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Magnet Hospitals Rely on I.T.
Health Data Management Magazine, February 1, 2008
When it comes to nurses, a magnet can indeed be a powerful attraction. Only about 263 hospitals nationwide have earned recognition for nursing excellence by achieving designation as a magnet hospital. These facilities use their magnet status as a powerful nurse recruiting tool.
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The magnet designation from the American Nurses Credentialing Center, a unit of the American Nurses Association, recognizes quality patient care, nursing excellence and innovations in professional nursing practices. But the program stops short of requiring that hospitals use information technology because “we don’t want to lock out some smaller hospitals that lack funding to support technology,” says Cynthia Hagstrom, an outcomes analyst with the Magnet Recognition Program.
The program’s 2008 manual, however, makes it clear that I.T. can play a vital role in improving the quality of care and facilitating interdisciplinary collaboration, she stresses. “We don’t specify that a hospital needs an electronic health record, but to achieve what the program requires, we expect many hospitals will use an EHR,” she adds.
“A large organization would be immensely hampered by not having good I.T. support” when seeking magnet status, says Sabrina Downs, R.N., director of the magnet recognition program for Vanderbilt University Medical Center, Nashville. Some smaller hospitals, however, might be able to provide the necessary documentation on paper, she acknowledges.
“The underlying philosophy of the magnet culture is that if you provide the right environment for nursing, nurses will perform exceptionally well and you’ll have positive patient outcomes,” Downs says. “Nurses have to be well supported. There are many factors in the magnet world that I.T. supports.”
In addition to academic medical centers, however, many smaller community hospitals realize the power of information technology to support nurses.
“I.T. really facilitates practicing at a higher level of excellence,” says Cathy Duquette, R.N., PhD., vice president of nursing and patient services and chief nursing officer at 148-bed Newport (R.I.) Hospital. The hospital, which has implemented an advanced electronic health records system, achieved magnet status in 2004.
Key Technologies
In addition to electronic health records, other key technologies magnet hospitals are using include: bar coding and other medication administration systems; computerized physician or provider order entry; automated nurse scheduling; and mobile hardware and wireless networks that provide access to clinical data at the point of care.
Many magnet hospitals also have created the position of director of nursing informatics and taken other steps toward involving nurses in all I.T. decisions. Some, like Vanderbilt, have taken the extraordinary step of appointing a point-person to lead the effort to achieve and then maintain magnet status.
Vanderbilt has capitalized on a wide variety of information technologies to support its nurses. The academic medical center, which includes three hospitals with a total of about 528 beds, self-developed an order entry system that’s now marketed by McKesson Corp., San Francisco, and also developed its own electronic health records system. It supplements those with a number of other applications from McKesson.
All medical disciplines, including physicians, nurses, therapists and pharmacists, use the CPOE system, which has decision support built in. For example, the system provides nurses with reminders about steps to take to prevent pressure ulcers among inpatients.
Other technologies supporting nurses include electronic scheduling, automated performance appraisals and online education. The Vanderbilt hospitals have shifted from distributing paper-based patient care pathways to using a document repository Web site, where nurses can print the documents as needed. “Something as simple as that has really changed the way we do business,” says Karen Hughart, R.N., director of systems support service and nursing informatics. Vanderbilt plans to eventually incorporate the clinical pathways into its electronic records system.
The academic medical center is phasing in a McKesson bar coding system for medication administration. Nurses scan bar codes on patients’ wristbands and the medication to help avoid medication errors. “It creates a culture of nurses doing their jobs safely and practicing in as safe an environment as we can provide,” Downs says. “One of the underlining principals of the magnet program is to create a safe environment.”
Highly Evolved EHR
In addition to holding the distinction of being a magnet hospital, Newport Hospital is one of only a handful of organizations recognized as having a Stage 6 electronic health record. HIMSS Analytics, a branch of the Healthcare Information and Management Systems Society, has created a model that shows seven levels of development of electronic records. In 2007, it determined that only .3 percent of U.S. hospitals had reached Stage 6, a highly advanced stage. None had reached Stage 7.
Newport Hospital uses clinical software from Siemens Medical Solutions, Malvern, Pa., which it heavily customized to provide caregivers with the data they need, Duquette says. For example, nurses’ initial assessment forms contain a scale for indicating a patient’s risk of pressure ulcers, she explains. The records system also provides direct access to diagnostic images.
Physicians and nurses also use CPOE for all orders. The records system is available primarily via computers mounted on mobile carts, mainly from Stinger Medical LLC, Murfreesboro, Tenn. The carts also carry bar coding equipment from Siemens used for medication administration. The bar coding system “has identified a whole host of issues we didn’t even know about,” Duquette says. For example, the system can catch if a medication was given too early or too late relative to a schedule outlined in the medical record.
The mid-size community hospital receives financial support for clinical I.T. from its parent company, LifeSpan, a delivery system that owns four Rhode Island hospitals. “We would not be where we are today if we were a stand-alone hospital,” Duquette says.
The hospital has designated a nurse who serves as clinical informatics coordinator, reporting to Duquette, and it has a clinical informatics council that involves nurses and other caregivers.
