Clinician View Implementation At Wilkes Regional Medical Center

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Clinician View Implementation At Wilkes Regional
Medical Center

• Carol S. Hermann RN,MSN
• Sherri Martin RN,BSN

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Wilkes Regional Medical Center
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Who We Are

• 130 bed Acute Care Hospital
• Owned by the Town of North Wilkesboro, North
  Carolina
• Not part of a Corporate Network
• Non-Profit
• Governed by an Authority Board

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Clinical Departments

• Surgical Unit - 24 Beds
• Telemetry Unit - 13 Beds
• Medical Unit - 30 Beds
• Pediatric/Med. - 15 Beds
• PostPartum - 15 Beds LDR - 4 Beds
• SNF - 10 Beds
• CCU - 7 Beds

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Clinical Departments cont.

• Surgical Services
• ER
• Ancillary Departments

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WRMC Operating Indicators

• Budget Year - OCT.-SEPT.
• Admissions - YTD JUNE 01 - 3862
• Average Daily Census - YTD JUNE 01- 62
• Average LOS - YTD June 01 - 4.4

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A Journey Forward

• Series Order Communications/Ancillary Response
  Implemented 1994
• 1996 Nursing department begins working toward
  automated documentation
• Key Leaders Key Players

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A Journey Forward

• Selection of Clinician View Summer, 2000
• Series Clinician View Orders Implemented
  November, 2000
• Began implementation of Assessments and Plan of
  Care March 2001

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What We Hoped To Accomplish With Clinician View

• Enhance patient care
• Improve quality of documentation
• Improved efficiency with nurses time
• Decrease in paperwork

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What We Hoped to Accomplish

• Adherence to JCAHO and other required standards
• Automate Clinical Practice Guidelines
• Point of Care documentation

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Selection Of Hardware

• First Priority Flexibility
• Selected Wireless network Touch
  Screen Laptops Fixed Workstations

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Review of our current documentation process

• Assessments
• Discovered that our current assessments were
  lacking important information.
• Evaluated number of forms used with paper system
  vs. Clinician View
• Plan of care
• Pre-printed care plans were not useful to nurses
• Care Plans not being used consistently (if at all)

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Assessments

• Used base assessments as a starting point
• Researched JCAHO standards and other required
  elements
• Allowed staff nurse involvement
• Standardized admission and shift assessments

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Assessments

• Review and sign off by CNO
• Admission assessments went from 12 sheets of
  paper to being entirely on the system
• User satisfaction

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Plan Of Care

• Started with a blank page
• Evaluated existing care plans
• Trashed existing care plans
• Researched the nursing process
• Developed a new philosophy for nursing and the
  POC

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Plan Of Care Cont.

• Organized a team of staff and charge nurses (we
  went to the nurse managers but they werent
  interested)
• CNO gave a power point presentation to the group
  re our new philosophy and planning nursing care

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Plan Of Care Cont.

• Abandoned care plan language
• Developed the plan of care so that nurses notes
  would be included within the POC
• Included interventions and goals
• Wanted the problem list to generate from the POC

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Plan Of Care Cont.

• Wanted all disciplines to document in the POC
• Opted to not use nursing diagnosis. Instead
  allowed the team to develop the POC based on
  their language

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Plan Of Care Team

• First meeting in April tight timeline
• Weekly meetings - 2 hours plus (often they did
  not want to stop working)
• A very hard working group with most nursing units
  represented
• Rewards - sand buckets and pizza lunch

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Plan of Care Team
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Where To Start?

• We selected a well organized unit.
• Cohesive nursing staff.
• Strong leadership skills exhibited by the Nurse
  Manager and charge nurse.
• 24 bed unit.

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Training

• Train the Trainer approach
• Created our own training manual to incorporate
  procedural changes
• Training time 5 to 6 hours average
• Training users for a new process

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Training

• Provided individual attention to users needs
• Allowing nurse and trainer input helped increase
  user acceptance during training
• Security is a key issue

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Go Live! June 12, 2001

• 0700 all documentation moves from paper to
  Clinician View
• Team decided to have a plan of care initiated for
  each patient before going live
• Extra staff on hand
• Go with the flow!

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Go Live Week

• 24 hour coverage by trainers to provide user
  support
• Extra effort to ensure that physicians had needed
  information
• Monitored documentation quality and provided
  clarification when needed
• Hardware issues continued
• Administrative support valuable

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Problems Encountered

• Lack of organization and interest by the hospital
  IS staff
• Hardware Issues
• Untested wireless network made troubleshooting
  difficult
• Carts for mobile units were uncomfortable to use
• Users unfamiliar with mix of operating systems
• Security issues

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What Would We Do Differently?

• Include IS staff in meetings earlier
• Have one individual in IS department assigned as
  contact person
• Have devices (hardware) on the units earlier to
  evaluate and work out problems

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What Would We Do Differently?

• Include an IS representative in initial training
  classes
• Include users in selection of carts for mobile
  units
• Include more technical information in user
  training sessions

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Benefits That We Are Starting To See

• Nurse testimonials -
• Wont go back to a paper system.
• You document it once and youre done.
• When can we get Clinician View on our unit?
• Feeling of pride and ownership by nursing staff
• Increased quality of documentation
• Decreased fluff charting
• Following Plan of Care

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Benefits

• Increased teamwork between nursing units
• Multidisciplinary use of the system
• Improvement of patient care processes
• Standardization of documentation system
• Prompts for new staff or those on unfamiliar
  units
• Team Nursing
• Time savings for Nursing Assistants

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Ongoing Meetings

• 2nd surgical staff
• Plan of care team
• Plan to meet with nursing staff representatives
  of each nursing unit after they go live.

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Keys To Success

• Commitment from the top down
• Must evaluate how you are doing everything be
  willing to change. If not, benefits will be lost.

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Keys To Success Cont.

• Train the trainer approach
• Allowing staff nurses to have a voice
• Focus on one time entry of data and ease of use

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Future Plans

• Telemetry go live - August 6, 01
• 3rd medical go live - September 4, 01
• No go live planned from Oct. -Jan. Due to JCAHO
  visit and holidays
• Remaining units to go live January - May 2002

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