Inter-Professional Collaboration

Inter-Professional Collaboration

Most healthcare workers obtained their education solely with others pursuing the same profession leaving them unexperienced in working as part of an integrated team.  The concept of inter-professional collaboration can be traced back to 1972 when it's predecessor, team-based care was introduced by the Institute of Medicine. Inter-professional collaboration was designed to remove those silos and encourage a collaborative effort towards patient care that considers the perspective of other healthcare disciplines.  Inter-professional collaboration among healthcare providers provides a comprehensive, holistic approach to patient care across disciplines that is aimed at improving patient safety, outcomes, and reducing health care costs.  The collective skills of the inter-professional team allow for a higher delivery of care because the team functions in a more efficient manner than a single discipline alone.  Inter-professional aims to address the inherent power struggles encountered between professions when attempting to provide care and change the current culture to a more interactive one.  The Robert Wood Johnson Foundation states

 “Effective interprofessional collaboration promotes the active participation of each discipline in patient care, where all disciplines are working together and fully engaging patients and those who support them, and leadership on the team adapts based on patient needs … It fosters respect for the disciplinary contributions of all professionals.”(RWJF, 2011)

To Learn More Read The Following Articles 

Interprofessional Collaboration to Improve Health Care: An Introduction

What Can Be Done to Encourage More Interprofessional Collaboration in Health Care?

Nurse Case Management: Setting New Standards for Transitional Care

The proposed evidence-based change in clinical practice is the implementation of an enhanced Nurse Case Management program based on Naylor’s Transitional Care Model within the ambulatory care management department at Rochester Regional Health.  Naylor’s model is a patient-centered, nurse-led model designed specifically for the improved management of patient transitions across settings during an acute phase of illness.   Naylor’s model includes a comprehensive approach to case management incorporating a structured approach, along with the use of evidence-based assessment tools, to shape how care is provided.  By nature, the practice of case management requires an inter-professional collaborative process, directed by the nurse, to improve patient outcomes. Implementation of this proposal will also require collaboration among a team of health care professionals.  Members of this team include the Vice President and Manager of the Case Management Department, CNO of Ambulatory Nursing, Medical Director of Primary Care, Nurse Educator, IT professionals and the Finance department.  The graphic provided indicates their rationale for be included on the team. 

Importance & Value of Inter-Professional Collaboration

The relationship of quality and safety to communication has been highlighted in several reports authored by the Institute of Medicine. If healthcare teams do not communicate and collaborate their performance and ultimately patient care and outcomes, will suffer.  The ability to attain the quadruple aim of healthcare requires that health professionals shift their focus towards collaborative relationships, sharing information, and partnering in a respectful environment rather than operating in silo's. In an increasingly complex and changing healthcare environment,  inter-professional collaboration should be the expectation, not the exception. 

Additional Learning & Resources

TeamSTEPPS ToolKit

A useful, evidence-based approach that promotes communication and team work skills among health care professions

References

Robert Wood Johnson Foundation (2011). What can be done to encourage more interprofessional collaboration in healthcare? Retrieved from https://www.rwjf.org/en/library/research/2011/09/what-can-be-done-to-encourage-more-interprofessional-collaborati.html

Tigerconnect Healthcare(2019). 5 Benefits of interprofessional collaboration in healthcare. Retrieved from https://tigerconnect.com/blog/5-benefits-of-interprofessional-collaboration-in-healthcare/

Vega, C.P. & Bernard, A. (2016). Interprofessional collaboration to improve health care: An introduction. Retrieved from https://www.medscape.org/viewarticle/857823

Nursing Leadership and Healthcare IT

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"Emerging nursing informatics leadership roles are critical to engage in the necessary transformational activities and bridge the new care delivery models into clinical practice with the right technology solutions"

(HIMSS, 2011)

