205 CARE MANAGEMENT

1. #205 CARE MANAGEMENT The Road Less Traveled

2. 2 Good morning. This session is entitled Care Management-The Road Less Traveled. My name is Toni King and I work at the Lexington, Kentucky VAMC as the Informatics/BCMA Coordinator. My co-presenters are Bonnie Altizer the ADPAC/BCMA Coordinator from the Huntington, WV VAMC and William (Bill) Barber a Staff/MOVE Nurse from the Pensacola, Florida Outpatient Clinic. I will be presenting the first part of the class and then turn it over to my efficient co-presenters.Good morning. This session is entitled Care Management-The Road Less Traveled. My name is Toni King and I work at the Lexington, Kentucky VAMC as the Informatics/BCMA Coordinator. My co-presenters are Bonnie Altizer the ADPAC/BCMA Coordinator from the Huntington, WV VAMC and William (Bill) Barber a Staff/MOVE Nurse from the Pensacola, Florida Outpatient Clinic. I will be presenting the first part of the class and then turn it over to my efficient co-presenters.

3. 3 HOUSEKEEPING Before we get started we need to take care of some Housekeeping issues. Before we get started we need to take care of some Housekeeping issues.

4. 4 HOUSEKEEPING This is 1.5 Hours Lecture Session Restrooms are located… Cell Phones Please turn off or change to vibrate If you must answer a call, please leave the room. This is a 1.5 hours class so if you need to use the restrooms they are located….. Please turn off or change your cell phones to vibrate. If you must answer a call, please leave the room as a courtesy for others. This is a 1.5 hours class so if you need to use the restrooms they are located….. Please turn off or change your cell phones to vibrate. If you must answer a call, please leave the room as a courtesy for others.

5. 5 HOUSEKEEPING Please, No questions during the presentation. Questions written on the 3X5 card will be answered at the conclusion of the presentation. For questions not answered, the question and the answer will be available on the web. In order to be able to finish the presentation on time we ask you not to ask questions during the presentation. If you have any questions please write them on the 3X5 card provided. We will try to answer as many of them as possible after the presentation. Questions not answered after the class will be posted on the VeHU website. So please check the website when you return home.In order to be able to finish the presentation on time we ask you not to ask questions during the presentation. If you have any questions please write them on the 3X5 card provided. We will try to answer as many of them as possible after the presentation. Questions not answered after the class will be posted on the VeHU website. So please check the website when you return home.

6. 6 INTRODUCTION As you know, Care Management has become an old friend, but just like the railroad tracks, Care Management seems to be the road less traveled. But if everyone knew the extraordinary uses of the application and recognized the Dashboard’s valuable beneficial perspectives, Care Management (CM) could and hopefully will become the road most traveled. We want to make CM the road most traveled, and realize the more we travel that road, we will hit some potholes and need some road repairs but that is no different than all the other applications in the past. Each one had their difficulties. So, like Bonnie and Bill who attended my VeHU 2006 class # 224 Improving Communication using Care Management, motivated them to return to their sites and move at lightning speeds to implement CM. WE are here today to pass on that same motivation to you. We are here today to encourage and motivate you to return with the same insight they acquired at VeHU, and give you tools to help implement CM at your site and at the same time learn the advantages of using CM. So, come and join the crowd, and next year it may be you up on this stage presenting your own VeHU class. As you know, Care Management has become an old friend, but just like the railroad tracks, Care Management seems to be the road less traveled. But if everyone knew the extraordinary uses of the application and recognized the Dashboard’s valuable beneficial perspectives, Care Management (CM) could and hopefully will become the road most traveled. We want to make CM the road most traveled, and realize the more we travel that road, we will hit some potholes and need some road repairs but that is no different than all the other applications in the past. Each one had their difficulties. So, like Bonnie and Bill who attended my VeHU 2006 class # 224 Improving Communication using Care Management, motivated them to return to their sites and move at lightning speeds to implement CM. WE are here today to pass on that same motivation to you. We are here today to encourage and motivate you to return with the same insight they acquired at VeHU, and give you tools to help implement CM at your site and at the same time learn the advantages of using CM. So, come and join the crowd, and next year it may be you up on this stage presenting your own VeHU class.

7. 7 LEARNING OBJECTIVES Let’s get started with the learning objectives we hope you will absorb during this class.Let’s get started with the learning objectives we hope you will absorb during this class.

8. 8 Learning Objectives Summarize the history of the Care Management application Examine a lesson plan & instructional method to use for staff education with teaching emphasis Process how to provide CEU’s to encourage participation Create a hyperlink on your home web page to view a VeHU Care Management class The objectives of this presentation are the participants will be able to: 1. Summarize the history of the Care Management application 2. Examine a lesson plan & instructional method to use for staff education with teaching emphasis 3. Process how to provide CEU’s to encourage participation 4. Create a hyperlink on your home web page to view a VeHU Care Management class and.. The objectives of this presentation are the participants will be able to: 1. Summarize the history of the Care Management application 2. Examine a lesson plan & instructional method to use for staff education with teaching emphasis 3. Process how to provide CEU’s to encourage participation 4. Create a hyperlink on your home web page to view a VeHU Care Management class and..

9. 9 Learning Objectives (cont’d) Employ ways to avoid resistance & problems with class scheduling vs. staffing Recognize uses on the utility of Care Management’s beneficial perspectives: Hand-Off tool and Queries for Performance Measures Describe the diverse and available uses of Care Management in their respective clinical settings Further objectives are: 5. Employ ways to avoid resistance & problems with class scheduling vs. staffing. 6. Recognize extraordinary uses of the utility of Care Management’s beneficial perspectives: Hand-Off tool, Electronic Kardex, and Queries for Performance Improvement Measures. 7.  And finally, describe the diverse and available uses of Care Management in their respective clinical settings. Further objectives are: 5. Employ ways to avoid resistance & problems with class scheduling vs. staffing. 6. Recognize extraordinary uses of the utility of Care Management’s beneficial perspectives: Hand-Off tool, Electronic Kardex, and Queries for Performance Improvement Measures. 7.  And finally, describe the diverse and available uses of Care Management in their respective clinical settings.

10. 10 HISTORY During this segment, we will examine a little of the history of the Care Management application. So let’s talk a little about the history of Care Management which is the first application that resides within the HealtheVet Desktop. Please don’t confuse this with My HealtheVet the veteran’s home computer program.During this segment, we will examine a little of the history of the Care Management application. So let’s talk a little about the history of Care Management which is the first application that resides within the HealtheVet Desktop. Please don’t confuse this with My HealtheVet the veteran’s home computer program.

11. 11 This slide is an overall view of the nursing dashboard perspective depicting a unit of patients with a task headlight opened on one of the patients. How many people in this room have implemented Care Management (HealtheVet Desktop) at their sites? Some of you may not be real familiar with the application so we thought we would start with a little history of the application. This slide is an overall view of the nursing dashboard perspective depicting a unit of patients with a task headlight opened on one of the patients. How many people in this room have implemented Care Management (HealtheVet Desktop) at their sites? Some of you may not be real familiar with the application so we thought we would start with a little history of the application.

12. 12 History Care Management was the first desktop perspective to be introduced at VeHU 2003 and deployed to the field. The HealtheVet Desktop was designed to be the container and launching point for all VHA rich-client applications. A provider dashboard and a nursing dashboard were implemented. The Desktop gives HealtheVet applications a common look-and-feel and allows them to work together seamlessly in a single rich-graphical user interface (GUI). After the release to the field, clinicians and nurses wanted the benefits of a co-existing dashboard application. You should view Hands-On Session 103H taught by Joy Pasternock, Mike Braithwaite, and Mary Lou Faustina to get a good idea of the dashboard’s functionality. There are also other sessions of Care Management classes available at VeHU like 291H Hands on Care Management for Nurses taught by Sheri Kreuz and Joy Pasternock if you wish to view a different URL session. Care Management was the first desktop perspective to be introduced at VeHU 2003 and deployed to the field. The HealtheVet Desktop was designed to be the container and launching point for all VHA rich-client applications. A provider dashboard and a nursing dashboard were implemented. The Desktop gives HealtheVet applications a common look-and-feel and allows them to work together seamlessly in a single rich-graphical user interface (GUI). After the release to the field, clinicians and nurses wanted the benefits of a co-existing dashboard application. You should view Hands-On Session 103H taught by Joy Pasternock, Mike Braithwaite, and Mary Lou Faustina to get a good idea of the dashboard’s functionality. There are also other sessions of Care Management classes available at VeHU like 291H Hands on Care Management for Nurses taught by Sheri Kreuz and Joy Pasternock if you wish to view a different URL session.

13. 13 IMPLEMENTATION We discussed a little of the history now let’s discuss Implementing Care Management at your facility. This segment is titled “Implementation” of the Care Management application and will be presented by Bonnie Altizer from the Huntington, West Virginia VAMC. In this segment you will examine a lesson plan & instructional method to use for staff education with the teaching emphasis. Bonnie? “Thank you, Toni. Hello, my name is Bonnie Altizer, I am from the Huntington, WV VA Medical Center and I worked there for 16 years, 14 years as staff nurse and 2 years as ADPAC/BCMA Coordinator. Since I got my position as coordinator, we have implemented using the Nursing dashboard at our facility and I came to discuss ways to implement and encourage using the nursing dashboard of the Care Management application at your facility. The training and implementation to use the nursing dashboard at our facility was mandated by our Associate Director for Nursing Services and took a total of approximately 3 classes a week and 3 months to complete and I did all the training. We are an 80 bed inpatient facility so the length of time to implement the program successfully will vary at different facilities. We discussed a little of the history now let’s discuss Implementing Care Management at your facility. This segment is titled “Implementation” of the Care Management application and will be presented by Bonnie Altizer from the Huntington, West Virginia VAMC. In this segment you will examine a lesson plan & instructional method to use for staff education with the teaching emphasis. Bonnie? “Thank you, Toni. Hello, my name is Bonnie Altizer, I am from the Huntington, WV VA Medical Center and I worked there for 16 years, 14 years as staff nurse and 2 years as ADPAC/BCMA Coordinator. Since I got my position as coordinator, we have implemented using the Nursing dashboard at our facility and I came to discuss ways to implement and encourage using the nursing dashboard of the Care Management application at your facility. The training and implementation to use the nursing dashboard at our facility was mandated by our Associate Director for Nursing Services and took a total of approximately 3 classes a week and 3 months to complete and I did all the training. We are an 80 bed inpatient facility so the length of time to implement the program successfully will vary at different facilities.

