Before a hospital adopts an IT system, it must consider the impact on the nursing staff.
|Lee Ann Runy|
As health care organizations adopt information technology to improve quality and patient safety, reduce errors, increase efficiency, decrease time-consuming and redundant paperwork, and enhance communication, they’re finding that IT can significantly impact nursing workflow. To ensure the adoption is successful, organizations need to thoroughly assess the impact of the technology on nursing workflow and involve nurses in the selection and implementation process.
Health Forum and Siemens recently convened a group of nurses and industry experts to explore how rural and community hospitals can gain maximum benefit from adopting IT. This closed-door, roundtable discussion identified strategies for effective implementation of clinical information technology to support clinical practice. The goal was to assist health care organizations and clinicians with clinical transformations.
Getting Implementation Right
“Implementation is an interesting process,” said Kay West, R.N., nursing informatics specialist at East Texas Medical Center in Tyler. While nurse feedback is imperative, it’s equally important to spend time on the nursing units and see how nurses work. “You need to get on the floor with the nurses and follow them to actually see what they are doing,” said West, who serves as a liaison between the nursing staff and the IT department. “The reality is not what you expect. It’s an enlightening process and makes you see IT in a different way.”
At East Texas Medical Center, the time spent on the nursing units brought several revelations during the implementation of a bar code administration system, noted West. Working directly with the nurses on their units identified the need for better quality bar codes for scanning. “It reminded all of us that we’re not identifying a label, we’re identifying a patient,” she said.
As crucial as it is to understand nursing workflow, it’s also necessary to understand how clinical IT systems impact the rest of the hospital. Getting the right group together can make or break an implementation. At Wise Regional Medical Center in Decatur, Texas, an IT governance board assists the implementation process. As clinical analyst Jennifer Graham, R.N., noted, the board, which includes representatives from various departments, helps set priorities for implementation. “Everybody has input, and everybody is on the same page to help make the implementation more successful,” she said.
It’s also important to get administrators involved in the selection and implementation process early on. Representatives from risk management, quality and health care informatics can provide leadership. Failing to involve these parties is a common mistake organizations make during the clinical implementation process.
Gail Latimer, R.N., vice president and chief nursing officer at Siemens Medical Solutions in Malvern, Pa., noted that health care organizations too often assume the IT implementation process is the responsibility of the IT department. “It’s important to have the IT implementation almost thread throughout the entire organization and not sit on its own,” she said. For example, nursing leaders must set a structure and goals for implementation and measure results, and they should share in the accountability of the implementation.
A multidisciplinary approach is also key to helping hospitals gain the maximum benefit from IT adoption. The quality team, for example, can help build a process to assist with the documentation and reporting of the Centers for Medicare & Medicaid Services’ core measures. “We use technology to look for those measures and make sure they’re being met,” said Graham. “It’s a proactive process, instead of a retroactive one when the patient has been discharged and we’re not going to get reimbursed.” The process, noted Graham, benefits both the hospital and the patient. The hospital receives proper reimbursement for the care it provides, and the patients receive high-quality care.
Building a New Skill Set
Adopting clinical technology requires a new skill set for nurses and nurse leaders, the roundtable participants agreed. “It’s an evolution, not a revolution,” said Nancy Chapman, principal of ACS Healthcare Solutions in Dearborn, Mich. She added that nurse leaders are becoming more cognizant of the overall capabilities of clinical information systems. “It’s something that many of them have never had to think about before,” she said, adding that nurses are questioning systems’ interoperability and functionality. “It is a skill set,” she said.
To that end, organizations need to provide training to nurse executives to ensure they have the appropriate knowledge base. Van Wert (Ohio) County Hospital has partnered with its local vocational school to provide basic computer skills to nurses. Pam Baker, R.N., Van Wert’s vice president and chief nursing officer, noted that the program has helped nurses become more comfortable with technology. Chapman said that some organizations are pairing new nursing school graduates with more experienced nurses. “The nurses coming out of school right now are used to technology,” she said. “Along the way, the tenured nurse begins to use the system.”
But implementations will be challenged if nurse leaders don’t show competency and acceptance of the systems. The nurse executive must be able to use the system to evaluate the care that’s been delivered. “Not everyone needs to be a super-user, but nurse leaders certainly need to know the system,” Latimer said. “They can’t delegate that responsibility to another individual on the leadership team.”
Lee Ann Runy is senior editor, custom publications, for Hospitals & Health Networks.
A full copy of the discussion, “IT and Nurse Workflow in the Rural and Community Hospital,” is printed in the August issue of Hospitals & Health Networks and is available at www.hhnmag.com.
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