A New Partnership: The Power of the Collaboration between CNIO and CNO to Maximize Nursing's Use of Technology within the Healthcare Enterprise

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1 A New Partnership: The Power of the Collaboration between CNIO and CNO to Maximize Nursing's Use of Technology within the Healthcare Enterprise

2 Welcome Disclosures Today s presenters do not have any relevant financial interests or endorsement of products. Participants must attend the entire session(s) in order to earn contact hour credit. Continuing Nursing Education credit can be earned by completing the online session evaluation. The American Organization of Nurse Executives is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation.

3 Learning Objectives Discuss ways collaboration between the Chief Nursing Information Officer (CNIO), CNO, and other key leaders enhance patient care and impact clinical outcomes through use of technology Recognize challenges of the CNIO role in supporting both IT and Nursing initiatives. Explain how the CNO and CNIO work together in promoting professional development of Nursing Informatics Discuss the structure and function of Nursing Informatics within the professional nursing practice/professional practice model framework. 3

4 Texas Health Resources One of the largest faith-based, nonprofit health care delivery systems in the United States Facts and Figures 14 Wholly owned hospitals (25 hospitals total) 18 outpatient facilities and 250 other community access points 3,100 Operational beds 4,100 licensed hospital beds 22,500 staff 7,500 RN s 5,500 physicians 557,785 annual emergency visits 24,573 annual deliveries More than 1.3 million inpatient & outpatient visits 4

5 THR s Use of Technology Current Complete EHR Bar-code med administration Bar-code specimen collection Device Integration Smart Pumps Vocera Nurse Call Integration Acuity System Tele-Tracking Future More integration Patient Portal Increased mobility eprescribing Secure Messaging Enhanced reporting 5

6 Overview of Nursing Informatics (NI) A specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice. Supports consumers, patients, nurses, and other providers in their decision- making in all roles and settings. Accomplished through the use of information structures, information processes, and information technology 6 Nursing Informatics: Scope and Standards of Practice, ANA

7 Background of Nursing Informatics Emerging discipline since the 1960 s, but has become more prominent since the 1990 s. - Nursing specialty by ANA in NI Certification since RN s certified in NI by end of % increase in NI Certification from 2009 to over 3000 Informatics Nurses participate in HIMSS or other NI activities 75% of Nursing Informaticists are implementing clinical systems, More roles defined for Nursing Informatics CNIO role in 8% of organizations HIMSS NI Leadership Survey,

8 Swindle, C., and Bradley, V. (2010, June 20). The Newest O in the C-Suite- CNIO. Nurse Leader, CNIO Role CNIO Role is a relatively new, emerging role within organizations. Bridges Nursing and Information Technology together. The CNIO is a Nurse Leader with variety of key responsibilities - Strategic direction of nursing s use of technology - Operational oversight of clinical application implementations - Relationship building between key leaders and departments- i.e.: Nursing, IT, Medicine, Quality - Professional Development of Nursing Informatics

9 Key Relationships Chief Nursing Officer Chief Information Officer Chief Medical Informatics Officer All 3 reporting lines are optimal For CNIO effectiveness. 9

10 Collaboration of Nursing and Nursing Informatics Case Studies - EHR Adoption and Optimization - Acuity Implementation - Quality and Patient Safety Issues CAUTI Vital Signs Early Warning System Nursing Informatics and Professional Practice Model 10

11 EHR Adoption Listening to staff Commitment to SuperUsers Nursing Leadership Support Ongoing training 11

12 Nurse Champions Purpose to optimize the EHR to meet the needs of nursing throughout our health system Staff Nurse representatives from all hospitals, and all nursing areas. Chaired by Nursing Super-User and RN Builder/Analyst Meet 1-day per month to make decisions about changes to the EHR. Supported by CNO s, and funded within each hospital. 12

13 Nurse Champions Reworked Admission History 286 rows to 130 rows Blood Administration Navigator Assessment Flowsheets Patient Hand-Off Report ifreq- Rounding Flowsheet Discharge Instructions Patient Summary Reports Standardization of Patient View Dashboard - Group worked totally by consensus - Changes approved by CNOs 13

14 Acuity Patient Acuity drives nurse staffing Evidenced-Based Coordination of scheduling and documentation provides acuity score Assignments based on acuity and hours of care required by the nurse. CNO led the effort, CNIO managed the project. 14

15 Quality and Patient Safety Initiatives Coordination between Nursing, IT, and Quality Ensure Nursing requirements are met within the context of managing workflows of clinician. Optimize the EHR to facilitate compliance Ensure Policies and Procedures reflect workflows and documentation 15

16 CAUTI System approach to managing removal of indwelling catheters. Protocol approved by every hospital. Changes to the EHR provided documentation and alerts to remind staff to adhere to protocol 16

