Leveraging

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Leveraging Technology to Improve Communication
Kris Becker, RN, MHA Cherie Galusha, RN,
MSN Melanie Flesland, RN, BS
Meditech Chief Nurse Executive Symposium November
3, 2005
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Spokane, Washington
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Sacred Heart Medical Center
623 Beds Largest hospital between Seattle and
Minneapolis
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Inland Northwest Health Services
To Palmer, Alaska
INHS Regional Network Connectivity
To Salinas California
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Overview of Current System Use
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The EMR at SHMC
CPOE
Clinical Documentation
Barcode POC
Pharmacy
Lab
Radiology
Order Entry
Pt. Finance
Admitting
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Implementation Timeline
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Strategies for Success

• Investment in hardware
• Top level executive involvement
• Basic computer skills tutorial for staff
• Clinical staff involvement
• Peer-to-peer training

• 24/7 red shirt support
• Daily summit issues log during go-live

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Challenges
Physician Access to Clinical Data
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Challenges
Back to Paper
Critical Care Flowsheets
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Challenges
With a wealth of data in there, how do we

• Get it out efficiently?
• Make it meaningful for clinicians?
• Make it work for us in delivering safe, quality
  patient care?

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Shift Change
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Patient Status Report

• Uses
• Shift-to-shift report
• Transfer report
• Emergency care

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Patient Status Report

• Uses
• Shift-to-shift report
• Transfer report
• Emergency care

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Patient Status Summary

• Uses
• Reference
• CN
• Aids
• Snapshot of unit

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Referrals
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Clinical Nutrition

• Based on Admission Assessment.
• Certain answers assigned points.

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1
3
1
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Clinical Nutrition

• Auto-print in Clinical Nutrition dept. at 0600
  the day after admission

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Smoking Cessation

• If patient accepts, a referral prints to
  Community Health Education Resource (CHER) for
  follow-up.

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Smoking Cessation

• If patient declines, no referral printed to CHER

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Smoking Cessation

• If patient unable to respond

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Respiratory Therapy
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Automatic Billing
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RT Patient Status Report

• Uses
• Shift-to-shift report hand-off

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Outcomes

• Streamlined and consistent shift change post-op
  reporting.

• Less verbal exchange note taking required.

• Efficient documentation billing process for
  respiratory therapy

• Automated, intelligent referrals to ancillary
  departments

• Staff satisfaction and efficiency.

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Discharge Planning Medication Reconciliation
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Patients Med List

• RN documents patients home meds during admission.

DAY OF ADMISSION
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Patients Med List
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Patients Med List
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Patients Med List
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DC Planning Worksheet
1

• DC PLANNING WORKSHEET placed under discharge tab
  in chart

DAY OF ADMISSION
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1
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Admission Med Orders
2

• ADMISSION/TRANSFER MED ORDERS
• Placed in chart for physician

Home meds only (if orders not yet written)
a
Home meds in-patient orders (if orders already
written)
b
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2
a

• Physician modifies home meds signs as admission
  orders
• Pharmacy enters med orders

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T Johnson, MD 10 25 05
Teresa Johnson
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2
b

• Physician reconciles home meds with in-patient
  orders signs
• Pharmacy updates med orders

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T Johnson, MD 10 25 05
Teresa Johnson
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2

• Physician writes orders for additional
  medications on regular Doctors Order sheet.

11/2 0800
Coumadin 5 MG PO Daily
T Johnson, MD
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Transfer Med Orders
3

• ADMISSION/TRANSFER MED ORDERS
  Transfer from one care level to another

• Physician reconciles, modifies and signs.
• Pharmacy updates orders.

DURING HOSPITAL STAY
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3

• Home meds all in-patient orders.

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T Johnson, MD 10 28 05
Teresa Johnson
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Planned Discharge Needs List

• RN uses DC Planning Worksheet to discuss plans
  with physician and enters data.
• Ancillary caregivers enter DC plans related to
  their specialty.

DURING HOSPITAL STAY
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Planned Discharge Needs List
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Planned Discharge Needs List
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Planned Discharge Needs List
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Planned Discharge Needs List
Yes, if going to another facility
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Planned Discharge Needs List
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Planned Discharge Needs List

• RN reviews additional DC orders with physician as
  needed
• RN completes data entry

EVENING BEFORE DISCHARGE
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Complete DC Orders
4

• COMPLETE DISCHARGE ORDERS
  Placed in chart

EVENING BEFORE DISCHARGE
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4
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Any additional order(s)
Teresa Johnson
10 31 05
T. Johnson, MD
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DC Med Orders
5

• DISCHARGE MEDS PRESCRIPTIONS
• or
• ADMISSION/TRANSFER MED ORDERS
  Placed in chart

EVENING BEFORE DISCHARGE
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5

• Home meds certain in-patient orders (scheduled
  non-IV some PRNs).
• Becomes the prescription.

TJ
30 x3
TJ
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30 x3
TJ
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30 x1
TJ
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30 x3
TJ
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TJ T. Johnson, MD
10/31/05 123456
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5

• Any additional discharge meds.
• Becomes the prescription.

Fosamax 70 mg Orally Once Weekly
12 x3
TJ T. Johnson, MD
10/31/05 123456
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Discharge Orders

• Physician signs and/or modifies Complete
  Discharge Orders
• RN updates data entry.

DAY OF DISCHARGE
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Final Med Reconciliation

• Physician reconciles specifies orders on DC
  Meds Prescriptions or Admission/Transfer Med
  Orders.
• RN updates med list.

DAY OF DISCHARGE
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Planned Discharge Needs List
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Patients Med List
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Patients Med List
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Patients Med List
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Patients Med List
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Patient DC Instructions
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• PATIENT DISCHARGE INSTRUCTIONS Includes
  fridge copy of DC meds

• RN reviews with patient Both sign

DAY OF DISCHARGE
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Patient
10/31/05
Nurse, RN
10/31/05
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Discharge

• Patient given DC Meds Prescriptions or
• Admission/Transfer Med Orders sent to next
  facility with patient.

DAY OF DISCHARGE
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The End
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Outcomes

• DC planning begins on admission is
  multidisciplinary

• Med reconciliation begins on admission
  continues through in-house transfer to DC.

• DC meds become home meds for next admission

• Personalized patient DC instructions.

• Retrievable DC information.

• Physician satisfaction and efficiency.

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Thank-You
QUESTIONS?