Using Partnerships to integrate Evidence-based Nursing into Professional Education Programs: Six Years of Experience

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1 Using Partnerships to integrate Evidence-based Nursing into Professional Education Programs: Six Years of Experience Judith J. Warren, PhD, RN, BC, FAAN, FACMI Christine A. Hartley Centennial Professor Director of the SEEDS Program Director of Nursing Informatics, KU Center for Healthcare Informatics

2 Objectives Discuss the benefits of integrating evidencebased practice into the nursing curriculum using an EHR. Describe the process of creating and revising evidence-based documentation forms, decision support, orderables, and care plans within a partnership model. Articulate the challenges of creating and maintaining partnerships among individuals, schools and vendors.

3 Health Professions Education: A Bridge to Quality All health professional should be educated to deliver patientcentered care as member of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.

4 The Vision EHR for everyone by 2014 Patient information accessible to all who need it, when they need it Enter once, use many times But most of all Ensure patient safety Improve quality Reduce costs

5 Patient accessing the Internet for information Bedside EHR for assessment documentation and patient information

6 Things to do to Realize the Vision of the EHR Be part of the selection, design, implementation, and evaluation Design with clinical workflow in mind Design with accreditation requirements in mind Design with quality metrics in mind Don t forget to use evidence based practice protocols Don t forget this is a tool to support your practice Don t forget the patient!!!!!

7 Importance of Partnerships Partnerships between business, service organizations, and academia may well allow for expertise and resources to be brought to bear on these challenges in ways that expedite and achieve gains that are not as achievable in each segment of the industry acting alone. Weaver CA & Hongsermeier T, Measuring outcomes: bringing six sigma excellence to health care. In Ball, Weaver & Kiel (Eds). Healthcare Information Management Systems, Springer-Verlag. 2004, p279

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10 EIGHT TESTS OF A HEALTHY PARTNERSHIP never sometimes often always Partners can demonstrate real results through collaboration Common interest supersedes partner interest Partners use "we" when talking about partner matters Partners are mutually accountable for tasks and outcomes Partners share responsibilities and rewards Partners strive to develop and maintain trust Partners are willing to change what they do and how they do it Partners seek to improve how the partnership performs

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12 Wikipedia Definitions A consortium is an association of two or more individuals, companies, organizations or governments (or any combination of these entities) with the objective of participating in a common activity or pooling their resources for achieving a common goal. Consortium is a Latin word, meaning 'partnership, association or society' and derives from consors 'partner', itself from con- 'together' and sors 'fate', meaning owner of means or comrade.

13 AES Consortium AES Domain Sharing knowledge and learning together creating economies of scale

14 AES Consortium Charter Purpose to enable collaboration between universities and colleges who are using the AES as an educational strategy Mission to improve health professions education through collaborative use of information technology Guiding Principles Continue to improve the AES for the good of all members of the consortium and ultimately all students in healthcare professions Contribute content equitably among all AES Consortium members Appropriately use and provide credit for members works Participate in collaborative research Engage in shared leadership Support initiatives targeting the use of informatics in health professions education Implement the Institute of Medicine s (IOM) recommendations for patient safety:

15 Developing Partners Capacity Building Member Responsibilities Support purpose, mission, and guiding principles of the AES Consortium Adhere to established Cerner change control process Develop cases for the Shared Case Library Create faculty guides to support the use of cases Contribute to the development of reference materials Participate in consortium communications

16 Evidence-based Practice Approaches for the Academic EHR: The AES Consortium

17 Seeking and Developing Evidence Developing, finding, and evaluating the evidence Parsing the guideline into assessments, goals, interventions, outcomes, and workflows Determining how to provide references to user Working with the informatics support team, faculty and students Designing screens supporting evidence-based practice Ensuring reliability and validity of tools

18 American Health Information Community Good site to monitor to stay abreast of quality work at the federal level AHIC Quality Work Group Identified health information technology (HIT) breakthroughs and recommendations These could produce tangible value to health care consumers Important to evidence-based practice

19 Conceptual Framework: Evidence-Based Decision University of Wisconsin at Milwaukee Support Process Using Information Systems and Aurora Health Systems

