MHI-815-INFORMATICS FOR ADVANCED PRACTICE
Module 5: Discussion
Assignment Description:
Health Information System
Based on this week’s readings and the safety measures identified in the text, respond to the following:
1. What quality improvement measures would you suggest to enhance patient safety and quality within the EHR?
2. What role do you see the APN playing in Quality and Patient Safety initiatives?
3. Explain from a provider perspective what data you would utilize within quality and patient safety initiatives.
What quality improvement measures would you suggest to enhance patient safety and quality within the EHR?
One thing we do within our department is to do audits of certain processes and workflows. We also do validation and piloting of any new functions of the EMR. Bernstein (2018) discusses how amazing the technology of EMRs is while also referring to how we need to be diligent in the construction and maintenance of these systems. The article goes on to review how usability tests need to be completed so the end users of the system can get the best and most practical use out of it. Our team utilizes our EHR to create reports and monitor the use of certain pieces of the system in order to enhance it and make it safer for patient and provider use. In the chapter by McBride and Tietze () they discuss the fundamentals of quality improvement and more importantly the FOCUS PDSA cycle and Lean Six Sigma. Using these tools we are able to initiate and work through the designated cycles to complete safety improvements and workflow upgrades. Using the EMR reports, workbenches, and dashboards we are able to measure KPIs for certain metrics and initiatives.
What role do you see the APN playing in Quality and Patient Safety initiatives?
The Advanced Practice Nurse could play a variety of roles in quality initiatives. Many of our providers and APRNs are collaborators withing our QI projects and initiatives. The APN could assist with change management and help be a driver for this change. Using QI methodology and workflow redesign the APN can implement safety changes and workflows that are more productive for staff and providers. The APN could work directly as a change manager or oversee the changes taking place and help to evaluate if the change was successful or needs to be rethought and re-piloted. An APN can act as a consult or a manager or the director of the quality department.
Explain from a provider perspective what data you would utilize within quality and patient safety initiatives.
In our organization we utilize a lot of dashboard, reports, and workbenches to track and monitor key performance indicators. Our quality dashboard has a summary page that can be broken down into the primary care or specialty pages. We also have pages within the dashboard to track patient level data and a scorecard to allow for quick reference on certain key metrics. Our providers use this dashboard to track their quality metrics and the managers of the offices use the patient level lists to do outreaches to help close gaps. We have other dashboards that track financial, safety, or other metrics. I've attached an image of our quality dashboard summary page. Identifying data has been removed from the images. Most of our quality metrics involve screenings and preventative measures. Our safety dashboard looks at more of the readmissions and hospital type of metrics. The quality dashboard was one of my favorite projects I've completed in the last 5 years and continues to be a work in progress as we upgrade our data systems. Part of my job is to make sure everything on the dashboard is correct as it utilized across the system by providers, executives, and staff to monitor the quality metrics and utilize the information to close care gaps and provide the best quality of care we can for our community. One of the big pieces of data we use involves our filters to see different populations and our patient section that allows us to use financial information to help our underserved population.
References
Bernstein, Z. (2018). Ways to Improve Electronic Health Record Safety. Retrieved from
McBride, S. & Tietze, M. (2023). Quality Improvement Strategies and Essential Tools. In S. McBride & M. Tietze (Eds.), Nursing Informatics for the Advanced Practice Nurse (3rd ed., pp. 1138-1185). Springer Publishing.
1. What quality improvement measures would you suggest enhancing patient safety and quality within the EHR?
Introducing a culture of patient safety and improving quality withing EHR is essential to achieving best practices. Nurses interact with patients for longer periods, utilize the EHR, and can give suggestions for templates that can make documentation easier preventing too much time spent on the computer and have more time on patient care (McBride & Tietze, 2023). In addition, user friendly EHR will also decrease the rates of nursing burnout. Utilize workflow redesign to identify areas for improvement or making changes to benefit patients by decreasing hospital stays and healthcare costs (Stanford et al., 2023). Encourage the staff to introduce new modalities that will enhance patient safety and improve quality care. Employees that have worked in different facilities can give suggestions that worked for their previous organizations that will improve quality and patient safety. In addition, learning from previous errors and making changes to improve quality and patient safety. Having employees feel free to talk about the errors they make and do in-services to rectify mistakes and improve patient safety and quality.