14. 14 Lesson Plan Overview & Purpose Target Audience Materials Needed Objectives Instruction Method Activities Verification Now for the Lesson Plan Outline: Let’s begin the implementation stage by discussing having a good Lesson Plan, which is very important- Knowing what you are doing. The first step in implementation is to develop a lesson plan on how to teach the Care Management-Nursing Dashboard at your facility. The Lesson Plan should include all the parts of a good lesson plan: an overview, the purpose, a target audience, some objectives, the materials needed, an instructional method, activities, and ways of verification of the education. One of the main requirements is getting to know your target audience and what you want them to learn then decide on your most important objectives and plan to achieve those objectives. Think about what items you will need to make your class a success. Then gather the materials needed to accomplish your objectives and decide on an instructional method that you feel will suit your targeted audience. Base your method on the educational and knowledge levels of your staff and available facilities and where you will have your classes. Plan the activities you want to do so your audience won’t get bored. When deciding upon activities, planning hands-on activities usually works best like using student test accounts and hands-on sessions. Try to find different ways to verify that the staff is learning the objectives you plan for them to achieve like completing tasks, doing competency check off sheets, and post tests. Be sure to include question and answer sessions with each class.Now for the Lesson Plan Outline: Let’s begin the implementation stage by discussing having a good Lesson Plan, which is very important- Knowing what you are doing. The first step in implementation is to develop a lesson plan on how to teach the Care Management-Nursing Dashboard at your facility. The Lesson Plan should include all the parts of a good lesson plan: an overview, the purpose, a target audience, some objectives, the materials needed, an instructional method, activities, and ways of verification of the education. One of the main requirements is getting to know your target audience and what you want them to learn then decide on your most important objectives and plan to achieve those objectives. Think about what items you will need to make your class a success. Then gather the materials needed to accomplish your objectives and decide on an instructional method that you feel will suit your targeted audience. Base your method on the educational and knowledge levels of your staff and available facilities and where you will have your classes. Plan the activities you want to do so your audience won’t get bored. When deciding upon activities, planning hands-on activities usually works best like using student test accounts and hands-on sessions. Try to find different ways to verify that the staff is learning the objectives you plan for them to achieve like completing tasks, doing competency check off sheets, and post tests. Be sure to include question and answer sessions with each class.

15. 15 A sample of a Lesson Plan Form: You might want to make up a lesson form to plan your class. Here is an example of the form for the lesson plan that I used for my class. This form provides an outline to enable you to develop a good lesson plan. Of course, feel free to develop your own. All you do is fill in the separate sections and save the form as a guide and to keep for your records. This form can be used for other types of lesson plans also. I have one like it for CPRS and BCMA. Now let’s talk about each individual section of the lesson plan outline starting with..A sample of a Lesson Plan Form: You might want to make up a lesson form to plan your class. Here is an example of the form for the lesson plan that I used for my class. This form provides an outline to enable you to develop a good lesson plan. Of course, feel free to develop your own. All you do is fill in the separate sections and save the form as a guide and to keep for your records. This form can be used for other types of lesson plans also. I have one like it for CPRS and BCMA. Now let’s talk about each individual section of the lesson plan outline starting with..

16. 16 Overview & Purpose Hand-off Communication/Electronic Kardex Utilize Nursing Dashboard’s Beneficial Perspectives Provide CEU’s The Overview & Purpose of implementing the Care Management application: As you noticed from the form, we start with the overview and main purpose of teaching the Care Management Nursing Dashboard. That purpose is to meet Joint Commission’s Hand-off communication standards; to improve patient care with documentation by creating tasks for treatments and procedures, verifying physician’s orders, and completing nurse text orders. We had a project going to try to get our nurses to complete nurse text orders in CPRS but we had limited success. We found that the Nursing Dashboard is a good way to bring this initiative to the forefront. The nursing text orders are grouped together and will be hard to ignore and more likely to be successfully completed. Another important aspect of Care Management is to provide immediate feedback for critical patient information like vital signs and lab results utilizing Care Management’s Nursing Dashboard’s red headlights. Plus, we should also use this opportunity to provide Continuing Education Units for our staff. The Overview & Purpose of implementing the Care Management application: As you noticed from the form, we start with the overview and main purpose of teaching the Care Management Nursing Dashboard. That purpose is to meet Joint Commission’s Hand-off communication standards; to improve patient care with documentation by creating tasks for treatments and procedures, verifying physician’s orders, and completing nurse text orders. We had a project going to try to get our nurses to complete nurse text orders in CPRS but we had limited success. We found that the Nursing Dashboard is a good way to bring this initiative to the forefront. The nursing text orders are grouped together and will be hard to ignore and more likely to be successfully completed. Another important aspect of Care Management is to provide immediate feedback for critical patient information like vital signs and lab results utilizing Care Management’s Nursing Dashboard’s red headlights. Plus, we should also use this opportunity to provide Continuing Education Units for our staff.

17. 17 Target Audience: Registered Staff Nurses (RNs) Licensed Practical Nurses (LPNs) Nursing Assistants (NAs) Student Nurses Nurse Managers Nursing Supervisors After deciding on your overview and purpose for teaching this class, we should now discuss knowing your Target Audience: Who is going to be your target audience? The educational method you choose should address all the target audience. Registered nurses will have the most training like verifying orders, acknowledging test results, making up the tasks to use for the hand-off report, completing nursing orders, and doing queries. Licensed practical nurses, student nurses, and nursing assistants can create and complete tasks and look up patient information. Nurse Managers and nursing supervisors should receive extra training on the query tools for performance improvement projects. Each person needs an overall view of what the application is all about. So in this case, with the nursing dashboard, if you let each person role play in the student account as an RN then everyone will learn the full function of the Care Management application.After deciding on your overview and purpose for teaching this class, we should now discuss knowing your Target Audience: Who is going to be your target audience? The educational method you choose should address all the target audience. Registered nurses will have the most training like verifying orders, acknowledging test results, making up the tasks to use for the hand-off report, completing nursing orders, and doing queries. Licensed practical nurses, student nurses, and nursing assistants can create and complete tasks and look up patient information. Nurse Managers and nursing supervisors should receive extra training on the query tools for performance improvement projects. Each person needs an overall view of what the application is all about. So in this case, with the nursing dashboard, if you let each person role play in the student account as an RN then everyone will learn the full function of the Care Management application.

18. 18 Materials Needed Student Personal Computers (PCs) Instructor PC with speakers for sound Access to 103H Care Management Class session from VeHU Test Account Patients Test Account Orders Nursing Accounts with access and verify codes and menus to use Test account What kind of Materials will be needed? Well, to be able to teach the Care Management application as quickly as possible, you will need a classroom full of student personal computers (PCs), an instructor’s PC with speakers for sound, access to the 103H Care Management URL Sessions from VeHU or it’s equivalent like 291H Hands On Care Management for Nurses by Sheri Kreuz and Joy Pasternock; test account patients; test account orders; and nursing user accounts with RN menus, and access and verify codes in order to use the test account for role playing. I entered orders just like new admission orders by a physician on patients in the test account for students to verify and create tasks for the electronic Kardex. You should work with IRM at your facility to set up the nursing test accounts with menu options, access codes, and verify codes. Hopefully, most facilities have a computer class room so you can watch the VeHU Care Management sessions as a group and you can demonstrate using the actual Care Management application. If you don’t have a computer training room with several computers, it will take a lot longer to get staff trained. The quicker you get staff trained, the better they will remember how to do the dashboard because they will be using it sooner after the training. To be able to get the best benefit from the electronic Kardex, it is important to have the staff start using the program at the same time. That way they can switch from paper to electronic Kardex easier. What kind of Materials will be needed? Well, to be able to teach the Care Management application as quickly as possible, you will need a classroom full of student personal computers (PCs), an instructor’s PC with speakers for sound, access to the 103H Care Management URL Sessions from VeHU or it’s equivalent like 291H Hands On Care Management for Nurses by Sheri Kreuz and Joy Pasternock; test account patients; test account orders; and nursing user accounts with RN menus, and access and verify codes in order to use the test account for role playing. I entered orders just like new admission orders by a physician on patients in the test account for students to verify and create tasks for the electronic Kardex. You should work with IRM at your facility to set up the nursing test accounts with menu options, access codes, and verify codes. Hopefully, most facilities have a computer class room so you can watch the VeHU Care Management sessions as a group and you can demonstrate using the actual Care Management application. If you don’t have a computer training room with several computers, it will take a lot longer to get staff trained. The quicker you get staff trained, the better they will remember how to do the dashboard because they will be using it sooner after the training. To be able to get the best benefit from the electronic Kardex, it is important to have the staff start using the program at the same time. That way they can switch from paper to electronic Kardex easier.

19. 19 Learning Objectives For Staff/Students Content & Parameters Set up Teams Verify & Complete Orders Link Tasks, Edit Tasks, & Complete Tasks Recognition of the red, blue, and gray lights (headlight display) Using column options (Results, Tasks, Events, Orders, Text Orders, Vitals) Go to Chart Option How to do a query What kind of Learning Objectives will you develop for Staff? Your learning objectives for your students should be sufficient in order to become familiar with the nursing dashboard. All the students should do the objectives in the student test account on the computers. Students should learn content & parameters of the Nursing Dashboard and set up their team of patients; verify & complete orders; link tasks, edit tasks, & complete tasks; recognize the red, blue, and gray head light display; use column options (Results, Tasks, Events, Orders, Text Orders, Vitals); use the go to chart option; and learn how to do a query. If they do all the objectives by role playing, then they can understand each staff member’s role in the nursing dashboard. They will learn how the RN verifies and completes orders, how the RN admits new patients by making a hand-off tool & electronic Kardex using the task option. All staff will learn how to look up vitals; test results which consists of labs, consults, and procedures; and how to run queries for performance improvement projects. This gives all the students an overall general understanding of the nursing dashboard and how it works.What kind of Learning Objectives will you develop for Staff? Your learning objectives for your students should be sufficient in order to become familiar with the nursing dashboard. All the students should do the objectives in the student test account on the computers. Students should learn content & parameters of the Nursing Dashboard and set up their team of patients; verify & complete orders; link tasks, edit tasks, & complete tasks; recognize the red, blue, and gray head light display; use column options (Results, Tasks, Events, Orders, Text Orders, Vitals); use the go to chart option; and learn how to do a query. If they do all the objectives by role playing, then they can understand each staff member’s role in the nursing dashboard. They will learn how the RN verifies and completes orders, how the RN admits new patients by making a hand-off tool & electronic Kardex using the task option. All staff will learn how to look up vitals; test results which consists of labs, consults, and procedures; and how to run queries for performance improvement projects. This gives all the students an overall general understanding of the nursing dashboard and how it works.

