revisions were made to fill competency gaps and update wording to reflect current technological advances. Five of the items were removed due to lack of current relevancy (e.g., turn computer off and on, load paper, change toner, remove paper jams, print documents), and other items were updated (e.g., adding use for emerging healthcare technologies such as artificial intelligence and machine learning of social media and texting to the email competency) to reflect current standards. Items were modified to reflect learning levels congruent with Bloom’s taxonomy.

The survey was finalized as a 19-item Likert scale instrument called the SANICS-19. Students were asked to rate themselves with a 5-point Likert scale (1=not competent, 2=somewhat competent, 3=competent, 4=proficient, and 5=expert). Higher scores on the SANICS-19 indicated higher perceived competence. The SANICS-19 was distributed virtually to nursing students of all program types across the country (n=202).

A Cronbach’s α of 0.959 was calculated, indicating excellent internal consistency. The lowest scoring item was on emerging healthcare technologies such as artificial intelligence and machine learning. The highest scoring item was about using electronic communication tools such as email, social media, and texting. A Mann-Whitney U test was used to compare the mean score (mean=58, SD 11.92) for BSN students (n=49) and the mean score (mean=55, SD 15.79) for RN-BSN students (n=121). No significant difference was found between the total scores (p = .589, Z=-.540); however, 2 of the 19 individual items had a significantly higher mean score for RN-BSN students and 6 resulted in a significantly higher mean score for BSN students. Comparisons were made between the SANICS-18 and SANICS-19 for items that retained original wording or had wording that remained very similar. The item “assess accuracy of health information on the internet” was worded the same in both surveys, and the mean scores were similar (SANICS-18: 2.99; SANICS-19: 3.08).

The SANICS-19 is a valid and reliable instrument that can be used to determine nursing students’ informatics competencies. Use of the SANICS-19 will support understanding of interventions that can support informatics competencies.

Purpose: This process improvement project aimed to develop and implement a dashboard to monitor telesitter utilization and fall rates. The project was intended to visualize telesitter utilization data points on a Tableau dashboard by collecting data from three databases. The project was conducted at an extensive healthcare system in Houston, TX, which operates eight hospitals, including the flagship location at the Texas Medical Center.

Background: Telesitter monitoring was implemented in the organization to monitor patients remotely using one-way video and two-way audio devices. The primary purpose of monitoring was to improve patient safety by preventing falls and events like medical device interference. The virtual operations team manages the telesitter monitoring services. The data were manually extracted and analyzed from electronic health records, telesitter applications, and adverse event reporting systems. The Tableau telesitter dashboard was intended to provide integrated information from all three databases.

Methodology: A literature review was completed to determine the significance and benefits of a dashboard in a healthcare setting. The dashboard was designed and developed in five phases, including two plan-do-study-act cycles. The process included stakeholders from virtual operations, information technology, and data analytics teams. The project was based on an IOWA model and design-reality gap analysis. Surveys were conducted twice using a heuristic questionnaire to evaluate the usability factors.

Results: The dashboard has seven tabs: overview, interventions, utilization, demographics, TAPS, Epic orders, and definitions. Data collected from the views of Tableau dashboards for the first quarter of 2024 shows the views for Epic orders increased from 60 in January to 133 in February. The subsequent highest frequency is for the overview tab with 104 views in January and 79 in February. A heuristic dashboard evaluation showed the need to address identified usability issues. The heuristics evaluation resulted in a score of >90% for all questions in the survey.

Implication for Practice: Implementation of this process improvement project improved data visualization of telesitter monitoring data on a Tableau dashboard. The information on the dashboard ultimately helps improve telesitter utilization by providing the percentage of utilization. The information on the dashboard can be used for research purposes relating to healthcare information technology (HIT) and patient safety. The telesitter dashboard can be used as a template for further design and development in healthcare information technology and patient safety dashboards.

Background: Due to the evolution of nursing practice and the development of the 2021 AACN Domains and Essentials, the doctor of nurse practice (DNP) program faculty restructured the DNP program to align and functionalize competency-based education utilizing the toolkits, essentials, domains, and sub-competencies. The goal was to restructure the program to facilitate measurable outcomes by using the level two sub-competencies from the ten AACN domains within the infrastructure of the DNP program. The outcome was to ensure transition of knowledge, demonstration of actualization of the core level of evidence-based practice translated to person-centered care, and synergy within the environment, analyzing systematic development of not only infrastructure but also incorporation of policy and guideline development, to enhance equity of care across populations.