Transforming Health Care through Nursing Leadership

The Importance of Nursing Leadership

Healthcare is changing at a rapid pace with the introduction of new technologies and enormous amounts of data that impact workflows and patient outcomes. Patient care is also becoming more complex as health systems navigate the challenging demands of health care reform and new regulatory requirements.  Nurse leaders are challenged to understand large amounts of data and make determinations that will impact workflow, process, and outcomes leading to improved patient care, staff satisfaction, better outcomes, and reduced health care costs. Continuing efforts to implement healthcare technology and big data into the patient care environment require nurse leaders to participate in the selection, development, design, and deployment of advanced technologies. As nurse leaders, it will be our responsibility to improve the safety, efficiency, and quality of health care by leveraging IT resources that enable safer patient care and support nursing staff at all levels (Nickitas & Kerfoot, 2010). Competency with nursing informatics will  be essential as systems and data continue to become more sophisticated.  According to Kennedy & Moen (2017), nurse leaders must demonstrate and develop informatics competencies in order to provide meaningful leadership and support ongoing transformation within the healthcare system (p. 197). It is essential for nurse leaders to have in-depth knowledge regarding technology to promote optimal nursing work processes and effectively manage technological challenges faced by their staff (Hirsch, 2014).  The American Organization of Nursing Leadership recommends development of the following information management and technology competency elements:

                                                                                                                         (Kennedy & Moen, 2017)

Nurse leaders must employ their skills to successfully integrate people, process, and technology using their awareness of nursing informatics metastructure along with defined professional competencies to maintain sustainability and further healthcare IT. As relationships and interactions grow along with the complexity of data, the scope of nursing informatics practice becomes increasingly sophisticated, requiring additional experience if success is to be realized. The ability to show competency is critical to the leadership role. 

Nurse leaders need to understand the importance of healthcare technology and how it's use can impact patient outcomes. In addition, they require knowledge of technological systems that can add to their ability to successfully manage and educate their staff. The use of blogs, infographics, recorded video tutorials, and virtual characters, among others is, a valuable resource that should be implemented into daily operational workflow. There is an abundance of technology available to assist nurse leaders in their role. 

View this interactive infographic depicting the essentials of leadership related to informatics & healthcare IT.

 For even more information visit the links below

Article: Nurse Leader Informatics Competency Assessment

HIMSS Nursing Informatics Competencies 

Nursing Informatics Learning Center

Final Reflection

This class turned out to be something totally different than I expected! I am happy to say that I was pleasantly surprised and enjoyed my journey through nursing informatics over the past five weeks. It was challenging, and very rewarding once I was able to master some of the new technologies we were exposed to.  I feel that we have just scraped the surface and that there is so much more to learn. I have gained an improved appreciation for the field of informatics and all that it embodies. If we are to further the science of nursing and keep up with the rapidly evolving demands of healthcare, then knowledge and competency around informatics is essential, along with solid leadership skills.  However, I also strongly believe that we can not get "caught up" in technology. We must remain true to the human interaction at the core of our profession. The art of nursing is the human connection, and it must not be lost as we continue to develop and expand technology within healthcare.

References

Hirsch, A. (2014). Technology management strategies for nurse leaders. Nursing Management, 45(2), 41-43. doi: 10.1097/01.NUMA.0000442645.01325.fe

Kennedy, M.A., & Moen, A. (2017). Nurse leadership and informatics competencies: Shaping transformation of professional practice. Studies in Health Technology and Informatics, 232, 197-206.

doi: 10.3233/978-1-61499-738-2-197

Nickitas, D.M., & Kerfoot, K. (2010).  Nursing informatics: Why nurse leaders need to stay informed. Nursing Economics, 28(3), 141-158.

Nursing Informatics Position Statement. (2017). Australian College of Nursing. Retrieved from https://acn.edu.au/wp-content/uploads/2018/02/nursing_informatics_position_statement_28092017_-_hisa_acn_nia2.pdf

Improving Workflow

Simple Steps to Improving Workflow

Improving the Care Management Referral Process

A current workflow concern within the ambulatory care management department is the amount of time required for a care manager to complete a referral review, intake process, and necessary documentation, to only have the patient not consent to services.  Time is wasted tracking down providers to clarify the referral reason, which in turn delays care management intervention with the patient.  Time is also wasted sorting through reports utilizing predictive analysis for the same purpose, especially when chart review indicates an appropriate use of healthcare services. A focus on high-risk care management for patients who have complex medical needs complicates the selection process and introduces new challenges in providing comprehensive care coordination (Cohen, Flaks-Manov, Low, Balicer, Shadmi, 2015).  Nurse Care Management staff have expressed that their time is better spent on direct patient contact and care planning with high-risk patients, rather than reviewing charts or reports, to determine if criteria are met, including making multiple attempts to contact and enroll patients.  

