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Admission History Data Base Changes VCH 11/2 1p-3p Place B319 11/8 Tue 3p-5p B319 makeup 11/15 730-930 am B319 makeup. Change in Philosphy. Admission History Data Base Changes VCH. Identify concerns Philosophy Change Commit to need for change Describe changes to admission history

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slide1

Admission History Data Base Changes VCH 11/2 1p-3p Place B319

11/8 Tue 3p-5p B319 makeup

11/15 730-930 am B319 makeup

admission history data base changes vch
Admission History Data Base Changes VCH
  • Identify concerns
  • Philosophy Change
  • Commit to need for change
  • Describe changes to admission history
  • Begin a unit-specific plans
  • Resources and tools to assist
  • GO LIVE 11/29/11.

Why

What

How

roles and responsibilities materials
Roles and Responsibilities & Materials

Unit Implementation plan template

Copies of the policies

Training Aides

Video clip

Practice scenario

Training patients name and MRN

LMS module

FAQ on SSS web site

Debriefings- flyer

  • SSS
  • Provide education for unit leadership
  • Resource for unit
  • Provider training resources for units
  • Round during implementation
  • Unit Leadership
  • Assess current workflow and impact of changes
  • Conduct unit education and assure staff complete
  • Support during implementation
  • Leadership to round during implementation to elicit feedback and monitor progress.
if it ain t broke1
If it ain’t broke…..

97% of admission hx started- only 10 % completed

TOO LONG!

Nurses “live” in HED – can’t we put this in HED???

No reminders if not finished

8 hours is not long enough time to get it done.

Must leave Admit History form and go to HEO to enter orders

It doesn’t track who entered each piece of data so I start a new one even if there is a draft

When I am worried about keeping patient alive upon admission, I shouldn’t have to document discharge plans

Redundant information collection- Patient complained they have already answered these

No one looks at it! This is just a waste of time

vuh and vch reps
VUH and VCH Reps
  • VCH Acute Care (& 3A) – Christy Weems, Educator, VCH Float Pool
  • PCCU, VCH – Lydia Colley, Educator, PCCU
  • Peds ED & Obs. – Missy Sweeney, Assist. Mgr., Peds ED
  • VUH Critical Care – Crystal Creath, 10N
  • VUH Acute Care – Sabrina (“Sam”) Henley, 8s
  • VUH Procedural Areas – Tiffany Richmond, Assist Mgr., Cath Lab
  • VUH OB – Rosha Spencer & Blair Anderson
  • VUH Op. Svcs. – Cathy A. Lee, RN, PACU; Diane Johnson, Dir., Op. Svcs.; Laura Hollis, Op. Svcs.
  • Vicki Thompson, VCH Admin.
  • Deborah Ariosto, Dir., Patient Care Informatics
  • Karen Hughart, Dir., Systems Support Services
  • Nancy Rudge & Bill Raines, HED Builder Team
  • Cheryl Dozier, Accreditation and Standards
  • Ex Officio for specific questions: Mary Reeves, Sandy Bledsoe, Julia Morris, Julie Morath, Page Conatser, Jenny Slayton, Stephanie Randa, (Exec. Sponsor)

Work began May 2011

vision and goals
Vision and Goals
  • Collect data once and pass to all systems and users who need to view
  • Collect data by time it will be needed
  • Minimize data collection during critical stabilization period (1st 1-2 hrs.)

Meet minimum regulatory requirements

Optimum workflow process associated with admission phase of care (up to 24 hrs. max.)

HITECH

tried to format in hed
TRIED TO FORMAT IN HED

DATA

Amount of scrolling up and down and back and forth to see data and what was incomplete was impossible

Future: Admit History data imported into HED

decreased need to toggle to heo wiz
Decreased Need to Toggle to HEO/WIZ

Auto generated orders and alerts eliminate need for nurse to enter some orders in HEO/WIZ

not a form to complete but data to collect
Not a form to complete but data to collect

Positive Social Work screen generates Social Work notification

Data displayed on OPC, Team Summary, Ancillary Dashboards

Immunization screen generates order for vaccine and scheduled for 10am next morning

Religion, tobacco status, and other information, stored and retrieved on subsequent admissions

electronic signature tied to data
Electronic Signature Tied to Data

Click to display ID of person collecting data

data shared
Data Shared

OPC, Charge Nurse Worksheet

Link to view

Team Summary, Resident Handover

Readmission Risk Scale

(in development)

Eventually imported into HED

reminders
Reminders

Adm

Tx

Dischg

Hover over indicator to see what Admission requirement is not yet completed (ie section 1,2,3)

= done within correct time frame

= time frame to complete nearly over

= time frame to complete has expired (BUT action still needed!)

i critical for safe care1
I Critical for Safe Care

New visitor policy: patient is allowed to have support person stay with them 24/7

Data will be shown on OPC initially and then other electronic documents later

i critical for safe care2
I Critical for Safe Care

Legal Documents

All permanent chart documents now scanned at discharge

i critical for safe care3
I Critical for Safe Care

New Present On Admission Screening

Awareness is Key to Improved Communication Among Team Members

slide23

Positives will trigger various decision support responses:

