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The transition from a paper to an EHR environment is a challenging process that impacts the entire health care team. A primary strategy of the project was to improve adherence to evidence-based care through incorporation of clinical order sets and nursing protocols into the CPOE application.
Significance:
Use of evidence-based order sets has standardized care processes and enhanced multidisciplinary communication. Order sets include not only those used by physicians, but also nursing protocols created for RNs. Computerized orders and protocols have enhanced the ability to deliver coordinated care.
Strategy and Implementation:
The implementation of a computerized clinical information system began in 2004. The system is named PLATO (Physician Leadership for Accurate and Timely Orders). A multidisciplinary team was identified including physicians, nursing leaders and staff nurses, Clinical IT, Quality, Lab and Pharmacy. Current workflows were identified, new workflow using PLATO was established and design and configuration of computer screens and order sets were accomplished. Users were extensively educated. Direct care nurses, called Super Users were identified from each unit to have advanced training in order to support their individual units. In addition to electronic entry of physician orders, nurses enter home meds, patient weights and vital signs. Upon recognition of the value of CPOE as evidenced by improved efficiency and outcomes, nurses expressed the desire to incorporate nursing protocols and screening into PLATO as a driver to improve outcomes for nursing sensitive and disease specific measures.
Evaluation:
NDNQI data is used. 1st Qtr. 2010 outperformed Critical Care NDNQI mean and median in Pressure Reducing Surfaces (100%) and Moisture Mgt(97.37%).
A study related to use of stroke orders/protocols shows 7.5% shorter length of stay; 9.4% more patients discharged home; readmit rate was 35.7% lower.
Implications for Practice:
Innovative use of technology improves adherence to best practices. Nursing protocols developed at Summa include Stroke Protocol, Wound Care Protocol, ED Triage Protocols, Falls Risk and Diabetes Categorization. A well-designed system ultimately enables more time for nurses at the patient's bedside.