20. 20 Instructional Method Instructional Technology Method (definition) Demonstration Role playing Group Activity Lecture What kind of Instructional Method should you use? Well, the instructional method I used was the “Instructional Technology Method” which is just what it sounds like: using modern technology like computers, CD-ROMs, interactive media, modems, satellites, teleconferencing, and other technological means to support learning (Funderstanding, 2001). This method is the one a lot of us are using today to teach classes. A classroom full of computers with student accounts and a hands-on session from VeHU are just the ticket for group learning. In addition, using other instructional methods like demonstration, role playing, group activity, lecture, and review gives the students a well-rounded educational experience and creates a learning atmosphere that helps them remember the information. In our case, the student RNs, LPNs, and NAs alike were given user test accounts set up with RN menu options so they could role play by admitting a patient, creating tasks, and verifying and completing orders. The students had a chance to get the whole experience working with the Care Management application. You will just need to work out the best instructional method for you and your facility. You can research different teaching methods on the internet.What kind of Instructional Method should you use? Well, the instructional method I used was the “Instructional Technology Method” which is just what it sounds like: using modern technology like computers, CD-ROMs, interactive media, modems, satellites, teleconferencing, and other technological means to support learning (Funderstanding, 2001). This method is the one a lot of us are using today to teach classes. A classroom full of computers with student accounts and a hands-on session from VeHU are just the ticket for group learning. In addition, using other instructional methods like demonstration, role playing, group activity, lecture, and review gives the students a well-rounded educational experience and creates a learning atmosphere that helps them remember the information. In our case, the student RNs, LPNs, and NAs alike were given user test accounts set up with RN menu options so they could role play by admitting a patient, creating tasks, and verifying and completing orders. The students had a chance to get the whole experience working with the Care Management application. You will just need to work out the best instructional method for you and your facility. You can research different teaching methods on the internet.

21. 21 Activities Demonstration using VeHU #103H Care Management for Nurses Role playing with Hands-on practice exercise in Student accounts Group activity by setting Dashboard parameters to use on the units and doing live queries Activities that Enhance Learning: Activities that promote the Instructional Technology Method are interaction with the Session 103H Web Based Training from VeHU 2004, practicing in student accounts, and setting parameters in their own individual dashboard application in the computer while in the classroom. First, staff watches the web-based training which goes through the technical application and then staff uses the student test account for hands-on practice with verifying and completing orders and creating tasks for procedures. This gives the learner a real life experience with patients and using the nursing dashboard just like they would on the units. Then staff should enter the computer using their own user name and password to set up personal parameters and running a real query on the Nursing Dashboard before they return to their unit. All this helps them remember what they learn and they will be prepared to start using the Care Management application right away. With group activity, the instructor should emphasize discussion and interchange of ideas not only between students and instructors but also among students themselves. Believe me, sometimes you get a lot more discussion going on then what is needed for the class.Activities that Enhance Learning: Activities that promote the Instructional Technology Method are interaction with the Session 103H Web Based Training from VeHU 2004, practicing in student accounts, and setting parameters in their own individual dashboard application in the computer while in the classroom. First, staff watches the web-based training which goes through the technical application and then staff uses the student test account for hands-on practice with verifying and completing orders and creating tasks for procedures. This gives the learner a real life experience with patients and using the nursing dashboard just like they would on the units. Then staff should enter the computer using their own user name and password to set up personal parameters and running a real query on the Nursing Dashboard before they return to their unit. All this helps them remember what they learn and they will be prepared to start using the Care Management application right away. With group activity, the instructor should emphasize discussion and interchange of ideas not only between students and instructors but also among students themselves. Believe me, sometimes you get a lot more discussion going on then what is needed for the class.

22. 22 Verification Sign in Sheet Post Test Competency Check off Sheet Questions & Review of any aspect that is not understood Complete Evaluation And then finally the Verification of Training: To receive credit for the course, you will need verification that employees received training. With Care Management this can be done by using a sign in sheet for each class, having the employee (student) take a post test, and completing a competency check off sheet. As an instructor you should allow time to let the staff member or student ask questions and review any aspect that is not understood. At the end of the class, you should have the student evaluate the course and instructor in order to get continuing education credits. In addition, each employee’s training on the Care Management application should be entered into their own personal education account in TEMPO or your facility’s personal educational tracking system.And then finally the Verification of Training: To receive credit for the course, you will need verification that employees received training. With Care Management this can be done by using a sign in sheet for each class, having the employee (student) take a post test, and completing a competency check off sheet. As an instructor you should allow time to let the staff member or student ask questions and review any aspect that is not understood. At the end of the class, you should have the student evaluate the course and instructor in order to get continuing education credits. In addition, each employee’s training on the Care Management application should be entered into their own personal education account in TEMPO or your facility’s personal educational tracking system.

23. 23 Here is a copy of the competency check-off form that we used for our class. You need to go over the list with them and verify that everyone has completed each item. For instance, if the form says “complete a task”, staff needs to make sure they complete a task, if they didn’t; you need to watch them do one. This form verifies that each person has a general understanding of the entire application.Here is a copy of the competency check-off form that we used for our class. You need to go over the list with them and verify that everyone has completed each item. For instance, if the form says “complete a task”, staff needs to make sure they complete a task, if they didn’t; you need to watch them do one. This form verifies that each person has a general understanding of the entire application.

24. 24 CONTINUING EDUCATION UNITS (CEU’s) We talked about implementing a Lesson Plan; now let’s talk about how to get continuing education credits for our classes so staff will want to come to the class: So this segment is about obtaining continuing education credits for your class so it will benefit the employee and encourage attendance to the training sessions. You will need a curriculum vita, an agenda, an advertisement, a post test, and method of evaluation in order to get approval for CEU’s. We talked about implementing a Lesson Plan; now let’s talk about how to get continuing education credits for our classes so staff will want to come to the class: So this segment is about obtaining continuing education credits for your class so it will benefit the employee and encourage attendance to the training sessions. You will need a curriculum vita, an agenda, an advertisement, a post test, and method of evaluation in order to get approval for CEU’s.

25. 25 Curriculum Vita Let’s start with the Curriculum Vita (resume’ for educators): First, you will need to create a Curriculum Vita that is almost identical to a resume’ and contains information about your professional experience, education, publications, speeches, fellowships, certifications, and your special skills. The exception is that you will include your professional characteristics and presentation skills. Include items that relate to the class for the CEU’s which you want to obtain and be professional when developing the form. Also include any publications or articles you may have developed. The example on the screen is similar to the one I used. I had to cut some of the items listed in order to fit the form on the slide. But you get the gist of it.Let’s start with the Curriculum Vita (resume’ for educators): First, you will need to create a Curriculum Vita that is almost identical to a resume’ and contains information about your professional experience, education, publications, speeches, fellowships, certifications, and your special skills. The exception is that you will include your professional characteristics and presentation skills. Include items that relate to the class for the CEU’s which you want to obtain and be professional when developing the form. Also include any publications or articles you may have developed. The example on the screen is similar to the one I used. I had to cut some of the items listed in order to fit the form on the slide. But you get the gist of it.

26. 26 Next the Agenda: This is an example of an agenda. You should make up an agenda that will tell how you will spend the class room time and how long the class will last. Be sure to include break times, post-test, and evaluation time. You can be creative and colorful when developing the form. It is lots of fun.Next the Agenda: This is an example of an agenda. You should make up an agenda that will tell how you will spend the class room time and how long the class will last. Be sure to include break times, post-test, and evaluation time. You can be creative and colorful when developing the form. It is lots of fun.

27. 27 Advertisement for the classes: Here is the advertisement used for my class. Again, be creative with your advertisement for the course you will be presenting. Place displays in different areas of the medical center and on the nursing units. You may get other interested parties wanting to attend besides just inpatient nursing staff. Advertisement for the classes: Here is the advertisement used for my class. Again, be creative with your advertisement for the course you will be presenting. Place displays in different areas of the medical center and on the nursing units. You may get other interested parties wanting to attend besides just inpatient nursing staff.

28. 28 The Post Test: You will want to develop a post test to cover the material you taught in the class room. Schedule enough time to take the test. Make sure you keep a copy with the answers on it so you can remember them and have it handy when students don’t know the answers.The Post Test: You will want to develop a post test to cover the material you taught in the class room. Schedule enough time to take the test. Make sure you keep a copy with the answers on it so you can remember them and have it handy when students don’t know the answers.

29. 29 Evaluation of the Presentation: This is an example of the evaluation method used when I taught my classes. You may want to develop your own. There are several examples of evaluations from other courses you can locate and adapt for your class. These forms can be your own creations. Make it fun.Evaluation of the Presentation: This is an example of the evaluation method used when I taught my classes. You may want to develop your own. There are several examples of evaluations from other courses you can locate and adapt for your class. These forms can be your own creations. Make it fun.

30. 30 Get Approval Staff Development Coordinator State Board of Registered Nurses Determine Amount of Continuing Education Units (CEU’s) Approval for CEU’s: You need to submit all the forms and paper work to your Staff Development Coordinator or equivalent to obtain approval for CEU’s. You may also get approved by your local State Board of Registered Nurses to provide continuing education on the classes you teach if you meet all the criteria to get it approved. After reviewing the material, your staff development coordinator will tell you how many CEU’s will be granted for the course. Record the amount of CEU’s on your Certificate of Training. Approval for CEU’s: You need to submit all the forms and paper work to your Staff Development Coordinator or equivalent to obtain approval for CEU’s. You may also get approved by your local State Board of Registered Nurses to provide continuing education on the classes you teach if you meet all the criteria to get it approved. After reviewing the material, your staff development coordinator will tell you how many CEU’s will be granted for the course. Record the amount of CEU’s on your Certificate of Training.

31. 31 Develop Certificate of Training: Here is an example of a CEU Certificate. You need to create a certificate so the staff can keep it for their licensing requirements. The certificate should tell the title of the course, the name of the person receiving the credit, the instructors with credentials and the provider number issued by the state, i.e.: WVBRN Provider #WV00-0000RN. You can include the Department of Veterans seal if desired. Develop Certificate of Training: Here is an example of a CEU Certificate. You need to create a certificate so the staff can keep it for their licensing requirements. The certificate should tell the title of the course, the name of the person receiving the credit, the instructors with credentials and the provider number issued by the state, i.e.: WVBRN Provider #WV00-0000RN. You can include the Department of Veterans seal if desired.

32. 32 HYPERLINK Well, we’ve talked about how to get CEU’s for the classes you teach, now let’s talk about setting up a Hyperlink to watch a VeHU class. This segment tells how you can get a hyperlink installed on your intranet home page website so everyone can connect to the VeHU classes for Care Management. You can also access VeHU from the internet outside the firewall. However I chose to make it a permanent hyperlink under Nursing Service on our home page.Well, we’ve talked about how to get CEU’s for the classes you teach, now let’s talk about setting up a Hyperlink to watch a VeHU class. This segment tells how you can get a hyperlink installed on your intranet home page website so everyone can connect to the VeHU classes for Care Management. You can also access VeHU from the internet outside the firewall. However I chose to make it a permanent hyperlink under Nursing Service on our home page.

33. 33 Hyperlink To VeHU Class Contact IRM Furnish Internet Address for Link: http://vaww.vehu.med.va.gov/vehu2004/ClassInfo/WBTInfo.cfm?ClassNum=103H Decide Location for Link on Home Website Decide Title for Link Make Available for All Nursing Service First you need to contact IRM (webmaster) and tell that person what you want. You will probably need to place a work order to get it done. Furnish the internet address for the link to IRM. Tell IRM where you want the link located on your intranet home page website and the title you want for the link. Place the hyperlink where all the staff can have easy access and even view the class by themselves if desired.First you need to contact IRM (webmaster) and tell that person what you want. You will probably need to place a work order to get it done. Furnish the internet address for the link to IRM. Tell IRM where you want the link located on your intranet home page website and the title you want for the link. Place the hyperlink where all the staff can have easy access and even view the class by themselves if desired.

