Admission History Data Base Changes VCH

11/2 1p-3p Place B31911/8 Tue 3p-5p B319 makeup

11/15 730-930 am B319 makeup

Change in Philosphy

Admission History Data Base Changes VCH

Identify concerns

Philosophy Change

Commit to need for change

Describe changes to admission history

Begin a unit-specific plans

Resources and tools to assist

GO LIVE 11/29/11.

What

Why

How

Roles and Responsibilities & Materials

Unit Implementation plan template

Copies of the policiesTraining AidesVideo clipPractice scenarioTraining patients name and MRNLMS moduleFAQ on SSS web siteDebriefings- flyer

SSS• Provide education for unit leadership• Resource for unit• Provider training resources for units• Round during implementation

Unit Leadership• Assess current workflow and impact of changes • Conduct unit education and assure staff complete• Support during implementation• Leadership to round during implementation to elicit feedback and monitor progress.

If it ain’t broke…..

If it ain’t broke…..97% of admission hx started- only 10 % completed

No reminders if not finished

TOO LONG!

Redundant information collection- Patient complained they have already answered these

No one looks at it! This is just a waste of time

Nurses “live” in HED – can’t we put this in HED???

Must leave Admit History form and go to HEO to enter orders

When I am worried about keeping patient alive upon admission, I shouldn’t have to document discharge plans

8 hours is not long enough time to get it done.

It doesn’t track who entered each piece of data so I start a new one even if there is a draft

VUH and VCH Reps VCH Acute Care (& 3A) –

Christy Weems, Educator, VCH Float Pool

PCCU, VCH – Lydia Colley, Educator, PCCU

Peds ED & Obs. – Missy Sweeney, Assist. Mgr., Peds ED

VUH Critical Care – Crystal Creath, 10N

VUH Acute Care – Sabrina (“Sam”) Henley, 8s

VUH Procedural Areas – Tiffany Richmond, Assist Mgr., Cath Lab

VUH OB – Rosha Spencer & Blair Anderson

VUH Op. Svcs. – Cathy A. Lee, RN, PACU; Diane

Johnson, Dir., Op. Svcs.; Laura Hollis, Op. Svcs.

Vicki Thompson, VCH Admin.

Deborah Ariosto, Dir., Patient Care Informatics

Karen Hughart, Dir., Systems Support Services

Nancy Rudge & Bill Raines, HED Builder Team

Cheryl Dozier, Accreditation and Standards

Ex Officio for specific questions: Mary Reeves, Sandy Bledsoe, Julia Morris, Julie Morath, Page Conatser, Jenny Slayton, Stephanie Randa, (Exec.

Sponsor)

Work began May 2011

Collect data by time it will be needed Minimize data collection during critical stabilization period (1st 1-2 hrs.)

Meet minimum regulatory requirements

Collect data once and pass to all systems and users who need to view

Optimum workflow process associated with admission phase of care (up to 24 hrs. max.)

Vision and Goals

HITECH

TRIED TO FORMAT IN HED

Amount of scrolling up and down and back and forth to see data and what was incomplete was

impossible

DATA

Future: Admit History data imported into HED

4 Admission HistoryAdult Admission History

• patients <18 in VCH or VUH

Pediatric Admission History

• Pulls data forward if prenatal care @ VUMC

OB

• Will add Immunization screen but date TBD

VPH Admission History

Net Change = 0

Some Items

Removed

Some Items Added

Immunizations

CPAP and medication

pumps

Changes to Tobacco Screen

Past medical surgical history

Shortened Screenings

Religion

Content

Decreased Need to Toggle to HEO/WIZ

Auto generated orders and alerts eliminate need for nurse to enter some orders in HEO/WIZ

Not a form to complete but data to collect

Positive Social Work screen generates Social Work notification

Data displayed on OPC, Team Summary, Ancillary Dashboards

Immunization screen generates order for vaccine and scheduled for 10am next morning

Religion, tobacco status, and other information, stored and retrieved on subsequent admissions

Electronic Signature Tied to Data

Click to display ID of person collecting data

MANY EYES WILL SEE THE DATA

Data Shared

Link to view

Eventually imported into HED

Team Summary, Resident Handover

OPC, Charge Nurse Worksheet

Readmission Risk Scale (in development)

RemindersAdm Tx Dischg

Hover over indicator to see what Admission requirement is not yet completed (ie section 1,2,3)

= done within correct time frame= time frame to complete nearly over= time frame to complete has expired (BUT action still needed!)

3 Sections

I•Critical for

Safe Care•1-2 hours

II•Plan of Care•6-8 hours

III•Discharge

Plan and Functional Screen

•20-24 hours

I Critical for Safe Care

I Critical for Safe Care

New visitor policy: patient is allowed to have support person stay with them 24/7

Data will be shown on OPC initially and then other electronic documents later

I Critical for Safe Care

Legal Documents

All permanent chart documents now scanned at

discharge

I Critical for Safe Care

New Present On Admission Screening Awareness is Key to Improved Communication Among Team Members

Positives will trigger various decision support responses:

• Pacemaker/ICD triggers HEO decision support w/ MRI orders

• Dialysis prohibits some renal dose adjustment warnings in HEO

• Pressure Ulcers on admission will display on the PUPS dashboard but an orders will need to be entered in HEO/WIZ if WOC specialists needs to see the patient.