To address these concerns the ambulatory care management department has instituted a clinical intake referral nurse whose prime function is to sort through referrals, complete a chart review, gain patient consent, complete the initial assessment, and assign appropriate staff.  This process involves enhancement to the current EHR, which includes the development of an electronic care management referral work queue.  The use of electronic systems to inform the structure and function of the referral process maximizes the level of care coordination (Tuot, Murphy, McCullough, Leeds, Chan, & Chen, 2015). As with any referral, the CM referral is easily accessible at the point of care.  Simple checkboxes consistent with care management inclusion criteria constitute the referral information. This eliminates provider confusion of having to remember selection criteria.  The submission process is streamlined, which reduces any interruption in referral delivery and improves process time, meaning patients receive an earlier intervention.  Implementation of a few key strategies makes a significant impact on the quality of the referral process, increases timely completion of referrals, and decreases the potential of undesired outcomes that may result from a delay in the workflow (Davidow, Sheth, Sixta, & Thomas-Hemak, 2018).

Once received in the care management work queue, the Clinical Intake R.N. Care Manager will work the referral to determine suitability based on chart review. She will then contact the patient to complete an initial assessment, which includes identifying barriers to care, as well as, obtaining patient consent for program participation.  The referral is then routed to the R.N. Care Manager so that patient-centered goals can be established and a care plan created.  Communication back to the ordering provider is completed through a direct link with the patient’s EHR and is also documented directly on the referral thus eliminating additional time spent scrolling through notes for patient status updates and closing the referral process loop.  Having a single R.N. care manager control the referral queue provides consistent documentation and removes any variation throughout the process leading to improved reliability.

The literature suggests that determining the most appropriate patients to participate in care intervention programs is of increasing priority to care coordinators and is most beneficial when completed through an integrated approach (Cohen et al., 2015).  Many benefits are realized as a result of enhancing current technology to enrich the current workflow process. Increased productivity, decreased provider confusion, increased workflow efficiency, improved communication, and timely patient engagement are included, among others.  Improving upon and building a robust referral management process assists the primary care provider with improved care coordination that contributes to achieving the quadruple aim of health care (Davidow et al., 2018). 

 For More Information on Improving Care Management Workflow

Automating Care Coordination Workflow

6 Stratgies for Improving Nurse Workflow

Transforming Nursing Workflow

Reflection 

This exercise has caused me to consider other workflows in my current role and how technology can aid in their improvement.  Even something as simple as a chart review can be improved upon by streamlining EHR records and creating a patient dashboard which displays pertinent categories of information with links to specific information embedded under each item.  The chart review process can be a long, tedious, and frustrating process. A patient dashboard would cut down on time spent "scrolling" through the medical record to locate information providing nursing with more time to do what we do best, care for our patients. Technology in nursing is improving the way care is provided, and as nurses we should harness our clinical expertise to assist with this process. Competencies in technology and informatics are central to the success of  future nurses, as well as, growing the profession.

References

Cohen, C.J., Flaks-Manov, N., Low, M., Balicer, R.D., & Shadmi, E. (2015). High-risk case identification for use in comprehensive care management. Population Health Management, 18(1), 15-22. Doi: 10.1089/pop.2014.0011

Davidow, S.L., Sheth, J., Sixta, C.S., & Thomas-Hemak, L. (2018). Closing the referral loop: Improving ambulatory referral management, electronic health record connectivity, and care coordination processes. Journal of Ambulatory Care Management, 41(1), 240-249.

