The Clinical Informatics Council (CIC) supports the mission/vision and values of UNMH by improving patient safety, nursing efficiency and multi-disciplinary teamwork. They do this by optimizing the electronic medical record used for our patient's care. In order to effect change, the CIC determines the need for change, organizes themselves into content expert groups, develop the content, test the content and teach the changes. Each of the achievements listed below highlights one of the CIC projects.
Psychiatric Treatment Plan: Team members interacted with both inpatient and outpatient adult and pediatric Behavioral Health to design, test and teach a multidisciplinary Behavioral Health Treatment Plan that met the needs of the patients, care givers and regulatory agencies. This treatment plan was an extraordinary project in that it included information from every member of the patient's team, identifying problems and goals, treatment resources and outcomes. The team also created a document for the inpatient nurses that allowed their shift summary to upload into the treatment plan. In that way, the Treatment Plan updates every day.
The Treatment Plan is visible to all caregivers and tracks across all treatment episodes, both inpatient and outpatient. It is quite unique and has been a success for nursing, providers and patients.
Nursing Plan of Care: Shortly after the inpatient electronic medical record was launched at UNMH,the team created a multidisciplinary summary of care document that pulled a summary from each specialty that treating the patient so that everyone involved knew what the overall plan of care was for that patient. However, a TJC survey recognized that the Nursing Plan of Care was missing specific components found in the plan of other disciplines. CIC met, divided the members into content subgroups and designed the entire Nursing Plan of Care. They designed 15 nursing problem domains with the related content and interventions. Each problem had a interventions, a progress statement and a goal statement. The group discussed workflow and made a decision to put the plan of care in the flowsheet because that was where nursing does the majority of their documentation. The group created it all in a day and a half.
Chart Usability: The CIC developed a survey to ask nurses about their experience with the EMR and what changes they felt were needed. One of the major issues was the ability to chart the same thing in multiple places. Even though the information charted in one place flows over to the other areas, the end users did not find this to be efficient or necessary. The CIC created subgroups and redesigned the nursing flowsheet. Areas re-designed were the charting of IVs, restraint documentation, critical lab values, status change notifications, report given/received and comments. Instead of charting each of these things on separate forms, placing them on the flowsheet increased efficiency and transparency. This change has increased the nurses ability to tell the story' as it is developing.
Wound Care: UNMH is the state's only Burn Center. It is also the facility that patients with the most complex wounds are treated. As such, there is a Burn Team, Wound Care Team, Physical Therapy team and regular nursing staff who all have to chart in the EMR. Each area has their own documentation tools. The Team decided that designing a single place to document these complex wounds would decrease documentation and communication errors and increase the specificity of the information. CIC formed a team from each of these areas and is collaborating to make one location and one lexicon for burns and complex wounds. Once they have completed the design, nursing IT will build it and the CIC will teach it to the rest of the house.
Pediatric Food Allergies: Nursing recognized that there was an issue with pediatric food allergies. Food was being sent up from dietary even though it was listed as an allergy. An audit of the EMR revealed that about 50% of the recorded food allergies were recorded incorrectly. When the allergies are recorded incorrectly, the information never reaches the dietary software that creates the patient's menu. The team discovered that one of the major contributors to the problem was that the field in the EMR was prefilled with the choice of 'drug'. People entering the information did not realize that they needed to change the choice to 'food'. Over a period of months, they were able to change that and make the field mandatory. Education went out to all of the providers and clinics. The correct information now went to the dietary computer and the incidence of food allergies decreased dramatically.
The Clinical Informatics Council Team Members:
Lauren Dyer, RN, BSN (Trauma ICU);
Aiko Slade, RN (General Medicine),
Deborah Minke, BSN, RN (Neuroscience),
Brian Carter, RN (General Pediatrics/Pulse Team),
Tristan Fin, BSN, RN (Medical ICU/Pulse Team),
Roberta Garcia, BSN, RN (General Surgery),
Isabell Tierney, RN (Trauma ICU),
Danielle Mora BSN, RN (Women's Special Care),
Robert Perry, BSN, RN (Emergency Department),
Meghan Black BSN, RN (Pediatric Specialty Care),
Meaghan Carey, MSN, RN (Interv. Radiology),
Karen Brown, RN (Wound Care)
Loryn Udell, BSN, RN (Newborn ICU),
Jessica Montano BSN, RN (Coronary Care Sub-acute)
Andrea Petitto, MSN, RN (Mother/Baby Unit; WSC),
Kellie Moudy, RN (IT),
Sam Baxley, RN (IT),
Steve Bass MSN, RN (Medical ICU),
Heather Alter, RN (Wound Care),
Kathy Jackson, MSN, RN (Post Transplant Clinic),
Christine Valdez, RN (Newborn ICU),
Amber Ivey, BSN, RN (Pediatric Psychiatry),
Raz Preda, MSN, RN (Adult Psychiatry),
Alice Whitt, BSN RN (Geriatric Psychiatry),
Kim McKinley, DNP, RN (Sponsor, CIC)