Nurse-Driven EHR Optimization

Navigating Blood Administration
Another project that the team worked on was creating an organized navigator to guide nurses through the entire blood administration process. “Because blood administration is so heavily regulated and there are so many checks and balances, there are challenges within the ordering of blood products—challenges with the transfusion, and then the documentation of the completion,” says Mitchell. “So there are several steps in blood administration and every one of them is in a certain sequence.”

In the previous vendor workflow, the system required the previous step to be completed before moving on to the next screen, but the blood administration steps were not organized. “So what we did was take all those steps and put them in a navigator, which is a step-by-step sequence, and we put the instructions so that you’d know your next step and also put in the prompts to complete the previous step before going to the next one,” Mitchell says. The blood administration workflow optimization was so highly praised at the Texas Health Presbyterian Hospital Dallas it achieved Nursing Magnet status.

Other EHR optimization activities included reorganization of nursing flowsheets to reduce redundancy, refinement of patient reports, as well as a total rework of care plans, providing better coordination between identification of a problem, goals, and interventions associated with flowsheet documentation. First, the collaborative tackled three care plans, the basic plan, heart failure, pneumonia, and will work on diabetes and acute myocardial infarction care plans next. “Care plans have been problematic for years and years, and my sense is we need care plans to be straightforward to guide the nursing process—helping the nurse see the total scope of the patient, what their needs are, to intervene on those needs, and report on how they’re doing [to meet those] needs,” says Mitchell.

Over the course of 13 months as these changes were implemented, the nursing team also assisted with training and support of the staff at their hospitals, along with other hospital nursing super users. With the last upgrade, in September 2011, workflow revision was completed. After the initial eight-week project, many of the same RN's have continued to meet and the group has now evolved into a Nursing Informatics Council that makes all recommendations for advancing technology, including, but not limited to CareConnect.

“This group, not only did they totally bond and become the experts, they became well-known as the go-to group to vet anything nursing-wise,” says Mitchell. “So everyone in IT, or in any other group, says they need to have the Nurse Champions look at this.”

The Nursing Informatics Council is currently reworking a patient handoff that tells the patient’s story with key data like relevant labs, alerts, and patient needs to communicate to other units or to other nurses at shift change. The group is also working on a nursing shift checklist that has color-coded prompts to show what has and has been accomplished during a shift.