34. 34 This is a screen shot of where we located ours under Nursing Service on our home Intranet Website and called it simply- Care Management for Nurses. It is convenient for all the nurses to access.This is a screen shot of where we located ours under Nursing Service on our home Intranet Website and called it simply- Care Management for Nurses. It is convenient for all the nurses to access.

35. 35 When you click on Care Management hyperlink, there will be a warning box that you are leaving your home Intranet website. Just click OK.When you click on Care Management hyperlink, there will be a warning box that you are leaving your home Intranet website. Just click OK.

36. 36 The site will open directly to the class, 103H Care Management for Nurses and you should start on URL session Part one. You can also arrange for another VeHU class if desired. We chose 103H because it was suitable for what we needed to teach the class.The site will open directly to the class, 103H Care Management for Nurses and you should start on URL session Part one. You can also arrange for another VeHU class if desired. We chose 103H because it was suitable for what we needed to teach the class.

37. 37 Have the whole class click on part 1 of the URL session at the same time so everyone will be in sequence with each other. Make sure the instructor is the only one to have the speaker turned on for sound to reduce confusion from all the different speakers on the computers. After watching the VeHU session, students can take a break and when they come back they can sign on to the student test accounts and role play.Have the whole class click on part 1 of the URL session at the same time so everyone will be in sequence with each other. Make sure the instructor is the only one to have the speaker turned on for sound to reduce confusion from all the different speakers on the computers. After watching the VeHU session, students can take a break and when they come back they can sign on to the student test accounts and role play.

38. 38 EDUCATIONAL PROCESS Now that you know how to set up a hyperlink on the computer for your classes, let’s get started with the Educational Process: My final section of implementation is about the educational process and how to coordinate scheduling your classes with staffing on the units. Now that you know how to set up a hyperlink on the computer for your classes, let’s get started with the Educational Process: My final section of implementation is about the educational process and how to coordinate scheduling your classes with staffing on the units.

39. 39 Schedule Classes Collaborate with Nurse Managers Schedule Computer Classroom Flexible Schedules: Days, Evenings, & Midnights Enter Training in TEMPO Scheduling Classes: It is vital to collaborate with the Nurse Managers for the best time to present a class. Then make sure the computer classroom is available for those particular days. Scheduling enough classes to cover all staff members will be challenging. Be flexible; divide the classes between days, evenings, and midnight shifts. Make sure to enter the training in TEMPO to keep a continuous record of who has had the class so you can schedule the next class during the correct shift to train the ones who have not had the training. Work with the Nurse Managers to make sure you get all the staff trained. You can run off a list from TEMPO that will tell you who has not had the training. Scheduling Classes: It is vital to collaborate with the Nurse Managers for the best time to present a class. Then make sure the computer classroom is available for those particular days. Scheduling enough classes to cover all staff members will be challenging. Be flexible; divide the classes between days, evenings, and midnight shifts. Make sure to enter the training in TEMPO to keep a continuous record of who has had the class so you can schedule the next class during the correct shift to train the ones who have not had the training. Work with the Nurse Managers to make sure you get all the staff trained. You can run off a list from TEMPO that will tell you who has not had the training.

40. 40 Scheduling vs. Staffing Patient Care Comes First Schedule Classes according to staffing levels Availability of classroom Finding Time Recruit Super Users Scheduling versus Staffing: When I thought I had a class scheduled to teach, I would come in on midnight or evening shift only to find out that I didn’t have a single student in my class due to staffing shortages and call-ins. So one of the hardest lessons for me to learn was patient care comes first over my classes and I am not as important as I thought I was. As frustrating as this can be, you need to persist in order to get a successful implementation accomplished. So be flexible yourself, schedule some of the classes on evenings and midnights to make sure you are available for all the shifts and get everyone trained. This helps with staffing shortages and besides, your schedule is easier to change than staff. Just make sure you call the Nursing Supervisor on the off-tours to check for staffing levels to make sure you will be having some students in your class. You may have to cancel and reschedule. Plan the classes on your Outlook Calendar and invite the staff members to attend. You might want to schedule all the RNs first for the classes then work your way down to LPNs and then the NAs. That way the RNs on the floors can help you train the LPNs and NAs on how to use Care Management. Train the Clinical Nurse Leaders and Nurse Manager Assistants to be Super users to help train the staff members who cannot attend the class for one reason or another. Completing the training could and will take months to do in order to get everyone trained. If you get down to one or two persons left who have not had the training, you can always have them watch the session at VeHU and then instruct one-on-one in the computer.Scheduling versus Staffing: When I thought I had a class scheduled to teach, I would come in on midnight or evening shift only to find out that I didn’t have a single student in my class due to staffing shortages and call-ins. So one of the hardest lessons for me to learn was patient care comes first over my classes and I am not as important as I thought I was. As frustrating as this can be, you need to persist in order to get a successful implementation accomplished. So be flexible yourself, schedule some of the classes on evenings and midnights to make sure you are available for all the shifts and get everyone trained. This helps with staffing shortages and besides, your schedule is easier to change than staff. Just make sure you call the Nursing Supervisor on the off-tours to check for staffing levels to make sure you will be having some students in your class. You may have to cancel and reschedule. Plan the classes on your Outlook Calendar and invite the staff members to attend. You might want to schedule all the RNs first for the classes then work your way down to LPNs and then the NAs. That way the RNs on the floors can help you train the LPNs and NAs on how to use Care Management. Train the Clinical Nurse Leaders and Nurse Manager Assistants to be Super users to help train the staff members who cannot attend the class for one reason or another. Completing the training could and will take months to do in order to get everyone trained. If you get down to one or two persons left who have not had the training, you can always have them watch the session at VeHU and then instruct one-on-one in the computer.

41. 41 Length of Training Total of 4 hours in the computer classroom Length of Training: For my class the length of training takes a total of 4 hours of instruction, web training session, hands-on training, competency check off, and reviewing aspects not understood. I have found that it takes the whole 4 hours to learn how to use Care Management the correct way and retain what you learn. The schedule breaks down like this: 1 ½ hours for the URL Session: 103H Care Management for Nurses; A 15 minute Break; then 2 Hours of lecture & hands-on training; and ½ Hour for questions and all the paper work: Post test, competency check off sheet, evaluation, etc. Length of Training: For my class the length of training takes a total of 4 hours of instruction, web training session, hands-on training, competency check off, and reviewing aspects not understood. I have found that it takes the whole 4 hours to learn how to use Care Management the correct way and retain what you learn. The schedule breaks down like this: 1 ½ hours for the URL Session: 103H Care Management for Nurses; A 15 minute Break; then 2 Hours of lecture & hands-on training; and ½ Hour for questions and all the paper work: Post test, competency check off sheet, evaluation, etc.

42. 42 Teaching Emphasis Stress Importance of Linking Tasks Stress Whole Team on One Screen Stress Importance of Red Headlights Stress Checking Task Status Stress Giving Hand-off Communication/End of Shift Report Using Tasks and Text Orders Teaching Emphasis: What teaching emphasis is important? Stress the specific items you want the students to remember. As the Instructor you should stress the importance of the task linking feature to ensure procedures get done and are not overlooked. The Instructor should also emphasize the ability to look at the whole team on one screen and stress the importance of the red headlight and lab results and vital signs variations. Note the importance of checking task status at the beginning of each shift and to make sure when you take an order off, that a task is linked to it if something needs to be done to the patient like a blood transfusion and complete the task if the job has been done. It is important to stress that the end-of-shift-report /hand-off communication tool (Electronic Kardex) should be done by reporting the tasks created in addition with the nursing text orders to the on-coming shift using the portable computers on rounds. Teaching Emphasis: What teaching emphasis is important? Stress the specific items you want the students to remember. As the Instructor you should stress the importance of the task linking feature to ensure procedures get done and are not overlooked. The Instructor should also emphasize the ability to look at the whole team on one screen and stress the importance of the red headlight and lab results and vital signs variations. Note the importance of checking task status at the beginning of each shift and to make sure when you take an order off, that a task is linked to it if something needs to be done to the patient like a blood transfusion and complete the task if the job has been done. It is important to stress that the end-of-shift-report /hand-off communication tool (Electronic Kardex) should be done by reporting the tasks created in addition with the nursing text orders to the on-coming shift using the portable computers on rounds.

43. 43 EXTRAORDINARY USESFOR CARE MANAGEMENT:INPATIENT SETTING Since we covered how to implement the Care Management application at your site from the Lesson Plan all the way down to the Teaching Emphasis, it is now time to learn about some extraordinary uses we have discovered for the Care Management application. We will examine all the different ways we learned about how to apply Care Management for the inpatient and outpatient clinical settings. I would like to give you some examples of the way Care Management can be used with the inpatient care setting. Since we covered how to implement the Care Management application at your site from the Lesson Plan all the way down to the Teaching Emphasis, it is now time to learn about some extraordinary uses we have discovered for the Care Management application. We will examine all the different ways we learned about how to apply Care Management for the inpatient and outpatient clinical settings. I would like to give you some examples of the way Care Management can be used with the inpatient care setting.

44. 44 Inpatient Setting To Complete Nursing Orders Hand-off Tool/Electronic Kardex Up Date Care Plans Query for Performance Improvement Information (Restraints, Falls) Incomplete Admissions Listed for you are just a few of the extraordinary ways Care Management can be used for the inpatient setting. We will discuss: Completing nursing orders and we’ll learn how to use Care Management’s query tool to locate orders that have not been completed; Creating a Hand-Off Communication Tool/Electronic Kardex which involves use of the nursing dashboard function. The Hand-Off Tool/Electronic Kardex will show how to use tasks and text orders for end of shift report in place of the paper report sheets (Kardex) and utilizing the portable computers and care management to give a quality hand-off report going room to room with the oncoming shift. 3) Updating Care Plans 4) Researching for information like falls and restraints for performance improvement reports which utilizes the query tool to accomplish those tasks. 5) Incomplete Admission Records using the query tool to find patients who do not have an initial nursing assessment, Braden, Advance Directive, or Care Plan. Let’s get started…Listed for you are just a few of the extraordinary ways Care Management can be used for the inpatient setting. We will discuss: Completing nursing orders and we’ll learn how to use Care Management’s query tool to locate orders that have not been completed; Creating a Hand-Off Communication Tool/Electronic Kardex which involves use of the nursing dashboard function. The Hand-Off Tool/Electronic Kardex will show how to use tasks and text orders for end of shift report in place of the paper report sheets (Kardex) and utilizing the portable computers and care management to give a quality hand-off report going room to room with the oncoming shift. 3) Updating Care Plans 4) Researching for information like falls and restraints for performance improvement reports which utilizes the query tool to accomplish those tasks. 5) Incomplete Admission Records using the query tool to find patients who do not have an initial nursing assessment, Braden, Advance Directive, or Care Plan. Let’s get started…

45. 45 Nursing Dashboard Complete Nursing Orders View Entire Panel of Selected Patients Sign Off for Several Patients at One Time The Nursing Dashboard Advantages are specifically geared to nurses. Using the Nursing dashboard to complete orders allows you to look for incomplete orders for the entire panel of patients you have selected on your dashboard. The dashboard, in conjunction with the Sign List, allows you to view your orders and select the ones that have been completed. Once selected, they are transferred to your Sign List where you can verify all the orders at one time with one signature. You can’t do that in CPRS which would require you to open each patient chart, review the orders, and sign them individually. So you can see this can be a real time saver. The Nursing Dashboard Advantages are specifically geared to nurses. Using the Nursing dashboard to complete orders allows you to look for incomplete orders for the entire panel of patients you have selected on your dashboard. The dashboard, in conjunction with the Sign List, allows you to view your orders and select the ones that have been completed. Once selected, they are transferred to your Sign List where you can verify all the orders at one time with one signature. You can’t do that in CPRS which would require you to open each patient chart, review the orders, and sign them individually. So you can see this can be a real time saver.