Tuot, D.S., Murphy, E.J., McCullough, C.E., Leeds, K., Chan, E., & Chen, A.H. (2015). Leveraging an electronic referral system to build a medical neighborhood. Healthcare, 3(4), 202-208. Doi: 10.1016/j.hjdsi.2015.014.001

Technology and the role of the Nurse Leader

Introduction

Emerging technologies in healthcare are impacting and changing the delivery of nursing care. These new technologies are being introduced into nursing practice at a rapid rate.  As a result, nurse leaders are challenged with implementing technology that will improve care delivery, improve patient safety, improve outcomes, create efficiencies, as well as, provide data for future purposes.  The nurse leader wears many hats in relation to their responsibilities regarding healthcare technology.  Responsibilities of the nurse leader include:

1. Act as a mentor or coach
2. Define a common goal for the purpose, implementation and use of healthcare technology
3. Research new technologies
4. Test technology and allow the end-user (nursing staff) to do the same
5. Develop an implementation timeline which includes an educational plan
6. Encourage appropriate and ethical use of available technology
7. Ensure that confidentiality is maintained
8. Monitor for breaches in use and discipline appropriately
9. Elicit staff feedback and facilitate open communication
10. Analysis of data to support quality measures, improved patient outcomes, and areas requiring improvement
11. Advocate for staff by working collaboratively with organizational leadership to select technology that meets the needs and demands of nursing
12. Ability to understand how implementation will affect current workflow

Nurse leaders play a critical role in achieving patient safety, quality outcomes, and staff satisfaction through the use of healthcare technology.                                      (Vogelsmeier & Scott-Caziewell, 2009).

Ethical Concerns

Critical Thinking

Concerns have been raised regarding the impact that healthcare technology has on our ability to think critically.  Bar code medication administration scanning systems, clinical decision support systems, and the future use of artificial intelligence to diagnose illness, are all designed to create efficiencies and promote improved patient safety and quality outcomes.  However, use of these systems becomes routine which can hinder critical thinking capabilities and prevent us from truly looking at and laying hands on our patients (McBride et al., 2018).  Image a computer in the ICU that can predict when your patient will die? What would you do with that information? Would it cause to you spend more time caring for that patient than the others on your assignment? What about a similar system that helps manage patients in the ambulatory setting by providing differential diagnosis and treatments. Who should have access to this type of technology and who should be using it? People practice medicine, computers don't (Goodman. 2010). These systems should be used in adjunct to education, skills, and experience. 

Privacy, Confidentiality, & Safety

The use of technology in the healthcare setting brings along with it obvious concerns for the privacy and confidentiality of a patients electronic medical record.  These concerns extend beyond patients to include clinicians and include alternate forms of technology such as social media.  Inappropriate posts on social media violate the privacy, safety and confidentiality of patients and practitioners alike.  It is unfortunate that regardless of policy and guidelines, nurses continue to post about their professional lives and interactions. These posts which include HIPAA violations, demeaning of patients, intra-professional aggression, and demeaning of patients put patients and nurses at risk for potential harm and could lead to an increase in workplace violence or undesired patient outcomes (De Gagne et al., 2019). 

Isolation

When does the implementation of technology go too far? While technology has it purposes, it can not replace human interaction and human contact. Will patients begin to feel isolated,lonely, and experience depression as a result of receiving their care through the newest and latest technological trends such as video visits or remote patient monitoring? Technology should not replace the nurse-patient or patient-provider relationship, rather it should enhance it. 

Learn more by visiting the links below

Nurse Leaders & Technology Decisions

e-Health Implementation Strategies RNAO Best Practice Guideline

Management Strategies for Nurse Leaders


Week 3 Reflection

I have gained a new appreciation for the role of the nurse leader as it relates to healthcare technology.  In order to be an effective leader in healthcare today, the nurse must be competent in numerous areas of business and human resource management, but more importantly, competent with the rapidly changing field of healthcare technology.  This week has brought to my attention a personal realization that I still have an enormous amount to learn and become proficient with in the area of nursing informatics. These skills are essential for success in order to be a knowledgeable and capable leader. I look forward to the challenge that lies ahead and plan to take advantage of some of the course offerings through nursing-informatics.com (when I have spare time). 

