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“Electronic Charting: The ‘Spring’ of a New Documentation Era”. Steve Biondi, M.S., RN Wendy Ehnis, M.S.N., RN Rita Roedel, M.S., RN Extendicare Health Services, Inc. Spring Thoughts. In like a Lion out like a Lamb Spring Forward Spring Training Spring Fever. Focal Areas. Why

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Electronic charting the spring of a new documentation era

“Electronic Charting: The ‘Spring’ of a New Documentation Era”

Steve Biondi, M.S., RN

Wendy Ehnis, M.S.N., RN

Rita Roedel, M.S., RN

Extendicare Health Services, Inc.


Spring thoughts
Spring Thoughts Documentation Era”

  • In like a Lion out like a Lamb

  • Spring Forward

  • Spring Training

  • Spring Fever


Focal areas
Focal Areas Documentation Era”

  • Why

  • Pilot Experience

  • Front Line Staff Characteristics

  • Documentation Elements

  • System Design

  • Operational Considerations

  • Teaching Strategies

  • Outcomes


Background
Background Documentation Era”

Why

  • Wanted to improve resident care

    • Real time documentation

    • Up to the minute compliance monitoring

    • Standardization of charting

    • Eliminate illegible handwriting

  • Wanted to improve manual system

    • Incomplete

    • Labor intensive

    • Data analysis was difficult

    • Trending was cumbersome

  • People at all organizational levels had positive experience with electronic CNA charting system


Background1
Background Documentation Era”

Outcomes

  • Easy to learn

  • Flexible as documentation parameters change

  • Easy to use


Background2
Background Documentation Era”

Pilot

  • Facility proven track record

    • Stable Administrator, DON, MDS Coordinator

    • Good survey history

    • Supportive of corporate systems

    • Adapts well to change

  • Five geographically diverse locations began in April 2006

  • Four basic clinical parameters chosen

  • Within 6 months decided to implement corporate wide



Front line staff
Front Line Staff possible.”

Characteristics

  • Visual Learners

    • Bright colors

    • Visual Cues

    • Emphasize key concepts

  • Native Language

    • Workforce diversity

  • Reading Skills

    • Simple terms

    • Reinforce with graphics


Front line staff1
Front Line Staff possible.”

As Adult Learners

  • Need to see value of system

  • Need to see practicality of system

  • Need to be shown respect for prior life and work experiences


Documentation elements
Documentation Elements possible.”

Why Chosen

  • Based on elements most frequently charted by CNAs

  • Encompass some of more prominent QI/QM and RUG elements that are critical to the resident POC


Documentation implementation elements
Documentation possible.”Implementation Elements


Documentation
Documentation possible.”

Elements

  • Mood (E)

    • 16 elements

    • Frequency

      • Up to 5 days

      • 6 to 7 days

  • Behavior (E)

    • 6 elements

    • Frequency

      • 1 to 3 days

      • 4 to 6 days

      • Daily


Documentation1
Documentation possible.”

Elements

  • Mood (E)/Behavior (E)

    • Consider alterability

      • System tracks interventions tried

      • Effectiveness of interventions


Documentation2
Documentation possible.”

Elements

  • ADLs (G)

    • 11 Elements

    • Self performance and support provided

    • Focus “late loss” because of RUG and QI/QM implications

      • Bed mobility

      • Transfer

      • Eating

      • Toilet Use


Documentation3
Documentation possible.”

Elements

  • Continence (H)

    • Bowel/Bladder

    • Self control categories

    • Scheduled toileting

    • Bladder retraining


Documentation4
Documentation possible.”

Elements

  • Weight Loss (K)

    • 5% 30 days

    • 10% 180 days

    • System has flexibility for percentages and time parameters

  • Nutritional Approaches (K)

    • Considers IV, tube feeding

    • Tracking of food and fluid intake


Documentation5
Documentation possible.”

Elements Added

  • Restorative Nursing (P)

    • Number of minutes/24 hours

    • Number of days > 15 minutes/24 hours

  • Staff consistently communicate they want documentation on elements added!!



Documentation system
Documentation System possible.”

Design

  • Easy to learn

    • Must be able to de-”CMSize” language (i.e. support provided of 1 person coded 2 on MDS)

    • Get up to speed quickly

  • Visual

    • Images/graphics reinforce key concepts

  • Basic reading skills

    • Target was 6th – 8th grade level

  • Time sensitive

    • Entries date/time stamped

    • Prohibit charting until logical (i.e. unable to document lunch consumption until time appropriate)


Documentation system1
Documentation System possible.”

Design (cont.)

  • Independent

    • Avoid “copy cat” charting

  • Staff working smarter

    • “Chart as you go”

    • Alerts staff to situations requiring attention

      • No bm in last 9 shifts

      • Less than 1000 cc fluid intake over 24 hours

  • Acknowledge job well done

    • Real time feedback

    • Able to pinpoint shift, location, individual employee performance


Operational considerations
Operational Considerations possible.”

Security access

  • Based on function at building

    • CNA kiosk for data entry

    • Licensed staff care alert reports

  • HIPAA compliance

    • Used unique resident demographic information

    • Reinforced confidentiality @ kiosks

  • System backup

    • Nightly back-up at off-site date center

  • Home like environment

    • Aquarium screen saver



Flexible teaching strategies
Flexible Teaching Strategies full of slush.”

  • Classroom

    • Initial rollout training

    • Short session

  • One – to – One

    • Kiosk for data entry

    • Work station for report overviews

    • Used tell-show-do approach

  • Chewable bits

    • ADL and Mood/Behavior coding week before

    • Education Resource Binder

      • Mood/Behavior Bingo

      • ADL cards describing scenario

    • Real time resident function/behavior


Flexible teaching strategies cont
Flexible Teaching Strategies full of slush.”(cont.)

  • Visual Aids

    • Quick reference laminates at Kiosks

    • Story boards

    • System has additional help screens

  • Key Points

    • 75% adults retain more information from sight education than other senses

    • 72 hours is key for retention of learning

      • Went live within 24 hours


Outcomes
Outcomes full of slush.”

  • Completeness of documentation

    • Corporate standard > 95%

    • Consider

      • 100 documentation elements

      • 100 bed SNF

      • 10,000 documentation elements/24 hours @ 95 compliance is 9500

  • Monitor resident status

    • Care alert reports

  • Enhanced communication

    • Messaging feature

  • Catch staff doing it right

    • Individual staff, shift, unit

  • Capture resident acuity

    • Fewer “holes”

    • Multiple entries

  • Fire story


Spring is natures way of saying let s party robin williams
Spring is natures way of saying “Let’s Party!” full of slush.”--Robin Williams


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