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Woman Child Education Day Hospital Information System Presentation

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Woman Child Education Day Hospital Information System Presentation

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    1. Woman & Child Education Day Hospital Information System Presentation Friday November 30, 2007

    2. EPR Phase 2 Computerized Provider Order Entry & Medication Administration Documentation

    3. HISP Goals & Outcomes

    4. Stakeholder Implications

    5. Stakeholder Implications

    6. Stakeholder Implications

    7. Clinical Transformation Building Blocks

    8. System & Workflow Redesign

    9. Process Flow Implications

    10. Process Flow Implications

    11. Physical Workflow Implications

    12. Content

    13. Orders Design Principles Standardization and Support of Clinical Thought Process are the bookends that frame the orders design philosophy All components of orders design strive to strike the balance between these two principles

    14. Content Design Elements

    15. Elements of order design – Order Items What is an order? An order is a directive written / placed in the patient chart that requires action on the part of another provider or department that produces a result, physical or psychological observations. eg. lab, diet, medication orders An activity that needs to generate a task that will be performed and documented on a worklist in the EPR Usual nursing activities that required some form of documentation that they are completed – eg. initials on a checklist Eg. Maternal Assessment Breasts Assists in acknowledging for the whole health care team the work that nurses are already doing

    16. Elements of order design – Order Sets What is an order set? an arrangement of multi-disciplinary order items/actions within one window allowing for multiple order entry Order set content was chosen so that all programs, disciplines, and departments are represented. Order sets were selected based on a specific set of criteria to leverage existing practices, promote standardization and incorporate leading practices. Standardization was built into the design process through content review by professional practice councils, PDT and CCDT Content developed by the content “experts”

    17. Elements of order design - Rules and Alert Rules and alerts are required to ensure and improve patient safety: e.g. medication allergy alert The EPR has certain rules and alerts already built into it. e.g. duplicate orders Additional rules and alerts will be built for Phase 2 Go-Live and on-going as required

    18. Technology

    19. Devices Stationary Workstations Mobile Workstations Carts – yes for phase 2a Tablets – no for phase 2a; future potential Goal - adequate number of workstations for all users

    20. Clinical Adoption

    21. Preparation Activities Using the EPR for results; allergy, height, weight, ACP documentation; patient list Accessing the unit experts / super users Participation in EPR Phase 2 Kick-off activities Order set content development Unit specific workflow development

    22. Training Workflow training General Unit specific Policy and procedure training Hands on EPR training Practice on the EPR using the training database

    23. Communication and Tools Read HISP Updates Regular directed communication to CRN’s, CNS’s and CEI’s Share and distribute to colleagues Use your Ready-Set-Go Tool for Phase 2 preparation and activation Ask you manager about EPR news Visit the HISP website

    24. EPR Phase 1 Evaluation Results Survey –through managers for SBGH and WRHA staff who were trained for phase 1 and directly to physicians, midwives and residents. Students not included. Survey data compiled using Teleform by SBGH Patient Safety Dept Focus Groups - Medical Advisory Council, Executive Team, Directors and Managers, Clinical Programs Council, Professional Advisory Committee, Nursing Practice Council, EPR trainers, registration super users and clinical super users. Survey –through managers for SBGH and WRHA staff who were trained for phase 1 and directly to physicians, midwives and residents. Students not included. Survey data compiled using Teleform by SBGH Patient Safety Dept Focus Groups - Medical Advisory Council, Executive Team, Directors and Managers, Clinical Programs Council, Professional Advisory Committee, Nursing Practice Council, EPR trainers, registration super users and clinical super users.

    25. Purpose To determine if the stakeholders felt they were adequately prepared for activation To identify which preparation strategies and tools were most successful versus those that were not To determine if the stakeholders felt there was adequate support during the activation period To identify opportunities for improvement in future activations

    26. Data Collection & Analysis During Activation EPR Log Sheet RSD work order process Four to eight weeks post go-live Evaluation Survey (n=2532) 18% (455) returned 20% (410) staff 10% (45) physicians Focus groups – 13 (n=122) Survey –through managers for SBGH and WRHA staff who were trained for phase 1 and directly to physicians, midwives and residents. Students not included. Survey data compiled using Teleform by SBGH Patient Safety Dept Focus Groups - Medical Advisory Council, Executive Team, Directors and Managers, Clinical Programs Council, Professional Advisory Committee, Nursing Practice Council, EPR trainers, registration super users and clinical super users. Survey –through managers for SBGH and WRHA staff who were trained for phase 1 and directly to physicians, midwives and residents. Students not included. Survey data compiled using Teleform by SBGH Patient Safety Dept Focus Groups - Medical Advisory Council, Executive Team, Directors and Managers, Clinical Programs Council, Professional Advisory Committee, Nursing Practice Council, EPR trainers, registration super users and clinical super users.

