Nursing Order Sets: Fast Tracking Knowledge Translation

1. Nursing Order Sets: Fast Tracking Knowledge Translation Rita Wilson, RN, MEd, MN January 16, 2013

2. Presenter Disclosure • Presenter: Rita Wilson • Relationships with commercial interests: • Nothing to disclose

3. Disclosure of Commercial Support • Potential for conflict(s) of interest: • Registered Nurses’ Association of Ontario benefits from the sale of a product that will be discussed in this program: Nursing Order Sets

4. Agenda • Challenges with traditional Knowledge • Translation (KT) approaches • RNAO’s nursing order sets: Accelerating KT • Implementation options

5. Knowledge Translation (KT) KT is a “dynamic and iterative process that includes synthesis, dissemination … and …application of ethically sound knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system”. (CIHR, 2011)

6. Traditional KT Approaches • Traditional KT approaches: • Research findings published in journals • Presentation at conferences • Development and dissemination of practice guidelines • Departmental Bulletin Board

7. Challenges With Traditional KT Approaches

8. Challenges With Traditional KT Approaches Nurses have few readily accessible evidenced-based resources at the point of care Minimal standardization in nursing care provided to patients/clients Patient safety jeopardized Hinders nursing research Invisibility of nursing care in the health record

9. Challenges With Traditional KT Approaches • Huge gap between knowledge and practice in healthcare* • 30-45% of patients do not receive care with • proven effectiveness • 20-25% of patients get care that is not • needed or is potentially harmful • Underlying need: • Find an effective way to deliver knowledge to the nurse when needed at the point-of-care.

10. Environmental Scan: Assessing RNAO’s KT Effort • RNAO’s environmental scan (2011) • Inconsistent Best Practice Guideline (BPG) implementation • Main barriers to KT: • Lack of resources (i.e. time, knowledge, human resources) • High cost of adapting BPGs to practice setting context • System limitations (i.e. outdated, limited functionality) • Variability in interpretation • Request for tools to improve KT(e.g. nursing order sets)

11. Results: Technology-Enabled BPG • Implementation & Evaluation

12. Nursing Order Sets • A nursing order set is a group of • evidence-based interventions • that are specific to the domain of • nursing. It is intended to • standardize the care provided for • a specific clinical condition • (e.g. pressure ulcers). It is ordered • independently by nurses • (i.e. without MD signature).

13. Nursing Order Sets: Standardized & Evidence-Based Clear, concise evidence- based nursing interventions aligned with the nursing process. Linked to respective practice recommendations (PR#) Highlights interventions with the strongest evidence Links to associated documents/ decision support resources Each nursing intervention formulated using standardized terminology

14. Standardized Terminology Standardized terminology language: International Classification for Nursing Practice (ICNP) Developed by ICN to describe nursing practice Endorsed by CNA Systematized Nomenclature of Medicine Clinical Terms®(SNOMED CT) Developed by pathologists expanded to include other disciplines Endorsed by Canada Health Infoway

15. Standardized Terminology: ICNP EMR Nurse B Nurse C Nurse A Decubitus Ulcer Care Completed Bed Sore Care Completed Pressure Ulcer Care Completed Pressure Ulcer Care Decubitus Ulcer Care Bed Sore Care 19003678 19003678 19003678 19003678 19003678 19003678 ICNP Data Base

16. Standardized Terminology Standardized nursing data is essential in electronic systems Improves data quality Standardized internally and externally among health care organizations to facilitate: Exchange of health information among clinicians Comparative analysis by policy makers Evaluation for quality improvement Research for knowledge creation

17. Nursing Order Sets In Acute Care • Assessment & Management • of Stage 1-4 • Pressure Ulcers • Nursing Order Set • Patient Discharged to Long-Term Care • Patient Admitted to Acute Care Hospital • Nursing Assessment • Pre-Discharge • No Pressure Ulcer • Nursing Assessment • On Admission • Stage 1 Pressure Ulcer Triggers Outcome Patient Flow Post Stroke

18. Nursing Order Sets In Primary/Community Care • Smoking Cessation Intensive Intervention • Nursing Order Set • (Duration: 10+ Min) • Smoking Cessation Minimal Intervention • Nursing Order Set • (Duration: 1-3 Min) • Initial Clinic/Home • Visit • Follow-Up • Visit #6 • Screen for tobacco use • in last 6 months • Smokes 2 Packs/Day • Assess for tobacco use in last 7 days • Quit Smoking Triggers Follow-Up Visit Patient Flow Smoking Cessation Intervention

19. Implementation Option#1 - TxConnect • Partnership with PatientOrderSets.com to disseminate nursing order sets. Web-based clinical document library and content management system Enables organizations to build and maintain their own customized library of nursing order sets. Order sets can be printed and used as a paper-based tool. Ideal for organizations with paper-based systems. RNAO Order Sets Order Set Library RNAO Order Set Library Development Library

20. Implementation Option#2 - EntryPoint Web-based tool that allows clinicians to complete nursing order sets electronically on a PC or mobile device. Can be customized to include patient demographics. Can be printed and stored in the patient’s chart. Ideal for organizations with ClinDoc but not CPOE

21. Implementation Option#2 - EntryPoint Provides real-time data analytics (e.g. frequency of ordering specific interventions or order set utilization)

22. Implementation Option#2 - EntryPoint Provides real-time data analytics to show ordering practices by clinician or by unit

23. Implementation Option#3 - Customized

24. Benefits of Nursing Order Sets • Facilitates technology-enabled BPG implementation • Evidence-informed decision-making at the point of care • Utilization of standardized nursing terminology. • Mechanism to embed evidence-based nursing assessments • and interventions in clinical systems. • Link nursing sensitive outcomes to specific nursing • interventions. • Provides data analytics to evaluate outcomes and inform • practice. • Improves patient safety and quality of nursing care. • Beneficial to health care organizations across the spectrum • of care 17

25. 27 Available Nursing Order Sets 16

26. Contact Information Rita Wilson, eHealth Program Manager Registered Nurses’ Association of Ontario rwilson@rnao.ca For more information visit: www.rnao.ca