Union Hospital in Terre Haute, Ind., entered into a development partnership with a software development company to develop state-of-the-art, intuitive technology that would make the nurses' jobs more efficient and optimize patient safety. The program is a workflow technology using touch screens in each patient room that has reduced documentation time and increased timeliness of documentation by approximately 50%, allowing nurses more time at the bedside with their patients.
IT Case Study Contest nominee: Union Hospital, Terre Haute, Ind., nursing workflow technology
The software focuses on items that traditionally cause compliance problems because of absent or late charting. It also integrates with other systems, which enhances patient safety and quality.
The hospital goals for this project were threefold:
- Improve patient care and patient safety (i.e., reduce falls, timely pain reassessment, etc.).
- Better integrate data alerts into nursing workflow processes so key information is received in a timely manner by the appropriate caregiver, and in a fashion that is best integrated with the workflow (to the right person/place, at the right time, in the right way).
- Increase hospital compliance with regulatory requirements.
The clinical components of nursing workflow being addressed include those that hospitals are under the most pressure to comply with from a regulatory and reimbursement perspective: Timely pain reassessment; prevention of skin ulcers; prevention of falls; timely monitoring of restraint use; nursing documentation (vital signs, I/Os, patient-care activities); and CMS core measures
Our team of nursing personnel (consisting of two staff nurses and two management nurses) worked directly with the software company's staff for months, creating the look of the touch screens and designing it in such a way that the application is seamlessly integrated into the nurse's workflow, as well as developing the triggers for the alerts, etc., based on the documentation input.
The software program provides alerts/reminders to caregivers in the manner most consistent with the nature of the alert. For example, if a patient is on restraints, and the date/time of the restraint order is more than 24 hours, then a reminder is displayed on screen to obtain a new restraint order. If two consecutive blood glucose tests are greater than 180 mg/dl, an order is printed for the physician in an effort to obtain an HbA1c order. During applicable seasons, a flu vaccine alert will display on-screen for those patients who have not had the vaccine and have not refused it.
The software also automatically generates care plans based on the clinical assessments entered via the touch screens, greatly enhancing nursing efficiency. Union Hospital received no citations regarding care plan initiation, reviews or updates during our recent hospital accreditation survey.
Nurses can view patients through the software by use of the cameras installed in patient rooms. This is particularly helpful for those patients with a high fall risk when the nurse has to spend time at the other end of the hall.
Charges are automatically generated out of the program's documentation. For example, daily IV pump charges are generated based on the documentation input by nursing staff.
In addition, reports are automatically generated to other disciplines as needed. Patients on Foley catheters are reported electronically to infection control department for proper monitoring. Patients with a history of COPD/asthma are reported to respiratory therapy for appropriate patient teaching. Chaplains services are contacted automatically upon patient request.
The software also integrates with numerous other systems enhancing patient-safety efforts. For example, integration with technology-smart beds has been developed allowing data to flow electronically into the software, thereby eliminating staff having to enter the data.
- More than 50% overall increase in timeliness of documentation (how close to the actual care time the nurse completed the documentation).
- More than 50% overall decrease in documentation time (actual time spent documenting).
- Compliance results: Union Hospital received 100% compliance from HFAP with all patient-care documentation standards.
- 100% of care plans were reviewed and revised daily.
- 100% of restraints had appropriate care plans initiated and assessments completed.
- Greater than 90% compliance with CMS core measures.
- 100% documentation of pain assessments, Braden skin assessment and fall risks.
- 94% documentation of meals eaten.
Because the application and technology is so intuitive, training class time was minimal—generally about one hour—and we were able to be fully functional on the software at our urban and critical access hospitals—including the pilot phase—within a 10-month period.
Our team continues to meet monthly to enhance the program even further. Because of the success, we are currently developing this touch screen technology for our inpatient therapies and medical rehabilitation departments.
Kym Pfrank is vice president and chief information officer at Union Hospital, Terre, Haute, Ind.
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