17 Management of CAUTI Nurses must evaluate the necessity of maintaining the catheter and document within the LDA flowsheets every 12 hours/every shift. This documentation is entered in the Indication/Necessity row of the Urethral Catheter LDA. Instructio n note in Group Informati on box 2013 Epic Systems Corporation. Confidential 17

18 18

19 Modified Early Warning System (MEWS) Research shows 60% codes could be prevented with early intervention. The MEWS is an evidence based tool used to identify patients who may show signs of an impending RRT event or Code Blue MEWS score automatically calculates based on Vital Signs and LOC Ties to defined interventions Anecdotal information Review of Codes past 6 months shows 26% decrease in Codes 19

20 What is Modified Early Warning System (MEWS)? Each vital sign element is given a score based on the most current reading. The score is then tallied within the EHR for an overall score Score: HR SBP RR Temp ( F) < CNS Level of Consciousness Alert Confusion/ Restlessness Responds to Pain Unrespon sive Risk for RRT or Code Blue: (0-2) = less risk (3-4) = medium risk (5 or above)= most risk 20

21 MEWS Viewed in the EHR 2013 Epic Systems Corporation. Confidential

22 Early Warning Interventions Flowsheet Clicking on the score opens the intervention flowsheet Nursing Flowsheet Documentation of Interventions: 2013 Epic Systems Corporation. Confidential 22

23 Nursing Informatics and Nursing Professional Practice Standardized Professional Practice Model corporate structure and entity structure. - Align Nursing Informatics Council and SuperUser Meetings within the PPM framework Robert Woods Johnson Report on Transformation of Nursing - Operationalized at system and hospital level - HIMSS Position Statement for Nursing Informatics 23

24 System Nursing Council Structure THR Entity Board CNOC Nurse Staffing Advisory Committee THR Entity Patient Safety Committee Nursing Operations Council Nursing Congress NI Council Clinical Education * Peer Review SG Development & Support * Entity IP Coordinating Council Clinical Nurse Leader Advisory Board * Nursing Excellence Advisory Board * Patient Education Council * Faith Community Nurse Advisory BD * Nursing Career Advancement Program System Committee * CNOC Representative * 24 24

25 Patient -Family Centered Care NI Council, SU Meeting Professional Development Recognition Professional Practice (IP) Nursing Leadership & Operations Entity IP Coordinating Council IP EBP and Research IP Shared Governance Council IP Quality and Patient Safety Chief Nursing Officers Council 25

26 RWJ The Future of Nursing Coordination between nursing s plan to implement the components of the RWJ standards and the HIMMS Nursing Informatics Position Statement. Opportunities to align Nursing and Nursing Informatics within the Transforming Nursing Care Framework. Committee on the Robert Wood Johnson Foundation, Initiative on the Future of Nursing at the Institute of Medicine. (2011). 26

27 The Future of Nursing Foundations Nursing APN s practice at highest level of education Expand opportunities for nurses to lead and diffuse collaborative improvement efforts Implement Nurse Residency Programs Increase proportion of Nurses with BSN degrees to 80% by 2020 Double number of nurses with doctorates by 2020 Ensure nurses engage in life long learning Prepare and enable nurses to lead change to advance health Build and infrastructure to collect and analyze workforce data Nursing Informatics Partner with nurse executives to lead technology changes that advance delivery of healthcare. Support the development of informatics departments. Foster the evolution of the Chief Nursing Informatics Officer role. Transform nursing education to include informatics competencies at all nursing levels Promote the continuing education in the areas of EHRs and health IT. Incorporate informatics competencies into nursing practice. Ensure data collection from existing heath IT systems to facilitate workforce analysis. HIMSS Nursing Informatics Position Statement on Robert Wood Johnson, Initiative on the Future of Nursing. HIMSS,

28 Challenges What are the challenges facing the CNIO and CNO? - Diverse and disparate projects - Integration - Infrastructure and Devices - Strategic Direction - Competing Initiatives - Keeping Up! Innovator Innovator 28

29 Nursing Challenges Affected by Technology Greater reporting requirements Patients expectations on use of technology Patients with more sophisticated medical devices Technology evolving- becoming more mobile and more connected Constant need for training and adoption may be slow Significant resources needed to implement, maintain and optimize Increase in coordination of care Changing roles to accommodate changing landscape 29

30 Nursing Informatics Council Reviews technology strategies within the organization Makes recommendations for technology use affecting nursing Recommends optimization, support, and training opportunities Reports to CNO Council Representatives from every hospital, various disciplines- Nursing, Physicians, Quality, Training, IT Includes Professional Development activities related to Nursing Informatics 30

31 We would love to hear from you! Mary Beth Mitchell, MSN, RN, BC Chief Nursing Informatics Officer Joan Shinkus Clark, DNP, RN, NEA-BC, CENP, FACHE, FAAN SVP & Texas Health Chief Nurse Executive 31

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