CINs in PI The Impact the Clinical Informatics Nurse Has on Quality - PowerPoint Presentation

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CINs in PI The Impact the Clinical Informatics Nurse Has on Quality Improvement

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R. Hummel, R. Lapchak, R. Gonzalez, & M. G. Smith

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Purpose of Clinical Informatics2

Clinical Informatics has the ability to transform not only the way clinical staff document, but to improve upon their career satisfaction by providing the tools necessary for them to do their jobs. In addition, a strong Informatics team has the ability to impact patient care, patient safety, and the overall patient experience in a positive way. Clinical Informatics also has the ability to grow the business of healthcare by identifying trends through data analysis and assisting leadership in prioritizing areas in need of improvement in order to maximize reimbursements and avoiding being penalized for not meeting government standards.

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QuestionsBelow are some questions that every organization can ask to help determine which areas can be focused on to maximize the effectiveness of Informatics. These prompts can assist you in coming up with ideas to help your informatics department partner with other areas in order to benefit all.

What types of resources do you currently have in place for your end users if they have questions about documentation within your EMR? What about if they are in need of workflow analysis?How is your training team structured? How much experience/contact do your trainers have with clinicians outside of the classroom?Who trains MDs/DOs, NPs, Pas, RNs, on how to use the EMR upon being hired/transferred?When your hospital/network has a visit from Joint Commission or the DOH

, what role does your informatics department have, if any?

What type of role (if any) does the informatics department have with the Quality Department? Do you work together in PI projects? Medical Students? Research?

Are managers of inpatient floors and practices using reports in employee performance evaluations, compliance, and quality? What about their leadership?

In what ways do you feel your organization is using Informatics nurses in a positive way?

In what ways do you feel your organization can improve by using informatics nurses?

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Overview of ReportsReports are a way to track compliance with defined metrics.

The Clinical Informatics Team works with various network PI committees to define the metrics and revise them as necessary.The information obtained from the reports is used to provide feedback to managers and staff through the PI committees.Reports can be set up for public viewing so all staff can see them.There are a few types of reports: Analytical- Comprehensive, large chunks of data. Theses are set to gather information over a

pre-set period of time. Ex. 30 days, 1 week, etc. These provide a broader overview of clinical

metrics.

Operational

- Smaller amounts of data with the ability to look at more granular detail. These are

easier for end users to run and filter data to see performance of individuals or specific

departments. These can be application level reports also, which are built in to user screens for

real time information.

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Example Reports

Operational Nurse Collection Compliance Report Shows labs missing collection details in computer. The information is sued to track compliance with network policy and regulatory standards. The patient’s chart can be entered directly from the report.

IP Active Pressure Injury Report

Shows patients with active pressure injuries and this goes by log in department. It provides useful information for staff,

managers, and wound care nurses to track new wounds and progression of existing wounds. Below is an example of the

column headers. Under line name is the type of pressure ulcer.

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Example ReportsAnalytical

IP BCMA Report6Shows data on bar code scanning for medications and blood over a 2-week period. Filtering options include unit and patient. Can’t open chart from these reports to see more detail.

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Reports SummaryIt is important to know the reporting environments for your institution.

Obtain access to these environments and learn about how to run and interpret these reports.Work with analytics team and Performance Improvement department to improve care and complianceWork with clinical managers to utilize these report at the department level.7

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Reports and QualityHow can reports drive quality?8

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SummaryIt is important to know the reporting environments for your institution.

Obtain access to these environments and learn about how to run and interpret these reports.Work with analytics team and Performance Improvement department to improve care and complianceWork with clinical managers to utilize these report at the department level.9

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Getting into Performance Improvement10

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Institute for Healthcare Improvement ModelGetting Started - the 3 Questions:

What are we trying to accomplish?How will we know that a change is an improvement?What changes can we make that will result in improvement?

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AIM StatementMeasurable

Time-specificDefine specific population affectedExample:“Reduce the Fall rate in the acute care setting at Anderson to target rate of 3.2 by December 2017.”Consider 6 Dimensions of Quality (IOM):

Safety -Effectiveness

Patient Centeredness -Efficiency

Timeliness -Equitable

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TeamSelect the right people

Consider staff, managers, clinical/non-clinical staff, external personnelConsider processes & systems involvedLook to AIM statement for guidance

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Establish MeasuresDetermine what data is relevant

What is best practice?Determine Performance Improvement (PI) tools to display dataTypes of measures:

Outcome – how is system performing

Process – are parts of system working

Balanced – is one part of system causing problems with another part

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Select Changes for ImprovementDetermine what change (action) will result in improvement

All improvement requires change but not all changes result in improvement

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Plan – Do – Check – Act (PDCA)

Rapid Cycle PDCA

Plan

Do

Act

Check

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Rapid Cycle PDCA

Does not require buy-in from all involvedUses less resourcesPlanDefine cycles of change, who and how to implement, length of cycle, what data will be collected with each cycle DoTest, define where, who is responsible for test

Check

Recollect data, compare to prior results. Was there improvement?

Act

Need to revise? Test on larger scale?

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Implementing and Spreading ChangeAfter testing on small scale, refine and continue PDCA with larger sampling

Spread to other areas after success realized

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Rapid Cycle Tool19

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PI Tools – Idea GeneratingBrainstorming

Provides large amount of ideas in short timeframeMulti-votingSummarize and group brainstorming ideasAllows narrowing of long list to reach consensus

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PI Tools – Information GatheringSampling

Systematic or RandomKeep it small and simple Test before implementingSurvey1-5 questionsQuantifiable – Likert scale

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PI Tools - ProcessFlowchart

Shows steps in a processIdentifies duplication, risk pointsCan show current and ideal processes

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PI Tools –Cause and EffectFishbone (Ishikawa)

chartWhy, Why, Why……Identifies causes or the Root Cause

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PI Tools – Process AnalysisRun Chart

Shows change over timeControl ChartStatistical boundaries giving range for “normal”Shows if process is in controlSpecial Cause variation

Time to Get to Work

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PI Tools – Process AnalysisBar Charts

Shows comparisonsTypesSimpleStacked

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PI Tools – Process AnalysisPareto

Shows most frequent/important (80/20 rule)HistogramShows distribution

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PI Tools – Process AnalysisScatterplotsCollection of points showing relationships

between 2 variablesPie ChartShows distribution of a whole

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Contact InfoRenee.Lapchak@sluhn.orgMary.Smith3@sluhn.orgRena.Hummel@sluhn.org 28