46. 46 You can see from this slide how conveniently all the nursing text orders are lumped all together in one location making it very easy to complete the nursing orders. The nursing orders stay on the list until they are completed making referral back to nursing orders very easy and accessible in one location. These nursing text orders can also be used along with tasks for creating an Electronic Kardex but this is dependent upon how your site wants to institute the tool. I will discuss the Electronic Kardex in more detail in a minute. You can see from this slide how conveniently all the nursing text orders are lumped all together in one location making it very easy to complete the nursing orders. The nursing orders stay on the list until they are completed making referral back to nursing orders very easy and accessible in one location. These nursing text orders can also be used along with tasks for creating an Electronic Kardex but this is dependent upon how your site wants to institute the tool. I will discuss the Electronic Kardex in more detail in a minute.

47. 47 This slide view of the sign list perspective demonstrates how you can sign and complete nursing orders on more than one patient at a time. This saves extra steps that are needed with completing nursing orders in CPRS and saves time for the nurse. This slide view of the sign list perspective demonstrates how you can sign and complete nursing orders on more than one patient at a time. This saves extra steps that are needed with completing nursing orders in CPRS and saves time for the nurse.

48. 48 HAND-OFF TOOL/ELECTRONIC KARDEX We talked about completing nursing orders for multiple patients; now let’s talk about creating an Electronic Kardex as a Hand-Off Communication tool. This segment explains how to use Care Management as a Hand-off communication tool to meet Joint Commission standards for reporting patient information during transfer/hand-off of the patient to others. This is used as an Electronic Kardex in place of the old paper Kardex used to do the end-of-shift report to the oncoming shift of nurses.We talked about completing nursing orders for multiple patients; now let’s talk about creating an Electronic Kardex as a Hand-Off Communication tool. This segment explains how to use Care Management as a Hand-off communication tool to meet Joint Commission standards for reporting patient information during transfer/hand-off of the patient to others. This is used as an Electronic Kardex in place of the old paper Kardex used to do the end-of-shift report to the oncoming shift of nurses.

49. 49 Hand Off Tool & Electronic Kardex As you know the goal of any electronic health record is to eliminate the paperwork. You are also aware that Joint Commission is looking hard at hand-off dialog between nurses and other disciplines when they have a patient transfer from ER & ICU, from an outpatient clinic to a VA, or even from a civilian hospital. While the hand-off tool from an ER or an Outpatient clinic might just be a note stating the patient’s condition, vital signs, diagnosis, and brief assessment for the accepting nurse, the task function in the nursing dashboard allows us to eliminate a favorite tool for Nurses – the paper Kardex. As you can see from the slide-Tasks have been created for each entry that would normally be on a Kardex. The patient’s diet, vital sign frequency, and numerous tasks can be created to help form a functional tool. As you know the goal of any electronic health record is to eliminate the paperwork. You are also aware that Joint Commission is looking hard at hand-off dialog between nurses and other disciplines when they have a patient transfer from ER & ICU, from an outpatient clinic to a VA, or even from a civilian hospital. While the hand-off tool from an ER or an Outpatient clinic might just be a note stating the patient’s condition, vital signs, diagnosis, and brief assessment for the accepting nurse, the task function in the nursing dashboard allows us to eliminate a favorite tool for Nurses – the paper Kardex. As you can see from the slide-Tasks have been created for each entry that would normally be on a Kardex. The patient’s diet, vital sign frequency, and numerous tasks can be created to help form a functional tool.

50. 50 Tasks as Hand-Off Tool & Electronic Kardex Use tasks to create a hand-off tool for reporting to the oncoming shift. This creates an electronic Kardex that does not become part of the viewable record. It allows for up dates and additions to the tools as orders are added. You can remove the task by completing it which eliminates the task from the tool. The tasks are not displayed in the viewable chart upon completion but are eliminated from the Electronic Kardex you have created, effectively cleaning the Kardex. However, tasks are stored in a file “Patient Task file #102.3” in VISTA. So make sure tasks are appropriate. If the tasks are updated as orders are written and viewed, the Electronic Kardex becomes an efficient Hand-Off tool. It is most effective in a face-to-face report situation where the portable computer can be taken to the patient’s room and reviewed with the oncoming shift. If more in depth explanation is needed for a particular task you can expand the order on the dashboard or use the “Go to chart” link which enables one to go to the CPRS chart to view a note. To be able to get the best benefit from the electronic Kardex, it is important to have the staff start using the program at the same time. That way they will have a smoother and easier transition from a paper Kardex to an electronic Kardex. Nursing staff at the Huntington VAMC thinks that the nursing dashboard is terrific for tasks and orders and could even become a more useful tool in the future with improved enhancements. Use tasks to create a hand-off tool for reporting to the oncoming shift. This creates an electronic Kardex that does not become part of the viewable record. It allows for up dates and additions to the tools as orders are added. You can remove the task by completing it which eliminates the task from the tool. The tasks are not displayed in the viewable chart upon completion but are eliminated from the Electronic Kardex you have created, effectively cleaning the Kardex. However, tasks are stored in a file “Patient Task file #102.3” in VISTA. So make sure tasks are appropriate. If the tasks are updated as orders are written and viewed, the Electronic Kardex becomes an efficient Hand-Off tool. It is most effective in a face-to-face report situation where the portable computer can be taken to the patient’s room and reviewed with the oncoming shift. If more in depth explanation is needed for a particular task you can expand the order on the dashboard or use the “Go to chart” link which enables one to go to the CPRS chart to view a note. To be able to get the best benefit from the electronic Kardex, it is important to have the staff start using the program at the same time. That way they will have a smoother and easier transition from a paper Kardex to an electronic Kardex. Nursing staff at the Huntington VAMC thinks that the nursing dashboard is terrific for tasks and orders and could even become a more useful tool in the future with improved enhancements.

51. 51 This slide gives an example of how you can expand an order that was linked to a task for more information on that particular order by clicking on the plus sign beside the task.This slide gives an example of how you can expand an order that was linked to a task for more information on that particular order by clicking on the plus sign beside the task.

52. 52 UPDATE CARE PLANS Since we talked about how valuable the Care Management application is when used as an Electronic Kardex, let’s talk about another valuable way it can be used-to update care plans. Updating and individualizing care plans is a requirement that nurses have dreaded in the past. In the days of the old paper charting, standardized care plans were taken from a file, the patients name was stamped on the care plan, and it became part of the chart. Now that we are in the electronic age paper care plans do not fit into the goal of a complete electronic health record. An example of how care plans can be integrated into the electronic heath record will be explained in the next few slides. Since we talked about how valuable the Care Management application is when used as an Electronic Kardex, let’s talk about another valuable way it can be used-to update care plans. Updating and individualizing care plans is a requirement that nurses have dreaded in the past. In the days of the old paper charting, standardized care plans were taken from a file, the patients name was stamped on the care plan, and it became part of the chart. Now that we are in the electronic age paper care plans do not fit into the goal of a complete electronic health record. An example of how care plans can be integrated into the electronic heath record will be explained in the next few slides.

53. 53 Update Care Plans Use This Query for checking to make sure care plans are done Use this query for checking on care plans to update Print and give the list to Staff for updating care plans With the query tool you can check to see if patients have a care plan or if the care plan needs updating. You can also print the list for a handy reference. After the query is set up, it takes only seconds to view the results. Let’s see how you create a search for updating care plans. With the query tool you can check to see if patients have a care plan or if the care plan needs updating. You can also print the list for a handy reference. After the query is set up, it takes only seconds to view the results. Let’s see how you create a search for updating care plans.

54. 54 Create Custom Search Select the query tool and click on create custom search, click on documents, and then click next at the bottom of the screen The items in blue will need to be addressed. This is where you tell the computer what you want to query. This slide shows you an example of the screen where you click on documents. Select the query tool and click on create custom search, click on documents, and then click next at the bottom of the screen The items in blue will need to be addressed. This is where you tell the computer what you want to query. This slide shows you an example of the screen where you click on documents.

55. 55 Find the Specific Document Next you want to click on Specific Documents, and then click in the white area on the blue lettered topics and do each of those. This slide shows the screen where you access specific documents and specify the team list, date, and the title of the document (blue lettering in the white area). Next you want to click on Specific Documents, and then click in the white area on the blue lettered topics and do each of those. This slide shows the screen where you access specific documents and specify the team list, date, and the title of the document (blue lettering in the white area).

56. 56 Find the Correct Team This screen shows you how to find the team or teams you want to search. There is a selection from 5 patient tabs. Select the tab from where you want to select your team. In this instance we have selected the Personal Team. To select the proper team find the team in the list on the left, highlight the team and click the right pointing arrow in order to select it. The team will be added to the right side, then just click ok.This screen shows you how to find the team or teams you want to search. There is a selection from 5 patient tabs. Select the tab from where you want to select your team. In this instance we have selected the Personal Team. To select the proper team find the team in the list on the left, highlight the team and click the right pointing arrow in order to select it. The team will be added to the right side, then just click ok.

57. 57 Then Select the Date Range This screen shows an example of the date range. Select the correct date range for your search. If you are checking care plans every day, then choose past 24 hours. This will look for new care plans and ones that need updating for each day you run the program. It is much easier to run it every day and keep up with it than to let the care plans pile up for days needing renewals or needing to be done especially with Joint Commission coming unannounced.This screen shows an example of the date range. Select the correct date range for your search. If you are checking care plans every day, then choose past 24 hours. This will look for new care plans and ones that need updating for each day you run the program. It is much easier to run it every day and keep up with it than to let the care plans pile up for days needing renewals or needing to be done especially with Joint Commission coming unannounced.

