Clinical Nurse Specialist Led Evidence-Based NDNQI Performance Improvement Enabled by Innovative EHR Technology

Purpose:
A Magnet health system's CNS led strategic initiative to imbed evidence-based standards into the EHR. Sustained results include the transformation of information into knowledge to inform decision making for the direct care RN and improved outcomes related to falls, pressure ulcer and restraint use.

Significance:
Nursing's influence at PPH is demonstrated by improved outcomes and integrated into the direct care RN's evidence-based practice and professional model of care. The CNS led design of a $35 million EHR initiative is value added with the return on investment demonstrated by improved NDNQI outcomes.

Strategy and Implementation:
Our Magnet journey began in 2004 and included participation in the NDNQI database and the implementation of the Clinical Nurse Specialist model for our health system. CNS's at the unit and population based level lead efforts to improve nursing sensitive outcomes with sustained and continued improvement over time that included dedicated teams of direct care nurses using NDNQI data. Nursing workflow was designed to be intuitive for our direct care nurses and to support evidence-based technology enabling the nursing process and facilitating the transdisciplinary work of patient care planning. The interactive electronic flow sheet trends the nursing assessment and facilitates the complete assessment based on standards that is necessary for optimal decision making related to high quality care and nurse decision making. Design and implementation included nurses at all levels and integration of technology enabled evidence based practice into daily care planning, staff support and workflow.

Evaluation:
Audit and outcome reports demonstrate compliance with skin, fall and restraint process improvement documentation. Nurses reported that the EHR plans were intuitive and easy to implement and use. Daily reports and follow-up with individual direct care nurses improves awareness and patient safety.

Implications for Practice:
The EHR enables improvement in NDNQI nurse sensitive outcome measures. Reimbursement is more frequently tied to outcomes and comprehensive inclusive evidence-based documentation is imperative to improved evidence-based nursing interventions and full communication within patient care transitions.