Glossary
NK - New Knowledge, Innovation, and Improvements

NK9. Describe and demonstrate the structures and processes by which nurses are involved with the evaluation and allocations of technology and information systems to support practice or nurses involvement in architectural and space design to support practice.

Various structures and process are in place to facilitate nurse involvement in the evaluation and allocation of technology and information systems to support practice. The key structures at JCMC in which nurses are involved in the evaluation and allocation of technology and information system are the Nursing Clinical Informatics Team, EMR Implementation Team, Medication Administration Work Group, and The Clinical Decision Support Steering Committee.

Liberty Soarian Clinicals Time Line

In 2011 Jersey City Medical Center started on its journey to implementation of the Sorian Electronic Medical Record System (EMR). The main reason for putting in the EMR is to improve quality, safety, and efficiency. During the implementation process a great deal of work was accomplished with the clinical staff and multidisciplinary team in clinical work sessions and work groups. The goal was to ensure that clinicians have streamlined their new work flow process with their focus on delivering high quality, efficient, evidences based care driven by improving patient outcomes.

In order to allow for a well planned role out of Sorian EMR implementation the following time line was followed: The first piece to go up was the pharmacy system upgrade which occurred in April of 2012, house orders and results began in June 2012, and between August through September of 2012, The clinical documentation system for nursing will be rolled out in phases by unit. In order to maintain the timeline the Nursing clinical informatics team was essential in making this happen.

Nursing Clinical Informatics Team

A core group of nurses comprise the nursing Clinical Informatics Department. This group was chosen due to their extensive clinical and EMR background.

NK9-Table 1

 

During the initial phases this core group took on the challenge of designing the system. They began with thorough investigation of the current process at JCMC to discover the different procedures impacting patient care in various departments. To accomplish this goal they had to work closely with the interdisciplinary teams from different department and specialties. After the design phase they began configurations of the programs that directly impacted work flows such as the clinical documentation and orders system. The third step was the testing. A testing environment was designed. Staff RNs and Patient Care Technicians from different units participated in the integrated testing. The test environment was created and tested using a test patient account. 26 Nurses and PCTs as listed on the attendance record (Appendix NK9-A), participated in charting and entering orders, navigating the system identifying problem areas and making recommendations for improvement (Appendix NK9-B).

Clinical Decision Support Steering Committee CDS

The CDS steering committee is a multidisciplinary group of doctors, nurses, IT, Health Information Management, unit staff and allied health professionals. The committee is charged with overseeing the implementation deployment and maintenance of Clinical Decision support tools using the EMR. During the last few months this they have been handling evidence based Physician order sets and other clinical rules and alerts that apply to medical practice. For an example of a meeting agenda please refer to Appendix NK9-C.

Nursing Members of the CDS Steering Committee:

NK9-Table 2

Medication Administration Check Workgroup

Medication Administration Check Workgroup
         

Medication Administration Check Workgroup

Along side the clinical informatics teams, various work groups were busy discussing the changes that will occur with the current processes, and led the design effort on the tools clinicians will use on a daily basis. The Medication Administration Check Workgroup comprised of Nurse, Respiratory Therapists, and Managers, were very busy making decision that were integral to the way that the nursing staff at JCMC will administer medication in the future. Please refer to (Appendix NK9-D) for groups working scope. The group main objectives were to:

  • Work with the nursing staff to identify the staff perspective on medication dispensing, retrieving, and administration workflow
  • Review the specific features of devices that would be used at the bedside
  • Discuss and evaluate bar coded patient arm bands

The MAK group’s first big task was to select the workstations that would be used for medication administration and documentation. The team considered using carts with multiple patient drawers to improve the work process in medication administration by decreasing the amount of trip to the medication room, thus raising efficiency. Team members also considered the significant differences between the carts as directly related to locked drawer capacity, in which nurse had individual patient drawers to store mediations, as well as separate drawers for locked supplies, such as syringes. A vendor fair was held to evaluate different products available. The fair was open to all nursing staff.