Development of community partners was critical to the actualization of project development, which enhanced transcendence of change at all levels of health care. The DNP program infrastructure was evaluated with the plan for all coursework to culminate in goals of leadership innovation and strength, practice change, enhancement of the art of nursing, demonstration of competence, and maximization of time in coursework to consolidate deliverables to manifest through project evolution and course outcomes. The course objectives were closely aligned with the program outcomes to ensure the course sequence was clear, concise, and solidified into ten courses within the 30-unit program.

Process: DNP faculty developed global course learning outcomes (CLOs) that would demonstrate competence through actualizing the level two sub-competency from the AACN domains – project implementation which focused on the social determinants of health (SDoH) and ethical use of artificial intelligence while managing person-centered care to enhance equity and individualized focused goals of care, such as maintaining mobility to demonstrate independence through aging. Each sub-competency was built into the evolution of the courses with scaffolding throughout the entire program. This was demonstrated through module objectives and measurable deliverables. Through the entire program, the syllabi were updated to clearly reflect a competency-based curriculum.

Results: Project development, implementation, and program completion have transcended from an on-time project completion of 40% to timely completion of DNP program > 95%. The courses are being delivered with outcome assignments that are all mapped to sub-competencies and build the project synchronously throughout the program. We recognize mapping is never done, and through the evolution and information learned from the project outcomes, there will be continuous evaluation to be sure the program continues to evolve with ongoing current, relevant, and new knowledge to align with our DNP, post-BSN, and early entry programs, demonstrating clearly our program learning outcomes (PLOs) and institutional learning outcomes (ILOs).

Recommendations: Developing a competency-based curriculum that is mapped to the 2021 AACN Essentials requires adaptive leadership and strong teamwork along with a structured process. This ongoing process will continue to evolve to prepare our nurses today to be our leaders tomorrow.

Optimizing healthcare technology across the continuum of care requires a multi-faceted approach that prioritizes safety culture, transparency, and system-wide integration. This poster explores strategies for embedding safety-focused workflows and technological enhancements that drive quality improvement and patient-centered care. A transparent, nonpunitive framework for reporting adverse events, close calls, and unsafe conditions serves as the foundation for learning and improvement. By fostering a culture of safety, healthcare organizations can encourage open reporting and continuous monitoring, which are essential for identifying systemic vulnerabilities.

Implementing policies that support safety culture and robust reporting mechanisms is critical. Leveraging data from safety assessments and surveys enables healthcare providers to gain insights into areas that need attention and to develop targeted initiatives that strengthen organizational safety systems. Embedding safety culture team training into quality improvement projects enhances staff competency and aligns individual and team efforts toward shared safety objectives. This training, integrated into the daily workflows, allows healthcare teams to address potential issues proactively, optimizing care processes and minimizing risk throughout the patient journey.

A key component in operationalizing these strategies is the development of technology-driven dashboards that track critical performance metrics and safety indicators. These dashboards are designed with patient scoring systems and patient context rules, allowing for streamlined data reporting and analysis across various operational levels. By providing summarized reports that feed into organizational resources, stakeholders at all levels, from front-line staff to executive leaders, gain access to real-time insights, fostering a responsive and adaptive healthcare environment. Enterprise-wide operational support is crucial in facilitating these tools, ensuring that technology solutions are seamlessly integrated into existing workflows without creating additional burdens on healthcare providers.

Additionally, proactively assessing the strengths and vulnerabilities within the healthcare system through these dashboards allows organizations to prioritize improvement efforts. Key performance indicators, including nursing-sensitive measures, can be closely monitored through these dashboards, allowing for timely interventions and ongoing adjustments in care practices. This data-driven approach enables healthcare providers to make evidence-based decisions that improve patient outcomes, reduce incident rates, and enhance overall care quality.

Through a comprehensive strategy that combines policy development, technology integration, and continuous staff training, healthcare systems can create resilient workflows that support safety and quality across the continuum of care. The demonstrated success of these strategies is evidenced by a downward trend in nursing-sensitive indicators following the operationalization of these technologies, showcasing a clear link between improved workflow design and better patient outcomes.