2. What role do you see the APN playing in Quality and Patient Safety initiatives?
APN role is to raise awareness of the errors and stop them from happening by implementing new modalities that facilitate achieving high quality outcomes for the patients. Nurses also play a pivotal role in preventing errors by being vigilant and introducing more efficient and cost-effective ways to provide care (Moldovan et al., 2022). In addition, APNs can take initiative by joining organizations that will facilitate passing laws that will improve quality and patient safety measures to facilitate high patient/family satisfactions scores, lower healthcare costs, and achieve high quality outcomes.
3. Explain from a provider perspective what data you would utilize within quality and patient safety initiatives.
Provider can utilize quality improvement data to facilitate implementing new innovations that will enhance patient safety and improve quality in the healthcare setting. For instance, when data is collected and analyzed, providers can learn from errors and create new modalities to facilitate achieving high quality healthcare outcomes. When data is collected and evaluated it is imperative to facilitate achieving high quality healthcare outcomes. Providers need to utilize programs to maintain the safety of the paints and improve quality. In addition, data that analyzes the care they provide and patient/family satisfaction scores and find ways to improve and provide high quality healthcare.
References
Moldovan, F., Blaga, P., Moldovan, L., & Bataga, T. (2022). An innovative framework for sustainable development in healthcare: the human rights assessment. International Journal of Environmental Research and Public Health, 19(4), 2222.
McBride, S. & Tietze, M. (2023). Quality Improvement Strategies and Essential Tools. In S. McBride & M. Tietze (Eds.), Nursing Informatics for the Advanced Practice Nurse (3rd ed., pp. 1138-1185). Springer Publishing.
Stanford, V., Barna, S., Gupta, D., & Mortimer, F. (2023). Teaching skills for sustainable health care. The Lancet Planetary Health, 7(1), e64-e67.
MHI 815 Module 5 Discussion
1. What quality improvement measures would you suggest to enhance patient safety and quality within the EHR?
There are a number of tools that can be implemented into the electronic health record (EHR) to improve patient safety and quality of care. The Health Information Technology for Economic and Clinical Health (HITECH) Act encourages the use of EHRs to improve quality and efficiency of care for this reason (Upadhyay & Hu, 2022). This is also supported by the Patient Safety and Quality Improvement Act of 2005 (Mcbride & Tietze, 2023). When considering which quality improvement measures may enhance patient safety and quality within the EHR, it is important to consider what errors may occur. For example, one study found that 15% of physicians claim an EHR led to incorrect patient identification and medication orders (Mcbride & Tietze, 2023). To overcome this, I would recommend designing the EHR to limit how many patient records may be opened at the same time. Another consideration for EHR design would be alert fatigue as several studies have also found that clinicians may choose to ignore alerts (Mcbride & Tietze, 2023). Therefore, I would suggest that alerts be minimized based on level of risk and quality importance. The EHR should also have an easily accessible link for users to report errors or issues that may impact patient safety and quality of care (Mcbride & Tietze, 2023)
2. What role do you see the APN playing in Quality and Patient Safety initiatives?
Advanced practice nurses (APNs) can serve in a variety of roles for quality and patient safety initiatives. The EHR should be designed to assist providers in evidence-based decision making and streamline their workflow for efficient coordination of patient care (Upadhyay & Hu, 2022). The APN is responsible for reviewing all EHR alerts including those triggered by a clinical decision tool to ensure patient safety. As for quality, advanced practice nurses are responsible for providing the standard of care and utilizing evidence-based guidelines. Additionally, APNs must understand their organization's approach to reporting adverse events and collaborate closely with their risk-management department (Mcbride & Tietze, 2023). They should also create a culture of patient-centered care which encourages patient engagement (Mcbride & Tietze, 2023).
