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    Real-time, meaningful metrics boost nursing quality

    October 1st, 2013

    A wise person once said, “Save one life you’re a hero, save 100 lives and you’re a nurse.” But how exactly do you measure quality in such a heroic profession?

    At Robert Wood Johnson University Hospital (RWJ) (New Brunswick, NJ), achieving quality in nursing is a top priority. The academic medical center employs 1,600 registered nurses to help manage more than 600 inpatient beds.

    In 2011 and 2012 the hospital took top honors for outstanding nursing quality in an American Nurses Association recognition program based on its National Database of Nursing Quality Indicators® (NDNQI®). The database collects and evaluates unit-specific nurse-sensitive data from hospitals across the United States.

    Methods that earned RWJ honors for quality nursing

    At our annual client conference, ACE, we learned more about how RWJ achieved success from Nicole Martinez, RN, director of nursing informatics. She credits the organization’s success to a few key strategies:

    Give metrics meaning. RWJ staff equates each number to a person. For example, rather than say the fall rate is 1 per 1000 patients, RWJ notes that one person fell. And that is one person too many.

    Visualize metrics in real time. Interdisciplinary clinical teams use real-time data to improve situational awareness, team work and compliance.

    Use the Magnet Model. About 30 years ago, the American Academy of Nursing studied hospitals to better understand how to attract and retain nurses who promoted quality patient care. It developed five key components to distinguish “Magnet” organizations. RWJ is one of about 380 facilities holding the credential today.

    Identify key data. At times nurses receive a deluge of patient information. Studies show that it can lead to cognitive overload and inaccurate decision making*. Using Knowledge-Based Charting, RWJ nurses follow guidelines to focus on the right pieces of information to help make good decisions.

    Collaborate with “Safety Huddles” – Care teams evaluate key information at the unit level and at the bedside. RWJ also offers forums called “M&M: Mistakes and Misjudgments” for nurses to discuss critical events how to prevent them.

    Focus on quality helps improve clinical outcomes

    All of these efforts helped RWJ achieve some impressive outcomes. For example, nurses helped reduce the number of patient falls by 33% in three years.  In that same time period, 60% fewer patients acquired pressure ulcers (also known as bed sores) during a hospital stay. Great clinical outcomes.

    Another key measure shows that job satisfaction for RNs improved 17% in five years. Nurses embrace quality measures. They want to provide the best care possible. Organizations such as RWJ help them do just that.

    One more thing we love about RWJ

    In the Connected Community of Health, we work with many talented, dedicated individuals. Nicole Martinez has been instrumental in sharing lessons learned at RWJ with other Allscripts nursing informatics teams, and nursing teams (that may not even use Allscripts) at the American Nurses Association (ANA) Quality Conferences. We appreciate their spirit of collaboration and willingness to share these insights to help improve health care.

    Read this case study to learn about other successes at Robert Wood Johnson University Hospital.

     

    * Source: Dale, C., Naden,D., von Kugh, G. (2005). Framework for Integrating NANDA, NIC, and NOC Terminology in Electronic Patient Records. Journal of Nursing Scholarship, 37,229-235.

     

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    Reflecting on United Regional’s remarkable rise to the 100 Top Hospitals award

    May 23rd, 2013

    United Regional (Wichita Falls, TX) earned distinction as one of the Truven Health Analytics 100 Top Hospitals®, from a field of nearly 3,000 short-term, acute care, non-federal hospitals.

    Performance in various clinical, financial and patient satisfaction measures helped United Regional win this recognition.  Leadership across these 10 categories reflects a commitment to developing and maintaining a hospital-wide culture of excellence and the motivation to adopt new technologies and techniques that improve the efficiency and effectiveness of patient care.

    United Regional also received an Everest Award. Only 17 hospitals in the country received this honor, which recognizes both greatest five-year improvement and top one-year performance.

    We recently talked with Dwayne McKee, Director of Clinical Intelligence and Business Intelligence at United Regional, to get his thoughts on how technology supported patient care quality initiatives that contributed to his organization achieving these honors. Below are some of the highlights from the interview:

     

    Can you give some examples of how technology has helped improve performance and outcomes at United Regional?

    We improved several clinical and financial outcomes, including:

    • A 20% reduction in mortality due to Sepsis from 2011 to 2012.
    • A reduction in Catheter-Associated Urinary Tract Infections (CAUTI) by 50% for the same date range in 2013 as compared to 2012.
    • A   reduction in heart failure re-admission from 21.9% for a two-year period prior to May 2012 to 14.5% from May 2012 through March 2013.

    We accomplished, most, if not all of the results by deploying standardized evidenced-base order sets, Computerized Physician Order Entry (CPOE), multiple Medical Logic Modules (MLMs) that assist in driving clinical decision at the point of care, and through clinical summaries.  Additionally, the use of dashboards and reports provides caregivers near real-time information that ensures that patient care is properly managed to provide the best possible outcome.

     

    Which Allscripts products are you using?

    We are using a number of Allscripts solutions.  We implemented Allscripts Access ManagerTM and Sunrise Record ManagerTM in 2006. Subsequently, we implemented Sunrise Clinical ManagerTM, (SCM) Allscripts EDTM, Sunrise Medication ManagementTM, and Sunrise Radiology Information SystemTM in 2008.  Over the last several years we have implemented several other Sunrise Performance Management solutions. We are currently in the process of implementing Allscripts Base Content for Physician DocumentationTM.

     

    How did using an Open platform help United Regional achieve better results?

    One way the Open platform assisted was through the use of the device integration.  Because of the Open platform, we are able to launch the iSirona solution (syncing device data with the electronic record) from within SCM to pull patient data into the vital signs flowsheet.  This ability to integrate improves data accuracy, reduces transcription time and improves access to data.

     

    What advice would you give to someone about to introduce new technologies?

    I would strongly suggest that they look for a solution on an Open platform that enables business partners access to develop solutions that will work in concert with their software.  We are fortunate in that the SCM solution has afforded us the opportunity to partner with other providers that have built their solutions on the same platform.

    Additionally, the solution needs to have the flexibility to adjust to new Meaningful Use requirements, and be scalable to meet new demands on technology.  Due to the fact that the Allscripts solutions are highly configurable, we have been able to modify the solutions to meet our needs as it relates to new health care initiatives.

    Lastly, the company needs to have a proven track record of innovation, flexibility, be outcomes driven, and be positioned to sustain the evolving healthcare market place.  I would look for an organization that is willing to partner with you, and is willing to accept a degree of risk as you move forward together in meeting the increasing healthcare demands.

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