58. 58 Select Progress Note Title Now you have to select the title of the progress note that has your care plans on it. In this screen example you see that in the small upper box Progress Notes has been selected. This brings up a menu of note titles. The selected note titled “Dip Note-Nursing (Child Note)” is the note that our facility uses to attach our care plans and the note stands for “Discharge Interdisciplinary Planning” the nursing part of the parent note. The note title needs to be selected by highlighting it as shown and then transferring the note selection to the box on the right – do this by clicking the arrow. It is possible to select more than one note at a time if so desired.Now you have to select the title of the progress note that has your care plans on it. In this screen example you see that in the small upper box Progress Notes has been selected. This brings up a menu of note titles. The selected note titled “Dip Note-Nursing (Child Note)” is the note that our facility uses to attach our care plans and the note stands for “Discharge Interdisciplinary Planning” the nursing part of the parent note. The note title needs to be selected by highlighting it as shown and then transferring the note selection to the box on the right – do this by clicking the arrow. It is possible to select more than one note at a time if so desired.

59. 59 Select and Add Items This is a screen shot of the patient identifiers you will need to select. Just select enough items that you feel are needed to identify your patient. If you are doing more than one ward/unit, you will have to select the ward also. If there might be two patients with the same name, you will need to select SSN. Just select the items you need to provide the information you need. Then click next at the bottom of your screen after choosing the items. This is a screen shot of the patient identifiers you will need to select. Just select enough items that you feel are needed to identify your patient. If you are doing more than one ward/unit, you will have to select the ward also. If there might be two patients with the same name, you will need to select SSN. Just select the items you need to provide the information you need. Then click next at the bottom of your screen after choosing the items.

60. 60 Name Your Report Name your report. Be sure to give your report a name that will identify what you are researching or the name of the report you are working on. Then click “finish” and then select “view report” at bottom of the next screen. When you see sensitive patients, just click on “select all” and continue query. Name your report. Be sure to give your report a name that will identify what you are researching or the name of the report you are working on. Then click “finish” and then select “view report” at bottom of the next screen. When you see sensitive patients, just click on “select all” and continue query.

61. 61 Finding Nursing Notes for PI Finally you will get the list of notes from your customized search. You can print the list or click on each one to see the note. You can also export your report to a file or excel. Finally you will get the list of notes from your customized search. You can print the list or click on each one to see the note. You can also export your report to a file or excel.

62. 62 Click on Note Click on the note to view it and then you can check for the date on the care plan to see if it needs updating. So as you can see, this is a handy way to check on care plans and once the query is set up, it is a very fast way to get results.Click on the note to view it and then you can check for the date on the care plan to see if it needs updating. So as you can see, this is a handy way to check on care plans and once the query is set up, it is a very fast way to get results.

63. 63 PERFORMANCE IMPROVEMENTUSINGCUSTOM QUERIES We talked about updating care plans; now let’s talk about research for Performance Improvement Reports. This section explains how you can do customized searches for performance improvement measures like falls and restraints.We talked about updating care plans; now let’s talk about research for Performance Improvement Reports. This section explains how you can do customized searches for performance improvement measures like falls and restraints.

64. 64 Falls & Restraints For performance measure like falls and restraints, you do the query the same way as the previous one except you just change the title of the progress note to the Post Falls note or Restraint Assessment note, and etc. Then you will get a list of patients who have had a fall or a restraint placed. Once the report is set up, the report would take only seconds to run each day. For performance measure like falls and restraints, you do the query the same way as the previous one except you just change the title of the progress note to the Post Falls note or Restraint Assessment note, and etc. Then you will get a list of patients who have had a fall or a restraint placed. Once the report is set up, the report would take only seconds to run each day.

65. 65 Incomplete Admissions Not only can you do queries on falls and restraints, you can also do one for incomplete admissions, choosing the option “List only patients where no documents meeting the above criteria were found” lets you find patients who do not have a progress note in their chart. When you want to check on incomplete admissions, you would choose that particular option on the custom query then you will get a list of patients who do not have an initial nursing assessment, Braden, or advance directive note thereby telling you the admission process was not completed. You can print the list and give it to your charge nurse on the units. This keeps our record complete and ready for any Joint Commission visit.Not only can you do queries on falls and restraints, you can also do one for incomplete admissions, choosing the option “List only patients where no documents meeting the above criteria were found” lets you find patients who do not have a progress note in their chart. When you want to check on incomplete admissions, you would choose that particular option on the custom query then you will get a list of patients who do not have an initial nursing assessment, Braden, or advance directive note thereby telling you the admission process was not completed. You can print the list and give it to your charge nurse on the units. This keeps our record complete and ready for any Joint Commission visit.

66. 66 EXTRAORDINARY USESFOR CARE MANAGEMENT:OUTPATIENT SETTING Now that you have looked at the inpatient uses of Care Management, you will want to know some outpatient uses of Care Management. The outpatient extraordinary uses will be presented by Bill Barber from Pensacola, Florida. Bill? Bill says: Good Morning everyone, I hope everyone is enjoying their time at VeHU. I know you have been captivated by my two co-presenters informing you on how Care Management was developed and about the excellent training program and innovative implementation that has led to the extraordinary utilization in the inpatient setting. Now I am going to tell you how I first started using Care Management in the outpatient setting that led to the extraordinary ways we are now using this wonderful application. Let me start by telling you that I am Bill Barber and I have been a nurse for 13 yrs – 5 with the VA. I currently work at the Pensacola Outpatient Clinic as the MOVE! Poster Child, I mean nurse. I attended VeHU last year for the first time, took a class on Care Management and was hooked. I knew this application could be assimilated into the daily operations of the clinic to enable me and my co-workers to become more efficient in the management of our Primary Care Panels. I was also encouraged to become more involved in the VeHU process. I never would have guessed that I would be standing here before you today giving a lecture. Well, enough about me. Now, I would like to give you some examples of how Care Management can be used several different ways in the outpatient care setting. Now that you have looked at the inpatient uses of Care Management, you will want to know some outpatient uses of Care Management. The outpatient extraordinary uses will be presented by Bill Barber from Pensacola, Florida. Bill? Bill says: Good Morning everyone, I hope everyone is enjoying their time at VeHU. I know you have been captivated by my two co-presenters informing you on how Care Management was developed and about the excellent training program and innovative implementation that has led to the extraordinary utilization in the inpatient setting. Now I am going to tell you how I first started using Care Management in the outpatient setting that led to the extraordinary ways we are now using this wonderful application. Let me start by telling you that I am Bill Barber and I have been a nurse for 13 yrs – 5 with the VA. I currently work at the Pensacola Outpatient Clinic as the MOVE! Poster Child, I mean nurse. I attended VeHU last year for the first time, took a class on Care Management and was hooked. I knew this application could be assimilated into the daily operations of the clinic to enable me and my co-workers to become more efficient in the management of our Primary Care Panels. I was also encouraged to become more involved in the VeHU process. I never would have guessed that I would be standing here before you today giving a lecture. Well, enough about me. Now, I would like to give you some examples of how Care Management can be used several different ways in the outpatient care setting.

67. 67 Outpatient Setting Personal Team Lists Patient Record Reviews Track Outcomes Complete Reports Let’s talk about the Outpatient setting uses of Care Management and how it is suited to case managing a Primary Care Team. We will look at 4 different areas: 1) Setting up Personal Team Lists for Record Reviews 2) Performing Patient Record reviews for Case Managing in the Outpatient Setting that utilizes both the nursing dashboard function and the query tool. 3) Using both the nursing dashboard and the query tool to manage patients in the clinical outpatient setting to track outcomes 4) And using both the dashboard and query tool to complete different reports. Let’s begin….Let’s talk about the Outpatient setting uses of Care Management and how it is suited to case managing a Primary Care Team. We will look at 4 different areas: 1) Setting up Personal Team Lists for Record Reviews 2) Performing Patient Record reviews for Case Managing in the Outpatient Setting that utilizes both the nursing dashboard function and the query tool. 3) Using both the nursing dashboard and the query tool to manage patients in the clinical outpatient setting to track outcomes 4) And using both the dashboard and query tool to complete different reports. Let’s begin….

68. 68 PERSONAL TEAM LISTS FOR PATIENT REVIEW The dashboard allows the nurse to create lists or subsets of the larger team. In this way patients may be grouped by a common need or diagnosis to allow for a more manageable case load. We need to learn how to set up our own personal team lists. So let’s talk about how to set up a personal team list for those of us who do not know how.The dashboard allows the nurse to create lists or subsets of the larger team. In this way patients may be grouped by a common need or diagnosis to allow for a more manageable case load. We need to learn how to set up our own personal team lists. So let’s talk about how to set up a personal team list for those of us who do not know how.

69. 69 Personal Team Lists The dashboard allows the nurse to create lists or subsets of the larger team. In this way patients may be grouped by a common need or diagnosis to allow for a more manageable case load. We need to review how to set up our own personal team lists. So let’s do a quick review of setting up a personal list. The first step in the process of team management is creating Personal Team Lists. This is done in CPRS in the tools menu. Click on options, then List/Teams. Again for Creating a Personal Team List go to: CPRS tools – Options – List/Teams- Personal Lists The dashboard allows the nurse to create lists or subsets of the larger team. In this way patients may be grouped by a common need or diagnosis to allow for a more manageable case load. We need to review how to set up our own personal team lists. So let’s do a quick review of setting up a personal list. The first step in the process of team management is creating Personal Team Lists. This is done in CPRS in the tools menu. Click on options, then List/Teams. Again for Creating a Personal Team List go to: CPRS tools – Options – List/Teams- Personal Lists

70. 70 When the window appears, name the new list as you can see in the small box VeHU Team List is entered. If that is the team name you desired then you would proceed by clicking OK which would place your team name in the Personal List area. Now enter the patients you want to place in your personal team. As you see in the patient section there are two patient names to choose from – select the patient you want and then Click on OK. You have created a Personal Team List. This screen shot shows the location in CPRS where you make your team list. When the window appears, name the new list as you can see in the small box VeHU Team List is entered. If that is the team name you desired then you would proceed by clicking OK which would place your team name in the Personal List area. Now enter the patients you want to place in your personal team. As you see in the patient section there are two patient names to choose from – select the patient you want and then Click on OK. You have created a Personal Team List. This screen shot shows the location in CPRS where you make your team list.

71. 71 Care Management Lists Now that you know how to make a team list in CPRS, let’s discuss the way to transfer that list to the Care Management dashboard. Bring up Care Management/dashboard and click on the word Patients (at top of screen in the blue area) and select create/edit list; this bring up the Patient List menu Box as you can see there are 5 different tab to select across the left hand window. Because we want to add the name of a Personal/Team select that tab and choose the name of the Team you have just created and click on the right facing arrow to move the new list to the right window. Click OK. Refresh the dashboard and you are ready to proceed to use Care Management with a Personal List of patients. The creation of this personal list can be helpful in managing specific groups of patients. I will give specific examples in just a minute. This screen shot shows the location of how and where to click to select your personalized team list. Now that you know how to make a team list in CPRS, let’s discuss the way to transfer that list to the Care Management dashboard. Bring up Care Management/dashboard and click on the word Patients (at top of screen in the blue area) and select create/edit list; this bring up the Patient List menu Box as you can see there are 5 different tab to select across the left hand window. Because we want to add the name of a Personal/Team select that tab and choose the name of the Team you have just created and click on the right facing arrow to move the new list to the right window. Click OK. Refresh the dashboard and you are ready to proceed to use Care Management with a Personal List of patients. The creation of this personal list can be helpful in managing specific groups of patients. I will give specific examples in just a minute. This screen shot shows the location of how and where to click to select your personalized team list.

