Winchester Medical Center, a 411-bed community hospital in Winchester, Va., part of the six-hospital Valley Health system in Virginia, West Virginia, and Maryland, has been taking an innovative approach to inpatient education. The hospital has been using patient engagement software from the Bethesda, Md.-based GetWellNetwork since 2003. Currently, the hospital has 360 beds live with the service and has implemented some key applications including a falls pathway, pain management pathway, and service recovery pathway. Beginning in 2008 the results from the patient engagement software fed back into the hospital’s electronic medical record (EMR) from the San Francisco, Calif.-based McKesson, and a GetWellNetwork tab was added in the EMR so clinicians could verify that patients watched certain education videos and record patient pain assessments.
Janet Palutke, R.N., M.S.N., administrative director of nursing support services at Winchester says in 2010 its patient engagement software prompted 16,854 patients with 199,000 prompts and elicited 7,436 patient responses. The software recorded 25,762 results, which was the same amount of times a nurse didn’t have to go into the patient’s room and document the effectiveness of a pain medication. In total for 2010, the software resulted in 1,604 saved nursing hours.
According to the Centers for Disease Control (CDC), more than one-third of people aged 65 and older fall each year, and those who fall once are two to three times more likely to fall again. In 2000, the CDC reports that direct medical costs for fall injuries totaled $19 billion. In 2010, Winchester improved its patient fall rates by 31 percent, with help from its patient engagement fall prevention pathway, Palutke says. She also notes it’s not all rosy news with this particular patient education pathway, as many patients enrol in this pathway, but few finish the last survey in the pathway, which is re-taking the initial survey. “Falls prevention is a challenge,” Palutke says. “The root of the problem is patients aren’t involved. If the patient doesn’t really grasp that indeed they are a falls risk, they’re not going to follow the interventions you prescribe.”
In November 2009 Winchester implemented electronic medication administration record (eMAR) and GetWellNetwork’s pain management pathway. When the nurse scans the pain medication it is electronically recorded in the patient’s record and automates the pain management pathway. After the requisite amount of time after medication administration, a message will pop up on the patient’s screen for the patient to rate their pain on a one to 10 scale. If the pain level is a three and below, that is considered manageable and charted in the patient’s chart. If the number is a four and above, the software sends a text with the pain number to the nurse. After a time and motion study, Winchester found it took nine minutes to respond to a patient’s call for pain management and nurses spent 2,164 hours checking on effectiveness of pain medications. With the pain management pathway, Winchester has saved 1,905 nursing hours and $165,218 in 2010.
Patient, Caregiver Education
Winchester is in the process of implementing a new patient/caregiver education pathway that allows both parties to learn via prescribed care videos about the medications the patient is on and post-discharge care, and then take a comprehensive quiz afterwards to test the efficacy of the training. The pilot that will be starting in May and focus on stroke patients in the neuroscience unit. “We want to ask the neurosurgeons if they would like us to develop a specific education video, and we’d do a PowerPoint and a voiceover on their discharge instructions,” Palutke says. “They’re not difficult to do, it’s just getting the time to do them.”
She says that nurses will take pre- and post-initiative surveys to evaluate if the patient education helps lighten their load. If this pilot is successful Palutke sees this program rolling out to oncology, critical care, and NICU units. Other ways that Winchester uses patient engagement software are in maternity to remind patients to add their newborns to their insurance policies, and during discharge to send a message to a patient’s family to tell them to bring the car around once the patient has been discharged. Palutke hopes that future uses for this software will include a post discharge module that will allow patients to log on to a secure site to get education and discharge instructions, as well as a pre-operative module.