The Jayhawk Medical Center uses an electronic health record (EHR) certified by the Office of the National Coordinator of Health Information Technology. To demonstrate nursing's contribution to patient care, the chief nursing officer supports the Council for Nursing Informatics and provides trained informatics nurses to help the Council achieve the goals of safe patient care and quality nursing data. Jayhawk Medical Center is a Magnet hospital and actively engages in a patient safety program, including the National Database for Nursing Quality Indicators (NDNQI) quality metrics. Cassandra Mendoza, MSN, RN, is one of the informatics nurse specialists. Her current informatics project is to design and implement a fall risk management protocol in the electronic health record that collects data to submit to NDNQI. She first meets with the nursing staff to determine the evidence supporting fall risk management. Based on this evidence, they select a falls risk assessment tool and other data that need to be collected to document and manage the falls risk. They determined that levels of risk are none, moderate, and high-risk and defined order sets for each risk level. Next, Cassandra interviews and observes the staff to determine the workflow surrounding the assessment, documentation, and management of fall risk. With this information, she begins to design the screens for assessment and order sets to facilitate accurate data entry and present the information so that all clinicians can understand and make accurate clinical judgments about the care of the patient at the point of care. As she evaluates the evidence, she determines the data elements and their values (assessment questions and possible patient observation) and the appropriate data types (numeric, free text, and code response list). This is the first step in representing the data for input and retrieval. Next, she matches each concept to the standardized language for each question and coded response list. Next, Cassandra selects the appropriate standardized language from a list that has been approved as HIPAA code sets and the "meaningful use criteria." Next, she ensures that the design reveals the nursing process and maps each component to the Reference Information Model of Health Level Seven, an electronic message standard required for health information exchange as specified in the HITECH act of 2009. Next, she adds a decision support rule that states: "When the fall risk assessment score indicates a risk, Falls Risk is added to the patient problem list, and an order set for the indicated risk level is presented to the nurse for approval." Finally, she determines the staff members who may view and interact with the protocol to ensure confidentiality. After Cassandra completes the implementation of the protocol, she meets with the nursing staff again to evaluate whether the protocol meets their needs and represents the evidence for fall risk management. After the final approvals for the protocol, she builds the screens in the electronic health record and implements a training program for the staff. Three months after implementation, Cassandra evaluates the protocol, and the team uses it. As a result, the number of falls has been reduced by 15%, and all the NDNQI falls metrics were collected electronically (saving money on data collection from charts). Nurses love the decision support that saves them time by automatically adding the risk to the problem list and entering orders. Patient satisfaction increased by 10% with free-text comments about the staff's thoughtfulness in keeping them safe. Question: What are some possibly challenges or barriers Cassandra may have faced as she developed and implemented this technology tool to impact quality and safety?
The Jayhawk Medical Center uses an electronic health record (EHR) certified by the Office of the National Coordinator of Health Information Technology. To demonstrate nursing's contribution to patient care, the chief nursing officer supports the Council for Nursing Informatics and provides trained informatics nurses to help the Council achieve the goals of safe patient care and quality nursing data. Jayhawk Medical Center is a Magnet hospital and actively engages in a patient safety program, including the National Database for Nursing Quality Indicators (NDNQI) quality metrics.
Cassandra Mendoza, MSN, RN, is one of the informatics nurse specialists. Her current informatics project is to design and implement a fall risk management protocol in the electronic health record that collects data to submit to NDNQI. She first meets with the nursing staff to determine the evidence supporting fall risk management. Based on this evidence, they select a falls risk assessment tool and other data that need to be collected to document and manage the falls risk. They determined that levels of risk are none, moderate, and high-risk and defined order sets for each risk level. Next, Cassandra interviews and observes the staff to determine the workflow surrounding the assessment, documentation, and management of fall risk.
With this information, she begins to design the screens for assessment and order sets to facilitate accurate data entry and present the information so that all clinicians can understand and make accurate clinical judgments about the care of the patient at the point of care. As she evaluates the evidence, she determines the data elements and their values (assessment questions and possible patient observation) and the appropriate data types (numeric, free text, and code response list). This is the first step in representing the data for input and retrieval. Next, she matches each concept to the standardized language for each question and coded response list. Next, Cassandra selects the appropriate standardized language from a list that has been approved as HIPAA code sets and the "meaningful use criteria." Next, she ensures that the design reveals the nursing process and maps each component to the Reference Information Model of Health Level Seven, an electronic message standard required for health information exchange as specified in the HITECH act of 2009. Next, she adds a decision support rule that states: "When the fall risk assessment score indicates a risk, Falls Risk is added to the patient problem list, and an order set for the indicated risk level is presented to the nurse for approval." Finally, she determines the staff members who may view and interact with the protocol to ensure confidentiality.
After Cassandra completes the implementation of the protocol, she meets with the nursing staff again to evaluate whether the protocol meets their needs and represents the evidence for fall risk management. After the final approvals for the protocol, she builds the screens in the electronic health record and implements a training program for the staff. Three months after implementation, Cassandra evaluates the protocol, and the team uses it. As a result, the number of falls has been reduced by 15%, and all the NDNQI falls metrics were collected electronically (saving money on data collection from charts). Nurses love the decision support that saves them time by automatically adding the risk to the problem list and entering orders. Patient satisfaction increased by 10% with free-text comments about the staff's thoughtfulness in keeping them safe.
Question:
- What are some possibly challenges or barriers Cassandra may have faced as she developed and implemented this technology tool to impact quality and safety?
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