72. 72 Daily Use of the Dashboard Review all labs for the patient appointments for that day at one time and in one place Review any task that may be outstanding Review any outstanding nursing orders that may need to be completed Now that we have covered how to create a patient list, we will cover the daily uses of the dashboard in the outpatient setting. In the daily operation of the Ambulatory Care Clinic, Care Management can have many functions but when I first located the icon on my desktop (being the curious soul I am) I did the double click thing and to my amazement this dashboard appearing thing popped up at me. Now that was over 3 yrs ago. When I asked about it I was told – just wait- you will learn about it soon enough. Nothing happened!! So I began to play with the application I learned several years before that you can’t really hurt a computer unless you take a hammer to it or pour liquid into the processor. I finally got my supervisor to come up with a manual that showed about the functioning of the dashboard and the sign list. And the things listed on the slide were the functions that I started performing- just basic operations of the dashboard for a panel of patients- but it was a start. After attending VeHU 2006, I was able to proceed with some more in depth functioning of Care Management. It has taken some time but we have been able to obtain the query tool for several of the nurses in the clinic. IMS does not want all nurses to have the query function for fear of people slowing an already over burdened system at times. So we have a few nurses with the capability of the query function and they are learning the function and are becoming quite capable.Now that we have covered how to create a patient list, we will cover the daily uses of the dashboard in the outpatient setting. In the daily operation of the Ambulatory Care Clinic, Care Management can have many functions but when I first located the icon on my desktop (being the curious soul I am) I did the double click thing and to my amazement this dashboard appearing thing popped up at me. Now that was over 3 yrs ago. When I asked about it I was told – just wait- you will learn about it soon enough. Nothing happened!! So I began to play with the application I learned several years before that you can’t really hurt a computer unless you take a hammer to it or pour liquid into the processor. I finally got my supervisor to come up with a manual that showed about the functioning of the dashboard and the sign list. And the things listed on the slide were the functions that I started performing- just basic operations of the dashboard for a panel of patients- but it was a start. After attending VeHU 2006, I was able to proceed with some more in depth functioning of Care Management. It has taken some time but we have been able to obtain the query tool for several of the nurses in the clinic. IMS does not want all nurses to have the query function for fear of people slowing an already over burdened system at times. So we have a few nurses with the capability of the query function and they are learning the function and are becoming quite capable.

73. 73 Outpatient Uses 0f Dashboard Case Management (Panama City): Post Hospital Follow up Medication Management for debilitated and impaired patients High Risk Patient Follow up Cancer patients Hepatitis C patients Patient Education Referrals from Physicians Some uses of the Dashboard in the outpatient clinical setting: In the clinical setting, the dashboard allows for the following of a group of patients; not just the individual patient as in CPRS. Patients can be grouped by a common bond such as Coumadin, High Risk, GYN patients along with patients who need assistance with medications. Setting up a patient list of Anticoagulation Clinic patients allows the nurse to track Protimes (PT) and INR’s. This, along with the query tool, can be helpful in the management of these types of patients. High Risk patients are consulted to a Nurse Case Manager who places the patient names on a list and is better able to follow the patients by adding task reminders on the dashboard as needed and to monitor labs and other ancillary services with the query tool. Some uses of the Dashboard in the outpatient clinical setting: In the clinical setting, the dashboard allows for the following of a group of patients; not just the individual patient as in CPRS. Patients can be grouped by a common bond such as Coumadin, High Risk, GYN patients along with patients who need assistance with medications. Setting up a patient list of Anticoagulation Clinic patients allows the nurse to track Protimes (PT) and INR’s. This, along with the query tool, can be helpful in the management of these types of patients. High Risk patients are consulted to a Nurse Case Manager who places the patient names on a list and is better able to follow the patients by adding task reminders on the dashboard as needed and to monitor labs and other ancillary services with the query tool.

74. 74 Outpatient Uses of Dashboard (cont’d) Assistance with Medications (Pensacola): Task setting for monthly med checks Increased medication compliance Fewer telephone calls from patients about medications not being received Assistance with medications is big problem at our clinic. It makes up about 80% of the phone calls to the nursing staff. Of course the clerks assist as they can such as flagging medications for renewal and referring calls to pharmacy as they can, but as you know some patients just insistent on speaking to the nurse about the problem. By using the Task Function of the Care Management you set tasks for your patients that you have in the personal patient list you create that meet this criteria – and the criteria is usual someone who is sight or hearing impaired that have no family to assist them with their medication refills. I set a reminder in Outlook to remind me to check the medication panel and the results have been dramatic. Patient phone calls for medications to my panel have dropped by 60%. My clerk is happier and the patients are happier and they are getting their medication in a timely fashion which has increased compliance. Assistance with medications is big problem at our clinic. It makes up about 80% of the phone calls to the nursing staff. Of course the clerks assist as they can such as flagging medications for renewal and referring calls to pharmacy as they can, but as you know some patients just insistent on speaking to the nurse about the problem. By using the Task Function of the Care Management you set tasks for your patients that you have in the personal patient list you create that meet this criteria – and the criteria is usual someone who is sight or hearing impaired that have no family to assist them with their medication refills. I set a reminder in Outlook to remind me to check the medication panel and the results have been dramatic. Patient phone calls for medications to my panel have dropped by 60%. My clerk is happier and the patients are happier and they are getting their medication in a timely fashion which has increased compliance.

75. 75 Outpatient Dashboard Uses (cont’d) Women’s Health: Manage all Pap Smears Mammograms RN at Mobile Outpatient Clinic and Pensacola Outpatient Clinic in collaboration with ARNP make call backs and send letters if the patient is not contacted by phone for all abnormal results Women’s Health for the Mobile and Pensacola Outpatient Clinics are being managed by a Nurse from the Mobile Clinic who utilizes the nursing dashboard to manage these Specialty Clinic Patients. She has her Dashboard set so that the patients scheduled for the Women’s Clinic that week at the two clinics are automatically shown on her dashboard as a patient list about twice a week. She can then review the lab and imaging data. All abnormal results are reviewed with the ARNP over Women’s Health for the Outpatient Clinics and then the patient’s are contacted by phone or letter. In speaking to this nurse during the preparation for this lecture she stated that this application has made her work with Women’s Health so much easier and faster. Working with an entire panel of patients rather than the individual patient as CPRS allows makes work time efficient and is just smart working.Women’s Health for the Mobile and Pensacola Outpatient Clinics are being managed by a Nurse from the Mobile Clinic who utilizes the nursing dashboard to manage these Specialty Clinic Patients. She has her Dashboard set so that the patients scheduled for the Women’s Clinic that week at the two clinics are automatically shown on her dashboard as a patient list about twice a week. She can then review the lab and imaging data. All abnormal results are reviewed with the ARNP over Women’s Health for the Outpatient Clinics and then the patient’s are contacted by phone or letter. In speaking to this nurse during the preparation for this lecture she stated that this application has made her work with Women’s Health so much easier and faster. Working with an entire panel of patients rather than the individual patient as CPRS allows makes work time efficient and is just smart working.

76. 76 Reports Pain Assessment Report: Weekly Random Check of 4 CBOC’S Primary Care Clinics Pain assessment, reassessment of and intervention if needed. Now that I have covered some of the daily uses of the dashboard in the outpatient setting, I want to tell you about some of the reports that are easily accomplished using the dashboard and the query tool: A weekly pain assessment report was requested by the Nursing Executives at the VAMC in Biloxi. Using the Query Tool I made short work of the time needed to perform the record review needed to compile the data. Before using the query tool, I had to obtain patient lists for 10 of the physicians in the 4 outpatient clinics for a particular day. Then I had to review the notes for that day. Keeping a tally of the data accumulated. The query tool allows you to construct a simple program that brings all the data together at the same time. Notes still had to be reviewed to obtain the data; but everything was in one simple package. What usually took about 3 hours to accomplish now could be done in a half an hour. If it had not been for the classes I took at last year’s VeHU, it would still be a pain doing the Pain Report in an antiquated way taking all day to do. The dashboard and query tool has saved me many hours doing reports and I can spend more time with my patients.Now that I have covered some of the daily uses of the dashboard in the outpatient setting, I want to tell you about some of the reports that are easily accomplished using the dashboard and the query tool: A weekly pain assessment report was requested by the Nursing Executives at the VAMC in Biloxi. Using the Query Tool I made short work of the time needed to perform the record review needed to compile the data. Before using the query tool, I had to obtain patient lists for 10 of the physicians in the 4 outpatient clinics for a particular day. Then I had to review the notes for that day. Keeping a tally of the data accumulated. The query tool allows you to construct a simple program that brings all the data together at the same time. Notes still had to be reviewed to obtain the data; but everything was in one simple package. What usually took about 3 hours to accomplish now could be done in a half an hour. If it had not been for the classes I took at last year’s VeHU, it would still be a pain doing the Pain Report in an antiquated way taking all day to do. The dashboard and query tool has saved me many hours doing reports and I can spend more time with my patients.

77. 77 Pain Report (cont’d) Initial time require to produce report 3 hrs/week Time to produce report using Care Management 0.5hrs/wk Total time savings per month = (3hrs x 4wks) – (0.5hrs x 4wks) = 12 hrs – 2hrs = 10hrs of time saved each month producing this report using Care Management This is a break down to show exactly how much time was saved by using Care Management to run the report. Once the initial query was created, changes could be made on a weekly basis to facilitate the production of this report for outpatient clinics. As you can see from the data it amounted to a saving of 10 hours a month in time producing the report with Care Management. This is a break down to show exactly how much time was saved by using Care Management to run the report. Once the initial query was created, changes could be made on a weekly basis to facilitate the production of this report for outpatient clinics. As you can see from the data it amounted to a saving of 10 hours a month in time producing the report with Care Management.