After reviewing five vendors, the group selected the Rubbermaid device that will be used on a majority of units by Physicians, Nurses, Respiratory therapists and PCTs. The carts debuted on the units when Siemens went live with clinical orders and results. Staff nurses on each unit are now becoming accustomed to the device prior to the start of electronic medication administration coming later this year.

In addition to selecting the carts and their configuration, the staff nurses also chose the patient armband that will be used. Staff nurses volunteered to wear the band for days at a time to ensure that they were durable.

The Medication Administration Check (MAK) workgroup

NK9-Table 3

Clinical Documentation Work Group

The Clinical Documentation Work Group took on the challenge of evaluating and evaluating and designing the process for the clinical documentation. They had the task of ensuring that the process was suitable for every clinician including physicians, nurses, and unit clerks. In order to be successful they had to design a workflow that incorporated every stakeholder from the ground up. This group met frequently to address workflows design such as lab ordering and specimen collection, verbal orders policy, stat orders, screen views etc.

Clinical Documentation Work Group Staff Nurses

NK9-Table 4

Work Flow Process Designed by Clinical Documentation Work Group

Work Flow Process Designed by Clinical Documentation Work Group

Nursing Testimonials

My staff and I have worked closely with the EMR team to build our portion from the ground up. As a nurse manager it is very important to embrace this project hands on and full assist my staff through the process – Selina Bray BSN, RN Nurse Manager of Behavior Health

I was concerned there would be a huge learning curve and feared people would not be willing to change, but now I know we can work together as professionals and are able to break through the barriers and learn from each other – Dhaneesha R. Bahadur MSN, RN 5E Staff RN

Implementation of Nursing “Super Users”

Jersey City Medical Center went live with EMR on July 24th 2012. A phased approached was implemented. After July 24th, all admission assessments, vital signs, patient education, falls assessment, discharge instructions, death assessment, NIH Stroke Scale, orders, and results are completed using the EMR. In order to prepare the nursing staff for the EMR go live date, Super Users were trained to provide frontline training support to nursing staff on all nursing units.

Adequately training users to learn a new computer application is extremely important to the success of EMR implementation house wide. The Clinical Informatics team understood the importance of providing education and support in a way that was beneficial and encouraging to the Super User. Michelle Ventura, a CNL Student from Seton Hall University conducted an extensive literature review on the modalities most effective in training super users. Based on this review an extensive education and training plan was established

All Super Users participated in the house wide education session provided to all nurses at JCMC. In addition the super user training plan consisted of daily open lab sessions which were held from July 10-20th. Super users came and practiced as often as necessary until they felt comfortable with their skills. During these sessions they were provided with a 20 question mini quiz that assesses most common actions. Work list and Tip sheets were also provided as additional resources for each Super User.

A four hour super user orientation was held on July 19th and 20th. Super Users were given the opportunity to attend either orientation. During this orientation a clear agenda was provided. Responsibilities for each super user were discussed and the facilitators ensured that each super user felt comfortable with their responsibilities.

There were a total of 51 Super Users that attended the open labs and 74 Super Users that attended the orientation. The following table further breaks down the attendance at each event

Results Open Lab Attendance
Results Orientation Attendance


Post Program Super User Evaluations revealed

  • “I’m feeling pretty confident in helping everyone. I was able to answer everyone’s questions and haven’t had to call the command center yet. But, it’s nice to know they are there in case I need them. It takes some of the stress away.”
  • “Everything seems to be going okay. The only real questions I get are about orders and how to check results. Other than that, everyone seems to be getting it.”

The Super Users provided extensive staff support during July 24 – August 3rd. They were scheduled as extra staff during the roll out period. They successfully provided support, engaged staff nurses, addressed difficulties, and provided ongoing feed back to the informatics team. The EMR implementation roll out was a success due to the ongoing support provided by the Super Users.

Super User Orientation
JCMC Super User