• CPAP home use will trigger protocol order for Respiratory Care evaluation

• Medication Pump usage will be shared as appropriate with other disciplines

• Patient Pregnant, Patient Lactating sent to Pharmacy for decision support on medications .

CPAP Summary –What You Need to KnowPatients that use CPAP at home need to use CPAP in the Hospital

RT will evaluate machine - will probably use VUMC equipment to assure proper functioning

In addition: • Increased vigilance when general anesthesia, sedation, or intravenous

(IV) analgesia/opioids are required.

• Elevate head of bed 30-40 degrees if not contraindicated

• Communicate that the patient has obstructive sleep apnea during handover to other care providers as well as in transfer to ancillary departments

A Protocol order will be generated from the Nursing Admission History when the nurse documents a positive response from the patient . “Home CPAP Evaluation and Initiation” order will generate to the Respiratory Therapy Department and the respiratory therapist (RT) will evaluate and initiate therapy at the patients bedtime.

Save As DraftSaves in StarPanel, generates

HEO/WIZ orders prn and updates electronic documents and

dashboard

Other Nurses can document additional information

Triggers indicators

Will display alert if all questions are not completed

Leaving a question blank or selecting “Unable to

complete” triggers indicators on the inpatient whiteboard.

CompleteSaves in StarPanel,

generates HEO/WIZ orders prn and updates electronic

documents

Do ONLY after all 3 sections completed

Additional edit must be done in an amendment

Triggers indicators

The option to complete is only in section III.

II - Plan of Care

Past Medical & Surgical History

Physician responsibility to enter and link displays in

Admission History

II Plan of Care

II Plan of Care

If select “yes” smokes must select response regarding frequency

It our responsibility to screen patients for appropriate vaccines and offer vaccines to patients that meet positive screening criteria.

Patients always have the right to decline.

Global Immunization

31

The 2011-2012 flu vaccine will protect against the three influenza viruses that research indicates will be most common during the season. This includes an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus.

Influenza

Flu season October till March 1 and everyone six months and older should get vaccinated.

5% - 20% of population in US gets the flu 200,000 people are hospitalized from seasonal flu-related complications between 1976 -2006, flu-associated deaths range from a low of about 3,000 to a high of about 49,000 people.

II Plan of Care

II Plan of Care

FUTURE: If selected that pt has had an immunization, it will automatically update the immunization record as a historical vaccine.

Positive screens will result in an order for the flu vaccine being automatically generated in HEO/WIZ when the admission history is saved. The vaccine will be scheduled in Admin Rx with frequency of 1XBYRX and Pharmacist will administer.

PCCU, heme/onc, ID, rheumatology and cardiology patients who qualify for the flu shot will have alert sent to a StarPanel worklist and be evaluated by the physician staff/clinical pharmacy.

Had flu shot elsewhere= automatic update to immunization record

+ screen = automatic order in heo/wiz

In VCH, the Pharmacist will administer the vaccines and document administration in Admin Rx.

Care Organizer and Admin Rx will list the frequency for the vaccine as “1X by RX” to indicate that the Pharmacist will administer.

The pharmacist will bring medication instead of it being delivered.

MAJOR CHANGE

II Plan of Care Screenings

Nutrition Dashboard

Positive screen trigger notification to nutrition services via the dashboard

II Plan of Care

Information will display on OPC and eventually feed Readmission screen and Patient Education and Engagement Record (PEER)

Learning Readiness/ADLs

II Plan of Care

Child Life Screening

III- Discharge and Functional Screen Section

III Discharge/Functional Screens

Physician will be notified of positive Functional screens as only providers may order Rehab evaluations in Tennessee

Use the Complete button ONLY WHEN ALL THE DATA HAS BEEN COLLECTED.

Can I do all sections at once?

YES The admit history may be completed at one time if that is practical.

Important thing is to get the data collected.Previously all data had to be collected within 8 hours.

Now have up to 24hrs to collect.

Section 3

Section 2

Section 1

Admission History Indicator

Not in nurses current workflow to verify Admission History is completed.

Indicator on whiteboard should help

Even if past 24 hours,

collect the data

The data is important.

Future ChangesNotification Bar at top of CWS to display dashboard of patient assignment while in HED or HEO/WIZ or any application. This will make it easier to see indicators and to navigate – coming in 2012

Braden Tool in HED instead of HEO/WIZ is projected to be available soon

Obstacles and Actions

“Nothing motivates more than success. We need to define and engineer visible performance improvement. “

Next Steps1. Discuss with

leadership team and finalize training / support plans.

2. Conduct Training

3. Print and distribute practice scenario

4. Monitor practice by staff

5. Round during implementation

6. Post Debriefing flyer and encourage attendance

Optional Resources Web Based ResourcesSSS Web Site->Documentation updates->Admission History Data Base Changeshttp://www.mc.vanderbilt.edu/root/vumc.php?site=sss2&doc=33860

LMS Module- Title “Admission History Changes 2011” http://vanderbilt.mzinga.com/app/servlet/navigation

Important Dates/TimesMore Sessions like this one11/8 Tue 3p-5p B319 makeup11/15 730-930 am B319 makeup

Implementation 11/29 Tue SSS will make rounds Call Help desk (3-3457) if need assistance

Debriefing Sessions Nov 29th Tue 4-430pm – 5009 VCH Nov 30th Wed 2-230 pm – 5009 VCH Dec 1 Thur 730-8am – 7011 VCH