    • Pacemaker/ICD triggers HEO decision support w/ MRI orders
    • Dialysis prohibits some renal dose adjustment warnings in HEO
    • Pressure Ulcers on admission will display on the PUPS dashboard but an orders will need to be entered in HEO/WIZ if WOC specialists needs to see the patient.
    • CPAP home use will trigger protocol order for Respiratory Care evaluation
    • Medication Pump usage will be shared as appropriate with other disciplines
    • Patient Pregnant, Patient Lactating sent to Pharmacy for decision support on medications .
slide24

CPAP Summary –What You Need to Know

  • Patients that use CPAP at home need to use CPAP in the Hospital
  • RT will evaluate machine - will probably use VUMC equipment to assure proper functioning
  • In addition:
    • Increased vigilance when general anesthesia, sedation, or intravenous (IV) analgesia/opioids are required.
    • Elevate head of bed 30-40 degrees if not contraindicated
    • Communicate that the patient has obstructive sleep apnea during handover to other care providers as well as in transfer to ancillary departments

A Protocol order will be generated from the Nursing Admission History when the nurse documents a positive response from the patient .

“Home CPAP Evaluation and Initiation” order will generate to the Respiratory Therapy Department and the respiratory therapist (RT) will evaluate and initiate therapy at the patients bedtime.

slide25

Leaving a question blank or selecting “Unable to complete” triggers indicators on the inpatient whiteboard.

ii plan of care1
II Plan of Care

Past Medical & Surgical History

Physician responsibility to enter and link displays in Admission History

ii plan of care2
II Plan of Care

If select “yes” smokes must select response regarding frequency

slide30

Global Immunization

It our responsibility to screen patients for appropriate vaccines and offervaccines to patients that meet positive screening criteria.

Patients always have the right to decline.

slide31

Influenza

  • 5% - 20% of population in US gets the flu
  • 200,000 people are hospitalized from seasonal flu-related complications
  • between 1976 -2006, flu-associated deaths range from a low of about 3,000 to a high of about 49,000 people.

The 2011-2012 flu vaccine will protect against the three influenza viruses that research indicates will be most common during the season. This includes an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus.

Flu season October till March 1 and everyone six months and older should get vaccinated.

slide34

FUTURE: If selected that pt has had an immunization, it will automatically update the immunization record as a historical vaccine.

Had flu shot elsewhere= automatic update to immunization record

+ screen = automatic order in heo/wiz

Positive screens will result in an order for the flu vaccine being automatically generated in HEO/WIZ when the admission history is saved. The vaccine will be scheduled in Admin Rx with frequency of 1XBYRX and Pharmacist will administer.

PCCU, heme/onc, ID, rheumatology and cardiology patients who qualify for the flu shot will have alert sent to a StarPanel worklist and be evaluated by the physician staff/clinical pharmacy.

slide35

In VCH, the Pharmacist will administer the vaccines and document administration in Admin Rx.

MAJOR CHANGE

Care Organizer and Admin Rx will list the frequency for the vaccine as “1X by RX” to indicate that the Pharmacist will administer.

The pharmacist will bring medication instead of it being delivered.

nutrition dashboard

II Plan of Care

Nutrition Dashboard

Positive screen trigger notification to nutrition services via the dashboard

slide38

Learning Readiness/ADLs

Information will display on OPC

and eventually feed Readmission screen and Patient Education and Engagement Record (PEER)

ii plan of care6
II Plan of Care

Child Life Screening

iii discharge functional screens
III Discharge/Functional Screens

Physician will be notified of positive Functional screens as only providers may order Rehab evaluations in Tennessee

Use the Complete button ONLY WHEN ALL THE DATA HAS BEEN COLLECTED.

can i do all sections at once
Can I do all sections at once?

YES

The admit history may be completed at one time if that is practical.

Important thing is to get the data collected.

Previously all data had to be collected within 8 hours.

Now have up to 24hrs to collect.

admission history indicator
Admission History Indicator

Not in nurses current workflow to verify Admission History is completed.

Indicator on whiteboard should help

slide44

Even if past 24 hours,

collect the data

The data is important.

future changes
Future Changes

Notification Bar at top of CWS to display dashboard of patient assignment while in HED or HEO/WIZ or any application. This will make it easier to see indicators and to navigate – coming in 2012

Braden Tool in HED instead of HEO/WIZ is projected to be available soon

slide47

“Nothing motivates more than success. We need to define and engineer visible performance improvement. “

next steps
Next Steps

Discuss with leadership team and finalize training / support plans.

Conduct Training

Print and distribute practice scenario

Monitor practice by staff

Round during implementation

Post Debriefing flyer and encourage attendance

optional resources
Optional Resources

Web Based Resources

SSS Web Site->Documentation updates->Admission History Data Base Changes

http://www.mc.vanderbilt.edu/root/vumc.php?site=sss2&doc=33860

LMS Module- Title “Admission History Changes 2011”

http://vanderbilt.mzinga.com/app/servlet/navigation

important dates times
Important Dates/Times

More Sessions like this one

11/8 Tue 3p-5p B319 makeup

11/15 730-930 am B319 makeup

Implementation 11/29 Tue

  • SSS will make rounds
  • Call Help desk (3-3457) if need assistance

Debriefing Sessions

  • Nov 29th Tue 4-430pm – 5009 VCH
  • Nov 30th Wed 2-230 pm – 5009 VCH
  • Dec 1 Thur 730-8am – 7011 VCH