3. Explain from a provider perspective what data you would utilize within quality and patient safety initiatives.
From a provider perspective, I would be interested in data related to quality metrics such as readmission rates, length of stay, hospital acquired injuries, and medication errors. After an adverse event, a root cause analysis should be performed to identify any underlying causes which may have contributed (Mcbride & Tietze, 2023). The data for a root cause analysis includes identifying what happened, determining what should have happened, and ask “why” at least five times (Mcbride & Tietze, 2023). This information will then be used to develop causal statements and a list of recommended actions to avoid the same issue in the future (Mcbride & Tietze, 2023).
References
Mcbride, S., & Tietze, M. (2023). Nursing informatics for the advanced practice nurse (3rd ed.). Spring Publishing Company, LLC.
Upadhyay, S., & Hu, H. (2022). A qualitative analysis of the impact of electronic health records (ehr) on healthcare quality and safety: Clinicians’ lived experiences. Health Services Insights, 15, 117863292110707.
1. What quality improvement measures would you suggest to enhance patient safety and quality within the EHR?
Ross et al. (2019) has a great example of using features within the electronic health record (EHR) to guide quality and patient safety. The use of hard stops versus soft stops allows the care to be guided by any provider and not dependent on a user and their education or process knowledge. Ross et al. (2019) were able to significantly reduce the clostridium difficile incidents as well as improve their ordering practices. Similar practices can be used to increase quality and safety metrics in all aspects from core measures to medication interactions. This reduces the chances for error, increase compliance with certain metrics, and eliminates variation.
1. What role do you see the APN playing in Quality and Patient Safety initiatives?
The role of the APN in quality and patient safety initiative should be in a leader whether that be informal or a formal position in the process. While the bedside or staff levels should provide feedback and be included in the process, APN's should do as the McBride & Tietze (2023) describe in the text and use the “toolkit” to guide the process. The tools included project charters, flowsheets, run charts, pareto diagrams to name a few. Being an APN, using and understanding these tools ensure that the initiatives are effective and make the changes needed without causing unnecessary waste or burden. In my current practice, we use several of these tools on daily basis with our daily management system to see effective change in metrics such as CAUTI/CLABSI and inpatient texting as a patient satisfaction metric.
1. Explain from a provider perspective what data you would utilize within quality and patient safety initiatives.
From a provider perspective, there are several data points that can used to measure success of a particular initiative as each will be dependent upon the goal. For example, to obtain stroke standards of the highest quality, order sets were created to be all inclusive of the components needed for accreditation. While some individual components are tracked, the metric of the order set usage is what is shared with the providers because if that piece is corrected, all other aspects will be addressed. In other instances, metrics such as surgical site infections rates, patient satisfaction per provider, and discharge times are shared as individual metrics for review. Sharing the data on what is important to the provider will be more beneficial that any overall metric to increase compliance.
References
McBride, S. & Tietze, M. (2023). Quality Improvement Strategies and Essential Tools. In S. McBride & M. Tietze (Eds.), Nursing Informatics for the Advanced Practice Nurse (3rd ed., pp. 535-561). Springer Publishing.
Ross, B., Greendyke, W. G., Zachariah, P., Simon, M., Whittier, S., Green, D. A., Westblade, L., Karp, J., Gouveia, A. L., Greenberg, Y. C., Parameswaran, L., Singh, H., Saiman, L., Calfee, D. P., & Furuya, E. Y. (2019). 2350. Electronic interventions to improve clostridioides difficile ordering practices and incidence: Impact of soft stops vs. hard stops. Open Forum Infectious Diseases, 6, S808–S809. https://doi-org/10.1093/ofid/ofz360.2028
