Standardizing the Documentation and Communication of the Nursing Plan of Care at the Handover Using HIT Gail Keenan PhD, RN PI, University of Illinois, College of Nursing Beth Yakel, PhD Co- PI, University of Michigan, School of Information Dana - PowerPoint PPT Presentation

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Standardizing the Documentation and Communication of the Nursing Plan of Care at the Handover Using HIT Gail Keenan PhD, RN PI, University of Illinois, College of Nursing Beth Yakel, PhD Co- PI, University of Michigan, School of Information Dana

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Title: HIT Support for Safe Nursing Care Author: Gail Keenan Last modified by: gmkeenan Created Date: 10/3/2004 9:49:27 PM Document presentation format – PowerPoint PPT presentation

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Title: Standardizing the Documentation and Communication of the Nursing Plan of Care at the Handover Using HIT Gail Keenan PhD, RN PI, University of Illinois, College of Nursing Beth Yakel, PhD Co- PI, University of Michigan, School of Information Dana


1
Standardizing the Documentation and
Communication of the Nursing Plan of Care at the
Handover Using HITGail Keenan PhD, RNPI,
University of Illinois, College of NursingBeth
Yakel, PhDCo- PI, University of Michigan, School
of InformationDana Tschannen, PhD, RNField
Research Director, University of Michigan, School
of Nursing
2
Currently Funded by AHRQ (2004-2007)
  • The presentation reports on the YR 1
  • findings of the study
  • HIT Support for Safe Nursing Care
  • Multi-site study (8 unit 4 organizations) and
    refinement of
  • the Hands-on Automated Nursing Data System
  • (HANDS) Method.
  • 1 R01 HS015054-01- HHS PHS National Institutes of
  • Health, Agency of Health Research and Quality
    (AHRQ)

3
HANDS Project Vision (1998-present)
  • Nurses everywhere will use the HANDS
    standardized technology supported plan of care
    Method to document and communicate about nursing
    care at every handover

4
HANDS Core Project Teams
  • Support Team
  • Annie Browning, MSPH
  • Elizabeth Brough, MSN, PhDc
  • Sally Decker, PhD, RN
  • Sharie Falan, MS, RN
  • Yvonne Ford, MS, RN
  • Crystal Heath, MS, RN
  • Mary Killeen, PhD, RN
  • Deanna Marriott, PhD
  • Rachelle Ramos, BSN, RN
  • Santosh Udupi, MS
  • Linda Scott, PhD, RN
  • Julia Stocker, PhD, RN
  • Kathleen Sutcliffe, PhD
  • Marcy Treder, BSN
  • Dana Tschannen, PhD, RN
  • Administrative Team
  • Gail Keenan, PhD, RN PI
  • Beth Yakel, PhD, Co-PI
  • Mary Mandeville, MBA, Director
  • National Policy Advisory Team
  • Carol Bickford, PhD, RN
  • Connie Delaney, PhD, RN
  • Barbara Frink, PhD, RN
  • Ada Sue Hinshaw, PhD, RN
  • Joan Shaver, PhD, RN
  • Judy Storfjell, PhD, RN

5
Goals of HANDS Project
  • Standardize method for collecting and
    communicating plan of care information at the
    Handover that
  • Is useful to clinicians
  • Promotes continuity of care across nurses
  • Creates a national database of comparable, valid,
    and rich nursing data
  • Supports research to continuously improve nursing
    care and practice

6
Standardization Defined
  • .the process by which the form or function of
    an artifact or technique becomes specified (Feng,
    2003)

7
To STANDARDIZE MUST
  • Gather SAME Data ELEMENTS
  • Same TIME Intervals
  • Same TERMINOLOGIES
  • Same DATABASE Structure
  • Apply SAME Rules for Selecting, Recording, and
    Rating NANDA, NOC, and NIC Terms and Measures
  • Apply a common approach to standardize hand-off
    using HANDS care plans as foundation

8
HANDS Method Provides
  • A common format and elements for entering and
    updating Plan of Care
  • A common database for storage and retrieval
  • Common terminologies to enter dx, interventions
    and outcomes
  • NANDA Nursing Dx Terms 167
  • NOC Nursing Outcome Terms 330
  • NIC Nursing Intervention Terms 514
  • A common structure (SHARE) for communicating
    about the Plan of Care at the handover

9
Research and HANDS Framework
  1. Continuously scan literature for related evidence
  2. Employ socio-technical research methods
  3. Regularly update HANDS Framework to reflect
    latest evidence generated from 1 and 2

10
Use Socio-Technical Approach
  • To achieve desired goals with technology (Berg,
    1999)
  • Involve the users
  • Use multiple methods of evaluation qualitative
  • Grow knowledge through continuous interation of
    the design, evaluation, and refine cycle