78. 78 Fecal Occult Blood Report Fecal Occult Blood Test (FOBT) Outcomes: Report of activity needed for monthly teleconference. Data previously gathered by individual logs Query Tool - quality data in short amount of time. Time to run query 2-5 minutes Here is another report where the training I learned at VeHU 2006 and using the query tool really has paid dividends: The Fecal Occult Blood Test (FOBT) monthly teleconferencing was being done by another nurse in the clinic. After learning how to use the Query Tool last year, I was able to show her an easier way of obtaining her data. A simple query of the FOBT orders for the time frame in question gives the total number of orders and the results of the orders in a tight package. What used to take hours now takes minutes. I have been able to train this Nurse in the use of the Query tool. Now she runs the report and obtains the data in a fraction of the time it took her previously saving her many tedious hours doing it the other way of researching each individual file. As you can see the query only takes minutes to run after the initial set up.Here is another report where the training I learned at VeHU 2006 and using the query tool really has paid dividends: The Fecal Occult Blood Test (FOBT) monthly teleconferencing was being done by another nurse in the clinic. After learning how to use the Query Tool last year, I was able to show her an easier way of obtaining her data. A simple query of the FOBT orders for the time frame in question gives the total number of orders and the results of the orders in a tight package. What used to take hours now takes minutes. I have been able to train this Nurse in the use of the Query tool. Now she runs the report and obtains the data in a fraction of the time it took her previously saving her many tedious hours doing it the other way of researching each individual file. As you can see the query only takes minutes to run after the initial set up.

79. 79 LDL Management Low Density Lipoprotein (LDL ) Management: Goal-Sharing Program – 8 Nurses and 2 Physicians at Pensacola Outpatient Clinic Identify 50 – 100 veterans with LDL’s >100 Documentation of education on diet, exercise, & administration of medication/supplements Reduction of the LDL by 10 – 20 % Veterans were followed for 5 months – initial LDL and then at least 1 repeat LDL. LDL Management as you know is a performance measure. The physicians at our outpatient clinic were falling a little short of meeting our goals – they asked the Nursing Department to help. Our nurses decided to turn it into a Goal-Sharing Project. The Slide describes the basic setup for the goal sharing: Identify 50-100 veterans with LDL’s > 100. 2. Ensure documentation of education on diet, exercise and nutrition, and administration of medication. 3. Reduction of LDL by 10 – 20 %. Veterans were followed for 5 months – an initial LDL and then at least 1 follow up LDL to be completed.LDL Management as you know is a performance measure. The physicians at our outpatient clinic were falling a little short of meeting our goals – they asked the Nursing Department to help. Our nurses decided to turn it into a Goal-Sharing Project. The Slide describes the basic setup for the goal sharing: Identify 50-100 veterans with LDL’s > 100. 2. Ensure documentation of education on diet, exercise and nutrition, and administration of medication. 3. Reduction of LDL by 10 – 20 %. Veterans were followed for 5 months – an initial LDL and then at least 1 follow up LDL to be completed.

80. 80 Results as of VeHU 2007 Beginning LDL Ranges 254 – 113.2 As of July 13, 2007 50% of subjects identified had completed a repeat LDL Repeat LDL Ranges 184.2 – 79.4 3 subjects LDL’s increased 47 subjects showed a decrease in LDL Percentage of decrease ranged from a high of 54.3% to a low of 4.3% for an average decrease of 23.5% The Goal sharing project was scheduled for completion on the 31st of July so I was not able to obtain all the data to show you the completed project. The nurses used Care Management to obtain all their data. A simple query for abnormal lipids panels and abnormal LDL’s got each member of the project started. As you can see from the data presented a dramatic effect was achieved in the patient’s who participated in the programs. The query had to be changed to include normal lipid panels for the repeat LDL’s because many of the LDL’s have decreased into the normal range. The Goal sharing project was scheduled for completion on the 31st of July so I was not able to obtain all the data to show you the completed project. The nurses used Care Management to obtain all their data. A simple query for abnormal lipids panels and abnormal LDL’s got each member of the project started. As you can see from the data presented a dramatic effect was achieved in the patient’s who participated in the programs. The query had to be changed to include normal lipid panels for the repeat LDL’s because many of the LDL’s have decreased into the normal range.

81. 81 Extraordinary Uses Electronic Kardex Hand-off Communication Tool Update Care Plans Performance Improvement Research Incomplete Admissions Personal Team Maintenance Assistance with medications Track Coumadin patients High Risk patient maintenance GYN – Women’s Clinic Mammogram Tracking Pain Assessment Report Fecal Occult Blood Test (FOBT) Outcomes LDL Identification/Education/Medication Reduction Program So, let’s review or recap again all the extraordinary ways that we can use the Care Management Application: As an Electronic Kardex As a Hand-off Communication Tool To Update Care Plans For Performance Improvement Researching To Find Incomplete Admissions Perform Personal Team Maintenance Provide Assistance with medications Track Coumadin patients High Risk patient maintenance GYN – Women’s Clinic Mammogram Tracking Pain Assessment Reports Finding Fecal Occult Blood Test (FOBT) Outcomes 13. LDL Identification/Education/Medication Reduction Program And so many more ways yet to discover! So if you haven’t started using the Care Management application, believe me, it will be worth your time & effort to start using this Vista application. So, let’s review or recap again all the extraordinary ways that we can use the Care Management Application: As an Electronic Kardex As a Hand-off Communication Tool To Update Care Plans For Performance Improvement Researching To Find Incomplete Admissions Perform Personal Team Maintenance Provide Assistance with medications Track Coumadin patients High Risk patient maintenance GYN – Women’s Clinic Mammogram Tracking Pain Assessment Reports Finding Fecal Occult Blood Test (FOBT) Outcomes 13. LDL Identification/Education/Medication Reduction Program And so many more ways yet to discover! So if you haven’t started using the Care Management application, believe me, it will be worth your time & effort to start using this Vista application.

82. 82 You have heard about many ways to use Care Management now, so what is the future for Care Management (HealtheVet Desktop)? We’re going to let Toni King tell you all about the application’s future plans. Toni?You have heard about many ways to use Care Management now, so what is the future for Care Management (HealtheVet Desktop)? We’re going to let Toni King tell you all about the application’s future plans. Toni?

83. 83 Future Uses Further development of Care Management for use to the field as a Hand-off communication tool Healthcare Analysis and Information Group (HAIG) at: http://vaww.va.gov/haig/handoff/Final_VHA_Nursing_HandOff06_Report.pdf Standardized Framework A person normally does not reconnect with an old friend without plans for the future. We will touch on just a few. In October of 2006 VHA nurses participated in a Handoff communication survey. There are 4 recommendations included in this report. The Office of Nursing Service under the direction of Oyweda Moorer, Program Director for Technology and Systems Design has been very busy working with various work groups to implement the recommendations. Today I want to focus on recommendation 1 since you can visit the Healthcare Analysis and Information Group (HAIG) and read the full 356 report. Recommendation 1: The Office of Nursing Services in collaboration with the Office of Information will develop a standardized framework for communication patient hand-offs. The group has been working to make recommendations for electronic tools that can be used at various sites throughout VHA. There is more information to come. With increasing focus being placed on patient safety and reliable handoff, Care Management is a friend that offers many options for using its applications on this journey.A person normally does not reconnect with an old friend without plans for the future. We will touch on just a few. In October of 2006 VHA nurses participated in a Handoff communication survey. There are 4 recommendations included in this report. The Office of Nursing Service under the direction of Oyweda Moorer, Program Director for Technology and Systems Design has been very busy working with various work groups to implement the recommendations. Today I want to focus on recommendation 1 since you can visit the Healthcare Analysis and Information Group (HAIG) and read the full 356 report. Recommendation 1: The Office of Nursing Services in collaboration with the Office of Information will develop a standardized framework for communication patient hand-offs. The group has been working to make recommendations for electronic tools that can be used at various sites throughout VHA. There is more information to come. With increasing focus being placed on patient safety and reliable handoff, Care Management is a friend that offers many options for using its applications on this journey.

84. 84 Future Uses (cont’d) Patch Status: ORRC*1*2 –corrects blank Patient Record Flag (PRF) dialogues ORRC*1*5 –Fixes to Care Management ORRC*1*6 –JRE compatibility issues with CM ORRC*1*7 what version and ORRC*1*8-Clinician/Nurse Dashboard co-existence and 508 fixes has been released by Enterprise Product Support (EPS) with a compliance install date of August 31, 2007 Several patches are in the works to correct some of the problems and to do enhancement fixes like eliminating blank patient record flags, compatibility issues, and 508 compliance. And, hopefully, with some future enhancement patches, like task and other printing options, we can use the application for a multitude of ways including using it in conjunction with our computer contingency plans. Several patches are in the works to correct some of the problems and to do enhancement fixes like eliminating blank patient record flags, compatibility issues, and 508 compliance. And, hopefully, with some future enhancement patches, like task and other printing options, we can use the application for a multitude of ways including using it in conjunction with our computer contingency plans.

85. 85 Summary Slide History Implementation CEU’s Hyperlink Educational Process Hand-Off Tool Update Care Plans Patient List Management Outpatient Uses of Care Management Future So what we have learned today? We can summarize the history of the Care Management application. We examined a lesson plan & instructional method to use for staff education with teaching emphasis. We processed how to provide CEU’s to encourage participation in training. We learned how to create a hyperlink on our home web page in order to view a VeHU Care Management class; and we learned how to employ ways to avoid resistance or problems with class scheduling and staffing. Finally, we can recognize the extraordinary uses of the functionality of Care Management’s beneficial perspectives: Like the Hand-Off tool/Electronic Kardex, Queries for Performance Measures, and we can describe the diverse and available uses of Care Management in their respective outpatient clinical settings. In addition we’ve had a glimpse of the future from this old friend. I hope everyone had a pleasant and informative learning experience. Thank you for gracing us with your time and attention.So what we have learned today? We can summarize the history of the Care Management application. We examined a lesson plan & instructional method to use for staff education with teaching emphasis. We processed how to provide CEU’s to encourage participation in training. We learned how to create a hyperlink on our home web page in order to view a VeHU Care Management class; and we learned how to employ ways to avoid resistance or problems with class scheduling and staffing. Finally, we can recognize the extraordinary uses of the functionality of Care Management’s beneficial perspectives: Like the Hand-Off tool/Electronic Kardex, Queries for Performance Measures, and we can describe the diverse and available uses of Care Management in their respective outpatient clinical settings. In addition we’ve had a glimpse of the future from this old friend. I hope everyone had a pleasant and informative learning experience. Thank you for gracing us with your time and attention.

86. 86 QUESTIONS? Now for the questions, let’s take a look at the index cards.Now for the questions, let’s take a look at the index cards.

87. 87 References Faustina, M.; Pasternock, J.; & Braithwaite, M. (2004). 103H Care Management for Nurses. Retrieved May 2006 from http://vaww.VeHU.med.va.gov/VeHU2004/ClassInfo/WBTInfo.cfm?ClassNum=103H Kreuz, Sheri & Pasternock, J. (2004). 291H Hands on Care Management for Nurses. Retrieved May 2006 from http://vaww.VeHU.med.va.gov/Catalog/WBT03.cfm?ClassNum=291H Funderstanding (2001). Instructional Technology. Retrieved February 26, 2007 from http://www.funderstanding.com/instructionaltechnology.cfm VHA Nursing Hand-Off Report (2006). Retrieved March 27, 2007 from http://vaww.va.gov/haig/Projects.htm