In summary, the integration of a safety-centered, transparent reporting system with advanced technological solutions represents a powerful approach to optimizing healthcare delivery. By aligning these tools with organizational goals and embedding them within routine workflows, healthcare providers can ensure a consistent standard of care that adapts to the dynamic needs of patients and staff alike. The findings underscore the importance of a cohesive, technology-enhanced strategy in transforming health care into a more proactive, data-informed, and patient-centered domain.

Jefferson Health has focused on implementing the Epic electronic health record (EHR) system across its multi-hospital network. In 2023, informatics took advantage of the interval between implementations to focus on optimization efforts aimed at improving EHR wellness for nurses. According to NEAT data, Jefferson Health nurses were averaging 160 minutes per 12-hour shift on documentation, which is 30 minutes above the industry benchmark. Like many healthcare organizations, Jefferson faces ongoing demands for new workflows within the EHR. To address these demands and prioritize nurse support, Project Starlight was launched, focusing on initiatives that reduce burden rather than add steps or requirements to Epic workflows.

Recognizing that adoption is critical yet challenging when implementing new tools or workflows, informatics developed a standardized set of resources for Project Starlight to educate and engage nurses on targeted efficiency improvements. Additionally, an EHR wellness section was incorporated into the informatics newsletter, which highlights positive outcomes from optimization efforts, showcasing direct impacts on nursing workflows. Project Starlight’s initiatives are implemented on a staggered timeline every few months, an approach that has helped maintain steady visibility with nursing staff and aligns with strategic goals. To foster adoption of these EHR efficiencies, informatics also established the clinical informatics champion program. This peer-support program empowers select nurses to provide training and feedback on EHR updates, specifically focusing on features that alleviate workload. Champions regularly review new features and efficiency tips, offering feedback tailored to specific nursing specialties.

To balance Project Starlight with competing priorities, informatics also created FLO zones, dedicated in-person work sessions held weekly to focus on advancing Project Starlight initiatives. These sessions bring together key informatics team members to strategize, design, and plan change management timelines. The FLO zones also incorporate a standard approach for onboarding the entire informatics team to each new initiative, including a focus on the “why” behind these efforts.

Outcome measurement is integral to Project Starlight’s success. Informatics partnered with the business intelligence team to create dashboards based on key performance indicators (KPIs) set for each initiative. These dashboards enable continuous assessment of progress, guiding future projects and identifying units that may require additional support due to lower adoption rates.

Through Project Starlight, Jefferson Health aims to streamline the EHR experience, reduce nurse documentation time, and foster a supportive culture around EHR use. The combination of strategic planning, peer support, and regular outcome measurement ensures that Project Starlight remains focused on optimizing nursing workflows, promoting both adoption and long-term sustainability of EHR improvements.

Nursing documentation burden has been linked to clinician burnout, which in turn has been identified as a significant factor contributing to nurse turnover. In a position paper from the American Nursing Informatics Association Board of Directors, Sengstack et al. (2020) write about six domains of documentation burden, with “self-imposed, aka ‘we’ve done it to ourselves,’” included. Frequently, organizations hold nurses accountable for documentation not mandated by regulatory, quality, or safety standards. For instance, despite patients in the observation patient class being outpatients, our organization mandated the same documentation for them as for admitted inpatients.

Instead, documentation for observation patients should be less restrictive than inpatient documentation, featuring focused assessments rather than comprehensive head-to-toe evaluations and fewer admission-required documentation. These changes aim to facilitate more frequent assessments, aiding in the decision to admit or discharge. Simultaneously, workflows must be designed to meet inpatient documentation requirements if the patient transitions to inpatient status. To address these challenges, the clinical informatics and Epic team collaborated with nurses, nurse leaders, regulatory specialists, and nurse practice leaders. Together, they formulated a solution and policy change to reduce documentation quantity while maintaining standards for these patients. An admission navigator and focused assessment flowsheet, coupled with shortened admission, daily, and shift-required documentation, were developed and set as defaults for patients in the observation class.

This streamlined approach not only decreased documentation requirements but also reduced the time spent on documentation, allowing nurses more time to concentrate on stabilizing and discharging patients. Utilizing the workflow analyzer, we conducted a comparative analysis between clinical staff documentation under standard practices and the new Epic workflows. The results revealed a noteworthy enhancement, with an approximate 70% reduction in calculated task duration, a 40% decrease in transitions, and a significant 70% decrease in overall actions required. Early feedback from nurses who have adopted the new documentation processes has been overwhelmingly positive. This indicates that the streamlined workflows not only contribute to efficiency gains but also are well received by front-line clinical staff.