11
Multiples Methods Used
  • Surveys repeated (R) Baseline skills, trust,
    safety culture, knowledge N3, satisfaction with
    POC and N3
  • Observations pre-go live, hand-off (R)
  • Interviews, Meetings, Focus Groups (R)
  • Think-alouds (R)
  • Analysis of transaction logs

12
Core Safety FrameworkHANDS Care Planning Method
Effective Nurse Communication
Effective Nurse Handover
(Keenan Yakel, 2005)
13
HANDS METHOD RN Requirements
  • Update (or Create 1st) Plan of Care at Handover
  • Re-Rate all NOC Outcomes (minimum)
  • Enter correct Tally for each NIC Intervention
  • Enter Care Period to closest 4 hour increment
  • As needed
  • prioritize NANDA diagnoses
  • add new NANDA, NOC, and NIC terms
  • resolve or inactivate NANDA Diagnoses NOC
    Outcomes
  • Adjust NIC Interventions
  • Use HANDS (SHARE Format) at Handover
  • Complete HANDS Discharge Note

14
Comparison of Baseline Measures N units 4, N
RNs 193
Comp Skills M (SD) Know NOC M (SD) Know NIC M (SD) Trust M (SD) Culture M (SD)
Unit A 3.6 (1.2) 1.8 ( .8) 1.8 (.8) 30.1 (6.3) 22.2 (4.7)
Unit B 3.2 (1.1) 2.6 (1.2) 2.6 (1.2) 32.8 (8.3) 23.6 (4.4)
Unit C 3.9 (1.0) 3.0 ( .8) 3.0 ( .9) 33.4 (5.9) 25.3 (3.8)
Unit D 3.6 (1.0) 2.3 (1.1) 2.3 (1.1) 36.5 (7.9) 25.8 (5.1)
p.valu .012 .000 .000 .001 .002
15
Comparison of Baseline Measures N units 4, N
RNs 193
  • No significant differences
  • nurses satisfaction with current care planning
    method (low satisfaction)
  • knowledge of NANDA

16
Term Meaning Reliabilites 3 months post go-live
Unit RNs Terms/RN Av Correct
A 10 6 65
B 11 6 60
C - - -
D 8 6 79
17
Observations of Report 3 Months Post
  • Ns
  • units 3
  • reports/unit 2
  • Total RNs all repots14
  • Findings
  • 2 units had access to HANDS Plan of Care in
    Handover 1 had NONE
  • 9 of 14 RN discussed at least on NNN term in
    handover
  • Format for unit report remained very close to
    original report format for each of 3 units

18
6 month Post Go Live Interviews and Focus Group
  • N for Focus Group off site (50)
  • 6 RNs (2 sites represented)
  • N for Interviews (on site) 10 for 10
  • 39 RNs (all 4 sites)
  • Tell whatever you want to say about what is and
    is not working about the HANDS Method

19
Positive Results 6 month Post Interviews and
Focus Group
  • agreed new Method was superior to old
  • Some RNs reported exceptional satisfaction (- to
    )
  • Role models for heedfully interrelating in report
    (3 units)
  • One unit used plans of care in rounds
  • Ensure current plans of care were in chart
  • Change was occurring and moving in the right
    direction
  • Desiring revisions to original templates
    (language learning taking place)

20
Needs Improvement 6 month Post Interviews and
Focus Group (cont)
  • RNs desired consistent handover format using Plan
    of Care to structure it
  • Difficult to access most current plan at handover
  • Some nurses not familiar with functionality
    needed to individualize plans
  • Education was variable and not completed by all
    RNs on unit

21
Integration of Finding into Next Steps Year 2
Units
  • Training revamped and standardized
  • Units required to set-up means of tracking
    compliance with training and baseline competency
  • Handover structure has been standardized (SHARE
    at Computer) and included as a baseline
    competency
  • HANDS tool improved-
  • Provides access to Plan of Care an HX from Pt.
    List
  • Other enhancements that promote ease of use added
  • On-line tutorials help available within the
    HANDS application

22
Method Meets 2 Major Mandates
  • American Nurses Association (Committee on
    Nursing Practice Information Infrastructure) GOAL
    to generate electronic interoperable nursing data
    across organizations
  • the Joint Commission on Accreditation of
    Healthcare Organizations new Safety Goal (2006)
    requirement to Implement a standardized approach
    to hand off communications, including an
    opportunity to ask and respond to questions.

23
SHARE Handover Structure
  • S Sketch pt. name, age, gender,
  • medical dx, code status, allergies,
  • other pertinent information
  • H HANDS Review Plan of Care Hx and
  • Current Plan AT COMPUTER add only
  • those essential details
  • A Aim discuss care focus of next shift
  • R Rationale explain your thinking
  • E Exchange invite questions, debate, dialogue

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