Magnet Nurses Embrace Computerized Provider Order Entry (CPOE) to Increase Patient Safety Standards. Kaileen Runnells BSN, RN The Acadia Hospital Bangor, Maine. Background.
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Kaileen Runnells BSN, RN
The Acadia Hospital
The case for implementing Computerized Physician Order Entry is strongly linked to an organization’s desire to improve the safety and quality of health care
The primary mission of the Acadia Hospital is the provision of both hospital-based and community-based mental health and substance abuse treatment services to the people of Maine that reflects the provision quality services fostering dignity and positive environment.
Patient First with Patient Safety is a key priority Why? Advances in patient safety is a requirement of Magnet Status. As a healthcare facility in the 21st century there is high rates of human error due to system failures. This process can assist the healthcare facility in reduction of human error with implementation of checks and balances
Federal Stimulus Package for electronic documentation
Patricia Benner’s Novice to Expert theory was used to incorporate a strategic method of implementing computerized charting that would involve nursing at all levels of the organization
The Coach Model
Identifying champions (CPOE) to Increase
The coach model
Integration into multidisciplinary existing hospital committees: Nursing leadership, Medical Staff Leadership, Compliance Committee, Executive and Clinical Leadership Committee
Go live support
Continuous improvement and evaluation
Our champions: Medical director, Chief Nursing Officer
3 doctors from patient care areas identified as knowledgeable and key to implementing CPOE
Doctors, LIP's were asking for electronic charting, and order entry.
2002 EMHS and The Acadia Hospital started electronic charting.
While working as a floor nurse our nurse educator began working with education to teach and implement electronic charting to employees.
In 2007/2008 Nurse educator began interviewing and questioning the process of educating nurses and doctors regarding electronic charting. The Coach model was utilized and revised.
Why did we choose the coach model?
Identified as the best model to disseminate information to all staff (subject matter experts) “SME”.
Promoted end-user (nurses, psychiatric technicians, doctors, secretaries, and clinicians) involvement which encouraged buy in by all staff.
Involved them in the decision making process
As classroom instructors, floaters, and/or facilitators
As end-user conversion support coaches at go-live
As end-user support post go-live
Participate in MEETINGS
Interface with the Training Coordinator, Department Managers and project team to accomplish training
Make referrals when special training situations occur
Serve as the main provider of work area support
Serve as a resource and mentor in performing proper application functions on the job
Ideal ratio: One Computer Coach for every 15 end users.
Who is a Coach (CPOE) to Increase
Into multidisciplinary existing hospital committees (CPOE) to Increase
Nursing Leadership Committee meetings
Medical Staff Committee meetings
Nursing Educators trained in CPOE
Set up mandatory training for all staff
Nurse managers and nurse educator identified staff and personally discussed and promoted staff involvement in CPOE implementation
How We Integrated CPOE
24 hour on campus support for 3 weeks (Consisted of Clinical IS staff, nurse educators and coaches)
Set up a command center where all calls were diverted to for assistance regarding CPOE and distributed CPOE command center telephone number to all inpatient units and all outpatient areas.
Nurse educator and several coaches carried cell phones utilizing text messaging to communicate where assistance was needed. This enhanced response time for the doctors and LIP's that were in need of assistance.
Daily meetings to review prior days implementation, reviewed logged calls from LIP’s; and reviewed all logged issues to resolve them. Put out flyer updates to coaches to educate the staff regarding any changes made to the CPOE environment.
Disseminated a schedule of coaches available to all managers for all 3 weeks, coaches were identified by a light blue t-shirt.
Coaches decreased anxiety as the end user knows there is someone available for support
Conditions of employment that requires utilization of CPOE
Establishing and measuring baseline measures of effectiveness
Performing audits after the implementation of applications and providing refresher training for staff as necessary.
Expectation that staff must achieve an 85% level of competency prior to implementation of any new application.
Initial Results (CPOE) to Increase
July 2010 (CPOE) to Increase
Quotes (CPOE) to Increase
Leadership Commitment, Support and Active Involvement IS A MUST HAVE
Planned/Staged Implementation of the Milestones
Dedicated Staff with subject matter expertise actively engaged in every aspect of the project. (Providers, Nurses, Unit Secretaries, Educators, etc….)
Effective Communication Plan that requires regular updates and reaches all staff affected by the process
Dedicated Coaches engaged as support for training and implementation.
Coaches that are providing at elbow support can not be included in direct patient care count.
Something to think about is going Live with the complete system versus staged implementation of each paper item to computer?
Interview with nurse educator for CPOE (CPOE) to Increase
Champion doctors and LIP’s