References

De Gagne, J.C., Hall, K., Conklin, J.L., Yamane, S.S., Roth, N. W., Change, J., & Kim, S. S. (2019). Uncovering cyberincivility among nurses and nursing students on twitter: A data mining study.  International Journal of Nursing Studies, 89, 24-31. DOI: 10.1016/ijnurstu.2018.09.009

Goodman, K.W. (2010). EHR's create startling new moral quandries. Retrieved from https://www.medscape.com/viewarticle/734193

Hirsch, A.(2014). Technology management strategies for nurse leaders. Nursing Management, 45(2), 41-43. doi: 10.1097/01.NUMA.0000442645.01325.fe

McBride, S., Tietze, M., Robichaux, C., Stokes, L., Weber, E., (2018). Identifying and Addressing Ethical Issues with Use of Electronic Health Records. OJIN: The Online Journal of Issues in Nursing, 23(5). DOI: 10.3912/OJIN.Vol23No01Man05

Vogelsmeier, A., & Scott-Cawiezell, J. (2009). The role of nursing leadership in successful technology implementation. JONA: Journal of Nursing Administration, 39(7/8), 313-314.

The Human -Technology Interface

What is it?

Technology is evolving at a rapid pace in today's world. This includes the development and implementation of health care technology. Technological innovation offers nurses and health care providers the ability to improve patient care and outcomes, as well as, have a positive impact on patient and provider satisfaction.  The Human-Technology interface describes the hardware and software through which the user interacts with technology (Simpson, n.d.). The Human-Technology interaction describes and provides insight into the actual interaction that occurs when human beings interrelate and work in harmony with technology (Simpson, n.d.). 

Human-Technology interface and interaction encourage patients and family members to become active and engaged participants in their care. Nursing practice also benefits from the implementation of technology through the development of evidence-based practice standards and point of care tools such as electronic charting, best practice alerts, bar code medication administration systems, and telemetry, that impact patient safety and improve the quality of care provided. 

As future nursing leaders, it will be important that we remain current with technology trends. In doing so, we can  use to technology to our advantage through the analysis of several different data points to improve quality, safety, outcomes, and satisfaction.  We must also support the continued integration of new technology into healthcare in order to attract staff and remain competitive in the healthcare marketplace.

Technology in Action-Case Exemplar

Jane Doe was recently discharged from the hospital after an inpatient stay for an acute exacerbation of CHF.  Upon discharge the nurse explains her discharge instructions and notifies Jane that home care will be initiated for the purpose of continued monitoring to ensure that she is not readmitted to the hospital.  The home care nurse visits Jane the next day in her home to set-up a telehealth remote patient monitoring system and educate Jane on how to use it. She explains to Jane,  that every morning when she wakes up, after voiding,  she will need to weigh herself on the scale provided, take her blood pressure, and check her pulse oximetery.  The nurse also explains to Jane that she can send send her information at anytime during the day or night, especially if she is not feeling well or notices a change in her condition,  as the monitoring center is staffed 24 hours a day. The home care nurse explains that Jane's patient-generated health data is then transmitted to a nurse in a remote location who will review the data making sure that the reported results are within the parameters set by her physician.  If there is any concern with the data submitted, the nurse will contact Jane directly to check on her well-being and complete an assessment, this may be done in person or via the telephone. Jane may also be asked to resubmit the data. In the event that the data remains outside of  the acceptable limits, Jane's physician will be contacted for instructions and orders to manage her current condition. In the event of a weight gain, additional lasix may be ordered. This technological intervention provides Jane with an immediate response to any change in her health status and allows for rapid intervention and treatment resulting in avoidance of an emergency room visit or additional hospital readmission.  Telehealth remote patient monitoring enhances improved patient outcomes through the analysis and timely treatment of actionable patient-generated health data. The ability to communicate patient specific data to nursing at any time keeps the patient in communication with and connected to the nurse providing increased satisfaction their care. 

