A Digital Prescription for Effective Nursing Practice · A Digital Prescription for Effective Nursing Practice Tricia Thomas, Chief Nursing Officer, Trinity Home Health Frances Dare,

A Digital Prescription for Effective Nursing Practice

Tricia Thomas, Chief Nursing Officer, Trinity Home Health

Frances Dare, Managing Director, Accenture

March 3, 2016

Conflict of Interest

Tricia Thomas, PhD, RN

Has no real or apparent conflicts of interest to report

Frances Dare, MBA

Has no real or apparent conflicts of interest to report

• Today’s Nurse Communication Challenges

• Technology’s Role with the Challenges

• Integrated Technology and Clinical Practice Examples

• Integrated Technology and Practice Vision

• Working Together

Agenda

• Discuss the primary communication challenges nurses face: frequent

interruptions, difficulties interacting with others, time loss locating other

team members and equipment, and barriers to communication with patient

families

• Explain effective communication methods and the best enabling

technologies

• Demonstrate how integrated communication technologies and mobile

devices can support efficient, effective clinical practice

• Identify ways IT leadership can collaborate with nursing leadership to

improve clinical practice, efficiency and quality enabled by information and

communication technologies

Learning Objectives

Question 1

TRUE OR FALSE:

More than half of the HCHAPS (Hospital Consumer Assessment of

Healthcare Providers and Systems) patient satisfaction questions

focus directly on nurse – patient communication or nursing practice

impacted by communication challenges.

Observation and 1:1 shadowing:

24 x 7

All shifts

Understanding The Situation

Wide range of units and services:

Emergency

Intensive Care

Medical-Surgical

Short Stay

Post Anesthesia Care

Three hospitals – two states:

Community and academic

Small and large

SATISFACTION • High stress for nurses

• Frustration for families S

Realizing Value . . . The Starting Point

TREATMENT / CLINICAL • 1 page every 2.5 minutes

T

ELECTRONIC SECURE DATA • Unencrypted text work arounds

E

SAVINGS • 19 lost minutes per hour

• 9 minutes to find receiving RN, complete handoff S

Sources: http://ihealthtran.com/wordpress/2013/07/infographic-realizing-the-value-of-health-it/

2.6m registered nurses in the US workforce

62% of nurses work in hospitals

4x as many registered nurses as physicians in the U.S

Why Nursing Communication Matters

Sources:

http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-fact-sheet

http://www.jointcommission.org/assets/1/18/Root_Causes_Event_Type_2004-2Q_2015.pdf

http://www.ncbi.nlm.nih.gov/pubmed/20812527 2010 Jul-Aug;55(4):265-81; discussion 281-2.

Communication top 3 cause of sentinel events

$12B waste annually in US hospitals due to inefficient

communication

Average 500 bed hospital loses approximately $4m

annually

A Day in the Life of a Nurse

15 interruptions 1 patient 1 hour

minute for transition

conversations

1

minutes between

overhead pages

3

minutes lost with

transfer delays

19+

Biggest time loss—

locating other clinicians

Frequency and variety of

interruptions

Need for communication

options with patients

and families

Technologies have

increased

communication

expectations

EHR potential for

streamlined

communication

not yet realized

Tension between best

quality and most

efficient communication

Communication Challenges Key Findings

Today’s Technology Avalanche

Trinity Initiative: “Doc Halo”

COMMUNICATION

NEED

• Secure, real time communication

between nurses and broader care

team

SOLUTION

• Secure text messages and images

• Mobile phone based

• Interruption management via phone

controls

IMPACT • Decreased interruptions

• Time savings

E

Trinity Initiative: “Clarvia” S

COMMUNICATION

NEED • Complete, timely acuity information

SOLUTION

• Application to determine nurse

staffing based upon clinical record

• Data from EHR nursing

documentation an interventions—

33,000 mapped items

• Partnership between CNO, CFO

and CIO

IMPACT

• Right number and types of staff

• Improved patient and staff

satisfaction

Trinity Initiative: Fetal Link

COMMUNICATION

NEED

• Simultaneous sharing of

information between nurses and

physicians

SOLUTION

• Fetal monitoring strips and some

nursing documentation shared

• Real-time viewing regardless of

location

• MD access via phone or tablet

IMPACT

• 14 fewer nurse-physician calls per

patient

• Improved patient safety and care

quality

S

Question 2

TRUE OR FALSE:

Hospitals should implement technologies that ensure nurses are

interrupted only as allowed within set clinical practice policies.

• One Device

– Integrated functionality

• Constant Visibility

– Patients

– Team members

• Control

– Availability

– Communication medium

• Rewards and Reinforcement

– Individual and team behaviors

– Fun

Technology Nurses Dream Of

The Mobile Prescription—A Technology Concept

15 interruptions 1 patient

A View of the Possible

Question 3

Which of the following is an important “best practice” for

technology teams to support more effective nursing

communication:

A. Customize technologies based upon requests from individual

departments or units

B. Establish end-of-life policies for legacy technologies

C. Follow a best-of-breed approach to identify and implement

communication and collaboration technologies

How Nursing and IT Can Work Together

• Essential to have partnership between nurses and IT

– Different vantage points

• Use of councils/committees

– Share purpose, common and shared language

• Enterprise approaches

– Collaborate on content, flow, function

• Address concerns related to safety, quality,

cost, and functionality

SATISFACTION • Easier workflows for nurses

• Improved patient satisfaction S

Realizing Value . . . Impact Achieved

TREATMENT / CLINICAL • Reduced interruptions

T

ELECTRONIC SECURE DATA • Increased data and image security

E

SAVINGS • 3 minutes saved per encounter

• 14 fewer calls to physicians per patient S

Sources: http://ihealthtran.com/wordpress/2013/07/infographic-realizing-the-value-of-health-it/

22

“This is a potential game changer.”

– Health System COO

An Executive-Level Imperative

Questions

Tricia Thomas PhD, RN

Chief Nursing Officer

Trinity Home Health

thompatl@trinity-health.org

@francesdare

Frances Dare, MBA

Managing Director

Clinical and Health Management

Services

frances.dare@accenture.com