First Use: Imbedded Nursing Terminology in Interdisciplinary Plans of Care

Transcription

1 First Use: Imbedded Nursing Terminology in Interdisciplinary Plans of Care Debbie Raposo, RN BSN, NI-BC, CIDI, LNC Clinical Informatics Director South Coast Hospitals Group Marina Douglas, MS, RN Principal Beacon Healthcare Consulting

2 Overview SouthCoast Hospital Group Statistics Nursing Taxonomy - A Brief Discussion Goals of the CCC Project Implementation Process Outcomes Achieved What s Next

3 SouthCoast Statistics 809 total Acute and Sub-acute beds in service 175,897 Emergency Department Visits 86,921 Home Care Visits 5898 Employees 756 Physicians HIS Meditech Magic 5.63 SR 6 Currently LIVE with EDM, NUR & emar/bmv, V2 Allergies & Medication Reconciliation Starting CPOE in the ED

4 Goals of the CCC Project Goal: A single, easily understood method for documenting plans of care and patient education that is both meaningful to all staff and to the patient. Objectives: Streamline the traditional care planning process Develop screens to auto-magically capture structured data as a by-product of clinical documentation.

5 Standardized, Coded Nursing Terminology Why is it so Important?? Captures nursing activities Measures nurse-sensitive outcomes Links problems to actions to outcomes Comparison of nursing data Establishes a basis for re-imbursement

6 Why is it so Important?? A nursing taxonomy defines, and thereby, can quantify,nursing care. If you can t name it you can t control it, finance it, research it, teach it, or put it into public policy. 3 Clark & Lang, 1992

7 Clinical Care Classification Developed by Dr. Virginia Saba and a research team Accepted and approved by ANA -- HHS -- HITSP -- ACH 21 care components 182 Diagnosis with 549 outcomes using 3 modifiers (improve, stabilize, deteriorate) 198 interventions with 792 actions using 4 modifiers (assess/monitor, teach/instruct. Care/perform, manage/refer) No licensing fee approval only

8 Taxonomy of Choice Clinical Care Classification Met initial project criteria SIMPLE EASILY UNDERSTOOD METHOD SUPPORTING AUTOMATION Strong multi-discipline support for clinical care documentation Follows the Nursing Process Outcomes of care included in the structure and linked back to the problem First/only taxonomy specifically developed with consideration for automation No fee for use

9 CCC System Framework Health Behaviors Psychological Functional Physiological Medication Safety Health Behavior Cognitive Coping Role Relationship Self Concept Activity Fluid Volume Nutritional Self-Care Sensory Cardiac Respiratory Metabolic Physical Regulation Skin Integrity Tissue Perfusion Bowel Elimination Urinary Elimination Life Cycle 182 Nursing Diagnoses 546 Outcome Statements 792 Care Interventions 9

10 CCC Supporting the Nursing Process Assessment Diagnosis Outcome / Plan Implement Evaluate 21 Care Components 182 Nursing Dx 3 Expected Outcomes 198 Interventions 4 Action Types 3 Actual Outcomes

11 Streamlining the Process Focus identification of problems to top 3 problems that, if resolved, will move the patient to a different level of care. Interventions- Limit interventions to those most likely to positively impact the patient s problem. Staff and allied health professionals learn the new perspective and terminology

12 Interventions Initiated Admission Assessment triggers potential care plan problems and education records. Streamlined Care Planning process. Development of screens and responses supporting structured terminology Interdisciplinary training for both application and structured terminology

13 Lessons Learned Too many Components of Care Nurses have a desire to NOT leave any blanks Not completing outcomes- Initially forgot to go back at Discharge. Now much better. Circling back is essential- Multiple concurrent implementations make it difficult.

14 Success Achieved Care Plan Reviews required q 24 h Pre-implementation Compliance = % Post-implementation (14 days after live) Compliance = 100% 100% interdisciplinary both education records and care plans

15 Success Achieved Decreased time to complete an admission Pre-Implementation Admission work and initial care planning = average of 75 minutes admissions per year for SHG minutes hours 25.4 FTE s

16 Success Achieved Post implementation after learning curve average of about 2 weeks 45 minutes per admission admissions minutes hours 15.2 FTE s SAVINGS of 10 FTE s

17 Dollars & Cents Pre-Implementation: X $27.50 = $1,447, Post-Implementation: X $27.50 = $853,065 SAVINGS: $594,892

18 Time & $$ Savings What to Do? Took advantage to restructure delivery of care GOALS: Increased patient & family satisfaction Decrease patient falls Quickly respond to patient needs Moved LPN s to PCO (patient care observer) for high risk falls 1:4 ratio. Frequent rounding and ADL assistance. RESULTS: Started Jan 2010 Feb results: Patient Satisfaction up 1%, Falls down 1% more data needed

19 Medication reconciliation technician One dedicated person in the ED Good product at the start makes all the difference. Med, dose, route, reason, last time taken. Pre trial forms 34% complete (missing all aspects) 3 days post trial 75% complete (Only missing last taken) 7 days post trial 89% complete (only missing last dose taken) Going to have 24/7 coverage in ED s

20 Wrap Up Thoughts Simplicity Triggers and links Top 3 care problems Auto-magic to support terminology codes Significant reduction in the amount of time to complete an admission assessment achieved True interdisciplinary care planning with coded nursing language success!

21 First Use: Imbedded Nursing Terminology in Interdisciplinary Plans of Care Debbie Raposo, RN BSN, NI-BC, CIDI, LNC Clinical Informatics Director South Coast Hospitals Group 508/ Marina Douglas, MS, RN Principal Beacon Healthcare Consulting 703/