20 Conceptual Framework for Building ACW Referential Knowledge

21 ACW KBNI Development Model: Synthesis Table Synthesis Table Example Evidence Search Create Evidence Table and Tool Comparison Table for Referential Knowledge Create Synthesis Table for Referential Knowledge: - Patient Assessment - Problem/Diagnosis Identification - Nursing Intervention - Nurse-Sensitive Outcome Reminder: Medication Adherence must be assessed at each encounter and include a number of key elements. These key elements include: health beliefs (perceived barriers and benefits of medications to overall well being), self-care abilities, medication knowledge, skills, confidence/ease, frequency and complexity of medication regimen, medication problems, socioeconomic, cultural,/racial factors, cognitive and mental health factors, and factors associated with overall relationship with health care provider experience. Barriers associated with access and costs are also important to determine overall medication compliance. Medication Assessment Key Elements - Ask questions regarding the following aspects of the patient s medication plan: 1.1. Medication History: (a) functional ability/mental status (b) typical routine (c) previous medication experience (d) medication & dosing facts Rationale: McDonald and colleagues in a Cochrane Review of interventions to advance medication adherence (2002) report typical adherence rates to be on average 50% (range 10%-100%). Dunbar-Jacob and colleagues (2000, 2003) report rates of poor adherence to be remarkably similar across chronic disorders at around 50%, with nonadherence to medications among the more common chronic diseases to fall near or below 50%(p.49). Some studies noted in the summary chapter work by Dunbar- Jacob and colleagues (2000, 2003) found that as many as 30% of patients fail to fill medication prescriptions, discontinue treatment within first several months, in particular for medications, appointment keeping, exercise, and diet (p. 51). The costs of poor adherence are high and are likely to contribute to unnecessary admissions and/or visits to the emergency departments. Dunbar-Jacob et al (2000) report that the costs of poor adherence to medication regimen are estimated to be as high as $100 billion annually, based on factors like unnecessary hospitalizations and emergency room visits. References & Level of Evidence Rating Ansari, M., Shlipak,A., Heidenrieich, P.A., et al (2003). Improving guideline adherence: a randomized trial evaluating strategies to increase B-blocker use in heart failure. Circulation.107: Level of Evidence: II Bennett, S.J., Milgrom, L.B., Champion, V., Huster, G. (1997). Beliefs about medication and dietary compliance in people with heart failure: An instrument development study. Heart and Lung 26(4), Level of Evidence: IV Bennett, S., Hays, L.M., Embree, J.L., & Arnould, M. (2000) Heart Messages: A tailored message intervention for improving heart failure outcomes. J Cardiovasc Nurs 14(4): Level of Evidence: II

22 ACW KBNI Development Model: Referential Knowledge on web (CKM) Synthesis Table in CKM Collaborate with Clinical Experts Synthesize for Executable by completing Clinical Spreadsheet (4) Initial mapping to ICNP & SNOMED (5) Publish 1& 2 on CKM website by Cerner; Program Synthesis (3b) Table on CKM (3c)

23 Using Process Flows to Develop Executable Knowledge Medication Adherence Activity Progression:

24 Creating a Plan of Care

25 Assess Progress Against Expected Outcomes

26 Evidence-based Decision Support in the AES Executable Multidisciplinary Knowledge Electronic Health Record Referential Multidisciplinary Knowledge Research Assessment Diagnosis Intervention Outcome Clinical Knowledge Management Terminology Server Clinical Data Repository

27 Types of Evidence within AES Terminology Standardized terminologies Definitions Unambiguous meaning Design Forms Educational purpose and clinical workflow Content and knowledge Evidence-based protocols

28 Context for the use of standardized terminologies receiving recording comparing Clinical Standards exchanging Information Standards Terminology Standards Technical Standards Courtesy of Anne Casey, MSc, RSCN Standards for Security and Confidentiality

29 Definitions and Reference Text

30 Educational Purpose: Form Organized by Technique

31 Collaboration on a form

32 Design of screen based on evidence: field-ground theory EHR screens adapted for students

33 Ensuring Validity of EBN Tools

34 Partnership: Challenges and Rewards Achieving common goals education, presentations, and publications. Engaging in creativity and innovation. Sharing knowledge and learning together. Obtaining greater resources, recognition and rewards. Promoting best practices in EHRs and nursing education.

35 Questions? Please contact me if you have more questions.

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