    27. Results and Discussion Survey –through managers for SBGH and WRHA staff who were trained for phase 1 and directly to physicians, midwives and residents. Students not included. Survey data compiled using Teleform by SBGH Patient Safety Dept Focus Groups - Medical Advisory Council, Executive Team, Directors and Managers, Clinical Programs Council, Professional Advisory Committee, Nursing Practice Council, EPR trainers, registration super users and clinical super users. Survey –through managers for SBGH and WRHA staff who were trained for phase 1 and directly to physicians, midwives and residents. Students not included. Survey data compiled using Teleform by SBGH Patient Safety Dept Focus Groups - Medical Advisory Council, Executive Team, Directors and Managers, Clinical Programs Council, Professional Advisory Committee, Nursing Practice Council, EPR trainers, registration super users and clinical super users.

    28. NursesNurses

    29. Nurses and ward clerks – workflow trainingNurses and ward clerks – workflow training

    30. HCA – reinforcement of HCA’s to complete height and weight documentation on the EPR Allied Health – limited use with phase 1 but will expand with phase 2 HCA – reinforcement of HCA’s to complete height and weight documentation on the EPR Allied Health – limited use with phase 1 but will expand with phase 2

    32. Too many paper bulletins for first few days Super Users not receiving consistent information in a timely manner – did not always receive the Issue Resolution Logs 19% of Super Users did not use the Go-Live Communication Bulletins SU’s who received communications – 78% found them useful Communication and support was lacking at time of command Centre shut down Too many paper bulletins for first few days Super Users not receiving consistent information in a timely manner – did not always receive the Issue Resolution Logs 19% of Super Users did not use the Go-Live Communication Bulletins SU’s who received communications – 78% found them useful Communication and support was lacking at time of command Centre shut down

    33. Nurses - ? Skewed as reported that nurse will log onto EPR for ward clerk – response to new workflow for ward clerks Porters – will reinvestigate with 6 month audit and determine if workflow needs to be changed 48% of trained users not using the EPR at 3 months. Focus group participants felt like there was not any incentive to use the EPR when results are still being printed, can use Continuum for their patient list, etc Will reinvestigate at 6 month audit and HISP team will focus efforts with those managers and physicians in the areas where the EPR is not being used. Nurses - ? Skewed as reported that nurse will log onto EPR for ward clerk – response to new workflow for ward clerks Porters – will reinvestigate with 6 month audit and determine if workflow needs to be changed 48% of trained users not using the EPR at 3 months. Focus group participants felt like there was not any incentive to use the EPR when results are still being printed, can use Continuum for their patient list, etc Will reinvestigate at 6 month audit and HISP team will focus efforts with those managers and physicians in the areas where the EPR is not being used.

    34. NursesNurses

    35. Training classroom evaluations – classes too rushed and with too much information being taught in time allottedTraining classroom evaluations – classes too rushed and with too much information being taught in time allotted

    37. Key Recommendations

    38. Key Recommendations Communication – continue previous; New: Directed communication with CRN’s, CNS’s, CEI’s, Physician Champions Workflow development and training for the clinical processes for Phase 2 is required as well as strategies to increase usage Technical Devices – deployed early, fully tested, practice stations available

    39. Key Recommendations (cont’d) Clinical Adoption Tools - use a similar type of tool as Ready-Set-Go; Practice Change Sheets developed early and available; orders and med admin functionality demonstrations for staff and physicians prior to training Training - workflow and new P&P training prior to EPR training; out-patient specific EPR workflows; try to develop alternate training approaches for physicians

    40. Key Recommendations (cont’d) Increase numbers of trainers in ancillary and allied health departments - need at a minimum one trainer each Define and communicate trainer expectations for pre go-live, go-live and post go-live periods during recruitment Specific trainers that focus on physician training Scheduling training – managers and clinical programs to manage

    41. Key Recommendations (cont’d) Super User role – critical to continue; define expectations and selection qualifications Dedicated super user(s) required for each shift for each unit, department and area. Clinical super users should not have a patient load for a period of 2 to 4 weeks post go-live Designated physician super users

    42. Key Recommendations (cont’d) Go-Live Support – clinical trainers support own units if possible; above baseline staffing all areas for first few days Revise Command Centre and Service Desk process for addressing work orders Provide improved support for trainers and super users during and after go-live Central repository for EPR-related information on each unit / department before, during and after go-live. Ensure smoother account management

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