 For examples of technology commonly used in nursing 

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A glimpse into the future

Additional Resources to further your learning on the Human-Technology Interaction

Explore Health IT.GOV for more information

 Explore the  Healthcare Information & Management Systems Society (HIMMS)

Striking the right balance between technology and patient care

Patient Care Technology and Safety

Reflection

It is startling to think of all the ways that humans interact with technology.   But does smart technology actually mean smarter health?   We have all used and heard the phrase, "there's an app for that".  With over 165,000 health related apps available to consumers, how can we be assured that these apps are built on evidence-based principles to achieve positive outcomes. We must also carefully consider the safety, security, and quality of information they provide (Price, 2017). These apps provide our patients with an insight and awareness of their current health status that they never had before.   This brings several questions to mind. How is this data being used to improve app functionality? Can we trust that the data that is extracted is even accurate, usable, and reliable?  Does this interaction between humans and technology actually improve the health of the consumers using them?  We can not have a "laissez-fair" attitude toward patient education. Patient education is more important now than ever before. As nurses it is imperative that in our role as educators, we assess a patients health literacy, as well as their knowledge and expectations from interacting with technology.  We must assure their understanding using teach back methodology and be readily available to clarify information, answer questions, and downplay myths.  I see the human technology interface as an enhancement to current medical practices. The human-human interaction will always be necessary in healthcare, even if technology is applied in order for that interaction to occur.  Advances in healthcare technology are exciting. The use of technology creates efficiencies and convenience in care delivery and the consumers self-management of health. We must advocate that it is developed on evidence-based practice, kept secure, does not cause harm, and promotes quality outcomes for our patients.  We still have a long way to go to gain full interoperability among the numerous forms of health care technology currently being interacted with by out patients.  

References

Nelson, R., & Staggers, N. (2018). Health informatics: An interprofessional approach (2^nd Ed.). St. Louis, Missouri: Elsevier.

Price, C. (2017).  How smart health technology is improving our quality of care. The Telegraph. Retrieved from https://www.telegraph.co.uk/business/social-innovation/smart-health-technology/

Simpson, D. (n.d.). Improving the human technology interface nursing informatics. Retrieved from https://slideplayer.com/slide/10750555/

INTRODUCTION: What is SNOMED- CT?

The acronym SNOMED-CT stands for the Systematized Nomenclature of Medicine - Clinical Terms.  SNOMED-CT provides a common language that enables communication among providers and electronic health records, increasing the collaboration, consistency, and quality of patient care across different medical specialties for any given patient (Ware, 2013). The primary purpose of SNOMED-CT is to encode the meanings of healthcare information and support the effective recording of clinical data with the goal of improving patient care. This language is recognized throughout the United States and Internationally as the most comprehensive clinical terminology and has become an international standard for the coding of healthcare data (Nelson & Staggers, 2018,p. 377).  According to Nelson & Staggers (2018), SNOMED-CT is considered the most precise and comprehensive multilingual health terminology in the world. It is also the current national standard required for Stage 2 Meaningful Use for the designation of the patient problem list and public health reporting (NLM, n.d.).  SNOMED-CT is far from simple. Nineteen hierarchies define the initial concepts which are then further broken down into more precise ideas that result in specific clinical concepts which define a patients condition. SNOMED-CT has been scientifically validated and is available for use free of charge from the U.S. Department of Health. SNOMED-CT offers a practical application to nursing by assisting with clinical decision making and providing links to shared resources such as clinical pathways, care plans , and other resources that support patient care. 

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Check out these links for additional information

Websites

SNOMED International 

SNOMED-CT Overview

Articles

Development of the nursing problem list subset of SNOMED CT®

An Applied Evaluation of SNOMED CT as a Clinical Vocabulary for the Computerized Diagnosis and Problem List

Weekly Thought

I have enjoyed the assignments throughout this first week of the course. They have been challenging but also eye-opening. Nursing Informatics is a much broader field than I realized. The tools and technology we are being exposed to offer us innovative and creative ways to work with both staff and patients. I look forward to next weeks learning experiences.

References:

National Library of Medicine (NLM) (n.d.). Overview of SNOMED CT. Retrieved from https://www.nlm.nih.gov/healthit/snomedct/snomed_overview.html

Nelson, R., & Staggers, N. (2018). Health informatics: An interprofessional approach (2^nd Ed.). St. Louis, Missouri: Elsevier.

Ware, E. (2013).  SNOMED what it is and why it was added to stage 2 meaningful use. Wolters Kluwer Health Language Blog. Retrieved from http://blog.healthlanguage.com/SNOMED-What-it-is-and-Why-it-was-Added-to-Stage-2-Meaningful-Use