Collaboration between caregivers and technology specialists is key to making the most of I.T. to support nurses, the chief nursing officer says. “Our corporate I.T. staff is extremely receptive to the input of the nursing staff, and is willing to tailor systems to meet the needs of the end users.”
Helping Veterans
Because the Department of Veteran’s Affairs developed its own electronic health records system, many VA hospitals are taking full advantage of clinical automation to support nurses.
James A. Haley Veteran’s Hospital in Tampa earned magnet designation in 2001 and was redesignated in 2005. It also won a Magnet Prize in 2003 in recognition of its patient safety efforts.
“Electronic records help us with our interdisciplinary approach to care and our comprehensive approach to quality, and they make nurses’ jobs easier,” says Susan White, R.N., associate chief nurse for quality improvement. “Nurses have the tools to immediately access clinical information and a reliable way of giving medications and documenting the process.”
The hospital uses bar coding for medication administration as well as CPOE, with all necessary equipment available on computer carts from Flo Healthcare, Norcross, Ga. “When we got the carts for bar coding and electronic records, the doctors started making rounds with the nurses because the nurses now had the good equipment,” says Heather Weckman, R.N., clinical nursing informatics coordinator. “It changed the dynamics of the team and leveled the playing field between doctors and nurses.”
Nurses uses hands-free communication devices from Vocera Communications, Cupertino, Calif. For example, in the overnight hours, the hospital does not use speakers to page nurses. Instead a nurse can use the Vocera badges to request help turning a patient. “If the person the nurse wants to reach is not available, the device will search by skill level to find the next available nurse to provide help,” says Erica Lewis, R.N., an informatics nurse. “The devices enhance communication so nurses don’t have to spend 10 minutes finding someone else to help them.”
Haley Veteran’s Hospital is one of five VA facilities designated to handle “polytrauma” cases, providing specialized rehabilitation to seriously injured soldiers returning from Iraq. The military’s ubiquitous electronic records play a crucial role in treating these patients, White says.
“Because polytrauma patients are traveling around the world, and may have multiple injuries, it’s critical that we’re able to share the history of what happened to that patient throughout the care continuum,” she says. The VA and the U.S. Department of Defense share electronic records on these patients and use teleconferencing to discuss the case before the patient arrives in Tampa, White explains.
Within the polytrauma unit, nurses use Symbol hand-held devices from Motorola Inc., Schaumburg, Ill., to access clinical documentation. The devices are used in other areas primarily to scan bar codes. They are equipped with software from Care Fusion Inc., Reston, Va.
Providing clinical information at the point of care is vital to quality improvement efforts, the nurse leaders at the VA hospital say. “We need to make sure that technology supports our nurses in their critical thinking and gives them the information they need to make the right decisions,” White says.
Learn more online
For more background on using information technology to support nurses, visit healthdatamangement.com and search “nursing information technology.” For more information on the magnet hospital program, visit www.nursecredentialing.org/magnet. (c) 2008 Health Data Management and SourceMedia, Inc. All Rights Reserved. http://www.cardforum.com http://www.sourcemedia.com
SIDEBAR
Scorecards Help Nurses Improve Quality
One of the nation’s largest hospitals is using business intelligence technology to improve the quality of care offered in its 73 nursing units.
The 1,352-bed Methodist Hospital, located at Texas Medical Center in Houston, is relying on Microsoft Office Business Scorecard Manager to collect quality data and measure performance.
The magnet hospital distributes scorecards quarterly to every nursing unit, measuring performance on 40 key indicators, says Mary Shepherd, R.N., nursing project and magnet program director. The scorecards provide hundreds of graphs and comparisons that nursing directors can use to identify problems and devise ways to address them, she says.
Any nurse can access a color-coded scorecard in a portal on the hospital’s intranet. Red data indicates an objective was not achieved, yellow indicates the department was on target, while green shows the unit is outperforming the target.
To track pressure ulcers acquired in the hospital, all units collect data on all pressure ulcer cases one day each quarter. The data is compared to benchmark information on national averages for occurrences of inpatient pressure ulcers. When a unit receives a scorecard indicating that it had a higher incidence of pressure ulcers than the national average, it must develop an action plan to improve the performance. This might include, for example, ordering pressure reduction mattresses for high-risk patients or using moisture barriers on bedding for older patients.
To help reduce the number of patient falls, every unit fills out an occurrence report for every incident, and that information is used to populate a scorecard. The quarterly scorecard includes links to supporting data that each unit can use to develop an action plan, such as improving education for new nurses or making sure that high-risk patients participate in fall-prevention programs.
“We are now a very data-driven organization, and nursing has led the way on this project,” Shepherd says.
Any hospital with a programmer familiar with Microsoft SQL Server could use the scorecard manager to support nursing, organizers at Methodist say. They estimate the project, which involves gathering data on Microsoft Excel spreadsheets to load into scorecards for analysis, cost Methodist about $17,000 to launch and $1,700 a year to maintain, plus the time of two analysts who devote about two weeks per quarter to the project.
“You don’t need everything automated to do this,” Shepherd says. “You can gather data on paper and then enter it in spreadsheets to populate a scorecard.”
(c) 2008 Health Data Management and SourceMedia, Inc. All Rights Reserved. http://www.cardforum.com http://www.sourcemedia.com
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