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1. No planner, presenter, faculty, authors, or content expert has identified a conflict of interest that would affect the educational activities. 2. No.

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Presentation on theme: "1. No planner, presenter, faculty, authors, or content expert has identified a conflict of interest that would affect the educational activities. 2. No."— Presentation transcript:

1 1. No planner, presenter, faculty, authors, or content expert has identified a conflict of interest that would affect the educational activities. 2. No commercial interest has provided financial or in-kind support for this educational activity. 3. The Arkansas Nurses Association has provided financial or in-kind support for this educational activity in the form of printing and food costs. 4. Neither ANCC, SCAP, or ARNA endorse any commercial products discussed/displayed in conjunction with this educational activity. South Central Accreditation Program (SCAP) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

2 Jason Eagle, RN, BSN Central Arkansas Veterans Healthcare System

3 The purpose of this activity is to enable the learner to understand the benefits of an RN triage documentation tool and its impact on productivity and cost savings in an ambulatory healthcare setting.

4 1. Describe the need for a standardized RN triage documentation tool in the ambulatory setting. 2. Discuss the process for implementation of a new documentation tool. 3. Describe the evaluation plan for updating a documentation tool.

5 The ambulatory setting is where the majority of patients receive healthcare in the United States. RN projected employment is expected to grow exponentially in the ambulatory healthcare setting. Health care delivery in the Unites States requires fundamental redesign to become effective, sustainable, and cost-effective. (Rondinelli et al., 2014; Smolowitz et al., 2014)

6 Nurse-sensitive outcomes and quality indicators. Hospital readmissions Quality of life Functional ability Self-care abilities (Rondinelli et al., 2014

7 Improved patient health outcomes Reduced health disparities Efficient spending of healthcare dollars (Smolowitz et al., 2014)

8 Community Based Outpatient Clinic (CBOC)– Searcy Primary Care facility dedicated to providing care to Veterans Approximate size 3400 enrolled Veterans Typical scheduled daily 35 (3 Providers) with additional same day access appointments made

9 The Joint Commission (2014) Inconsistent documentation by RN staff Inability to locate specific modifiers Omitted data

10 What does it mean for you?

11 Streamline documentation for nursing staff involved in the Primary Care setting Follow guidelines related to the Nursing Process, as outlined by the American Academy of Ambulatory Care Nursing Provide a consistency in charting for all RN’s delivering care, within the service Decrease patient wait time Provide a better clinical picture of present symptoms for provider Provide an accurate and thorough data collection system

12 How does this comply?

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14 1. Guided by Critical Thinking 2. Accurate and Thorough Data Collection 3. Integration of Data and Information at Every Step 4. Provides Organized Framework 5. Theory and Research Based 6. Not Static, Fixed, or Linear 7. Provide a Feedback Loop 8. Documentation

15 Defined as: “The ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process, used to ensure safe nursing practice and quality care (Laughlin, 2013).” Problem-solving and decision-making are crucial skills Critical Thinking is thought to be the most essential of all nursing competencies

16 Assessment is the first of five steps in the nursing process Defined as: “Systematic collection of data to determine the patients health status and to identify any actual or potential health problems (Laughlin, 2013).” Incomplete data collection can lead to errors in decision making and possibly the wrong treatment for current conditions “In the assessment phase of the nursing process; obtaining, classifying, and organizing data is the main function of critical thinking (Laughlin, 2013).”

17 Classify data, grouping significant and related data Create a list of suspected problems Rule Out similar problems using critical thinking skills Determine risk factors that must be managed Includes Objective and Subjective data through the measurement of physical data and examination

18 Document data in a Systematic manner Problem focused Structured and Accurate assessment data to delineate responsibility Provide a basis for Consistency Describe steps and actions in exact order

19 Directly complies with Core curriculum for ambulatory care nursing (3rd ed.). Pittman, NJ: American Academy of Ambulatory Nursing. (14).

20 Based on Current Best Practice Does not supersede clinical judgment BEST OUTCOMES Aimed to achieve BEST OUTCOMES Allows for data to be personalized to meet patient specific care needs Template serves as a framework for data collection based on the standards of care that guide our nursing actions

21 “ Organize, Synthesize, and Summarize assessment data (Laughlin, 2013).” Provide an accurate clinical picture for provider to determine needs in a more structured and objective framework Data systemically displayed, Problem Focused

22 A crucial step in the nursing process Used by nurses in all settings of care Provide uniform framework to create a basis for consistency

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24 Provide a basis for Consistency Describe steps and actions in Order Delineate Responsibility Do not supersede Clinical Judgment *The current charting used does not meet these goals and outcomes; allowing significant error and omission of necessary assessment data. Most information is entered by RN without guidance in assessment criteria. *All charting should have the same framework and outline similar data within the Ambulatory Care Setting.

25 Based on Standards of Care that guide nursing actions Based on Current and Best Practice Aimed to achieve Best Outcomes

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29 Each section contains additional assessment data within the system Vital Signs Populated Select Location Chief Complaint Allergy Assessment

30 Use the “Additional Information” Section to free type problems patient presents with today.

31 NO NO, you do not have to complete each section of the template. Sections that must be Completed: Provider and Location Chief Complaint Allergy Assessment Pain Assessment Data Plan Designed to be Problem Focused

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33 Provide an easy to use, conclusive, and up to date charting framework that meets the Academy of Ambulatory Nursing Guidelines. Streamline problems in a system by system manner to focus on immediate needs Decrease time spent by provider gathering assessment data, by providing a better clinical image of patient initially Concise charting throughout the service Guide nursing staff in assessment Allow for personalized and appropriate care for our patients

34 1 Month 3 Clinics 1 clinic-no template 2 clinics-problem focused template

35 No Template Used: 16 patients average time with provider of 524 Minutes creating a yield of 8.73 hours spent in a 1 Month time frame for overbooks. This later yields a yearly total of 104 hours spent. Template Used: 16 patients average time with provider of 165.6 Minutes creating a yield of 2.76 hours spent in a 1 Month time frame for overbooks. This later yields a yearly total of 33.12 hours spent. When the template was used; time spent by provider on overbooks was REDUCED by 68%.

36 By a change in documentation, it will allow access to 34 more patients per month (417 patients/year, PER PROVIDER), without any change in time spent with those patients.

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38 Laughlin, C. B., & American Academy of Ambulatory Care, N. (2013). Core curriculum for Ambulatory Care Nursing. Pitman, NJ: American Academy of Ambulatory Care Nursing. 192 (14). Retrieved from EBSCOhost. (s8897724). Rondinelli, J.L., Omery, A.K., Crawford, C.L., & Johnson, J.A. (2014). Self- reported activities and outcomes of ambulatory care staff registered nurses: An exploration. The Permanente Journal, 18 (1), e108-e115. Smolowitz, J. et al. (2014). Role of the registered nurse in primary health care: Meeting health care needs in the 21 st century. Nursing Outlook, 63, 130-136.


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