Making Information Flow to Patient Safety

1. Making Information Flowto Patient Safety Presented by: Deb Stroud, RN POC Clinical Specialist Mayo Regional Hospital Dover-Foxcroft, Maine

2. LIVE with Point of Care Electronic Documentation • April 7th, 2008 – Electronic Charting & Bar Coded Medication Verification • July 2008 – E-forms live in the OR • January 2009 – E-forms use in nursing departments

3. 15 months after ‘go live’ we stopped printing notes by streamlining information using: • Flowcharts • Electronic Forms • MedAct • Problem Lists • Patient and 24 Hour Summary

4. Including Ancillary Service Notes • Physical Therapy / Rehab Services • Cardiopulmonary • Social Services • Dietary

5. Presentation GoalTo demonstrate how the diverse communication capabilities in electronic documentation can enhances the environment of patient safety.

6. Effective communication is critical during the countless interactions that occur among healthcare providers on a daily basis. When effective communication is absent, patient care is compromised.

7. Need to convey comprehensive information efficiently and limit the possibility for errors in communication. • Risk for Pressure Ulcers • Fall Risk • Aspiration Risk • Therapeutic Activities • Pneumonia Risk • Hygiene • MRSA Screen Inclusion • Nutritional Risks • Immunizations • Smoking Cessation • Venous Thromboembolism (VTE) • Restraints • Risk for Abuse

8. Help Me ?!?!?!? DONE !!! With the help of communication ability via Electronic Charts

9. Reflexes in Flowcharts: Create Nursing Order • Braden Scale results – Calculates in the flowchart – if score is less than 17, on exiting - reflexes nursing order to the MedAct (kardex) Pt. Safety Productivity Staff communication

10. Reflexes in Flowchart: Send an E-mail Notification • Admit status change – reflexes email to the nurse manager and swing assistant • They review the chart to assure all swing requirements are initiated. Nurse selects answer “Acute to Swing” on flowchart Quality Care Staff communication

11. Reflex E-mail: Wound Form Started To ensure correct staging, documentation, and use of standards, the nurse manager receives an e-mail via a reflex through the flow chart when a wound form is initiated. Selecting answer generates reflex to send email E-mail auto pop up when manager logs into system Quality Care

12. Important information from documentation flows to the Nursing and Physician reports • Patient Summary – prints 2x a day for use in nurse shift report • Physician 24 Hr Summary – prints @ 7am Pt. Safety Productivity Staff communication Quality Care

13. What Goes Where?

14. Dietician Note Social Service Note Physical Therapists Note Occupational Therapist Note Nurses Shift Summary Note Notification that a wound being monitored Also Appearing Here: Cardiopulmonary & Pharmacy notes

15. Example of PCA - Nursing Information and Physician Information

16. Physician Report Prints @ 7am

18. How we decided what would be included in the 24 hr Summary? Attended the Medical Staff meeting giving them an opportunity to identify what items they needed on report.

19. * How About E-Forms

20. E-Forms have provided multiple ways to communicate through sending emails, faxing, placing orders on Medact, order entry, which help ensure communication as well as consistency in care.

21. Initial Interview is set up to ensure compliance with assessment requirements & provides patient safety through knowledge of risks. • Aspiration Risk • Physical/Emotional Abuse • Nutritional Risk • Smoking Cessation or MDI education needs • Wounds present on admission • Hx of drug resistant organisms requiring special isolation • Immunization Hx and assessment of need • Anesthesia risks • Surgical and Medical history • Functional level and home environment • Learning ability and needs assessment

22. Example History information will carry forward from past visits to verify and update. Productivity Pt Safety

23. Infection Control Information in this section copies forward from previous visits, quickly informing staff of precaution needs helping to prevent unnecessary exposure. Sends E-mail to Infection Control nurse notifying her to review the chart Instant access to ‘help’ window Pt. Safety Productivity Staff Communication

24. Sends E-mail to Cardiopulmonary Dept. The numerical answers cross over to the Dietician’s physical assessment flow chart – Calculates – and the total score indicates nutritional risk. Dietician identifies risk and comments on plan – this answer appears on the Physician’s 24 hr summary report. Pt. Safety Productivity Staff Communication Quality Care

25. Faxing Physicians requested an improvement in the communication of information when OB patients were triaged and treated by the on-call providers. This was accomplished by creating an electronic triage form and faxing the triage form to the prenatal care provider after each visit. Quality care Productivity Staff Communication

26. Rule out Labor – DischargeInstructions Our Problem: Inconsistently providing discharge instructions, education, and follow-up information to the mother when she was certified not in labor. Our Solution: OB Triage E-Form pulls information to a patient education form automatically. After completion the form is printed – the patient discharge instructions are automatically created based on the nurses documentation.

27. 100% of the OB patients that are discharged from facility with ruled out labor have instructions / education information automatically created based on nurses documentation during visit. • Medication reconciliation • Information about returning to the hospital or contacting their physician Self populates I am so excited !! Pt. Safety Quality Care

28. Places Alerts on MedACT for High Risk Conditions or Tasks Based on answers in the OB admission form nursing orders are created and sent to the MedAct (Kardex) and emails for consults. Pt. Safety Staff communication Quality care

29. Other Ideas

30. Cardiac Rehab Pt. Safety Staff communication Quality care Documents Education needs, Tools used, status of understanding and any observations All steps are listed on MedACT, Documentation is entered into MedACT Items are completed on MedACT leaving a constant view of what rehab level the patient has achieved. Education level on transfer / discharge

31. Standardized Care in OR and PACU • Forms designed based on standard care plan for patient in the OR / PACU • Time Out reminder and Site Verification • Implementation of Aldrete discharge scoring system. Pt. Safety Quality care

32. Surgical Care plan incorporated into form Pop up window provides policy or standards of care

33. As a documentation tool MedACT

34. Therapeutic Activities for Swing Ambulation Hourly Rounding Turning q2 hrs Daily hygiene Fall Risk Meals Consults Extra Nourishments Equipment use Glucose Readings Vital Signs Intake & Output Immunizations Future Tasks …and much more Documentation of Activities / Care Reminders

35. Viewing Documentation Select activity • Required for SNF • Ancillary dept view • Nursing view • MD report Select Review Pt. Safety Quality Care Communication

36. High Risk Alerts Risk Level Pt. Safety Quality care Communication Interventions

37. Problem List aka Careplan

38. Why document with problem list • Hospitals MUST ensure that the nursing staff develops, and keeps current, a nursing care plan for each patient. (Reg # 482.23) • Standardizes documentation of specific care in consistent location • Proves utilization of care plan in daily care • Easy to identify intervention and evaluation documentation • Communicates progress of identified problems Pt. Safety Quality care Communication

39. Example:Documenting Education in OB Select Intervention Document comment

40. Quality care Communication How do I see documentation?

41. Appearance in Progress notes and Shift Summaries Quality care Communication Documentation of type of education Education on infant hygiene Mom’s return demo

42. In Conclusion • Flowcharts, Electronic forms, MedACT, and Problem lists when configured to complement each other create an electronic medical record environment that promotes increased patient safety and enhances quality care through reliable communication.

43. THANK YOU !!!!! Questions ?

44. One thing is certain: That is that the power of belief, the power of thought, will move reality in the direction of what we believe and conceive of it. If you really believe you can do something ……..you can.