INTERNATIONAL CONFERENCE ON HOSPICE AND PALLIATIVE CARE August 31 to September 2, 2015 Orlando, Florida Julia A. Greenawalt PhD, RNC, CHSE Associate Professor Indiana University of Pennsylvania

DISCLOSURES Julia A. Greenawalt -Site Coordinator for a study sponsored by NLN/Laerdal/USAF. -Research committee for International Association of Clinical Simulation and Learning (INACSL). -Research committee for Society for Simulation in Healthcare.

1. Describe the use of simulation in nursing education to provide nursing students with the opportunity to learn informatics competencies through simulation scenarios that support inter-professional collaboration through the academic electronic health record. 2. Illustrate my experience with teaching students informatics skills to include medication administration, CPOE, interdisciplinary care planning and consultations. 3. Outline ideas for other academic institutions and clinical disciplines to consider when advancing documentation in palliative care. OBJECTIVES

Largest campus in the Pennsylvania State System of Higher Education and 5th largest PA University Research-based, teaching-focused and student-centered learning community Combines the academic opportunities of a large university with the highly personalized and intimate learning-centered environment of a small college Approximately 15,000 undergraduate and graduate students enrolled in accredited and nationally recognized programs ABOUT IUP

Programs: PhD, Nursing Master of Science, Nursing Bachelor of Science in Nursing Integrated the use of an academic electronic health record into Master and Undergraduate level nursing courses Nursing and Allied Health Professions

American Association of Colleges of Nursing (AACN), Institute of Medicine (IOM) Technology Informatics Guiding Education Reform (TIGER) Quality and Safety Education for Nurses (QSEN) American Nurses Credentialing Center (ANCC) Recommend that student nurses learn to navigate the healthcare environment including health care informatics. AACN recommends core competencies identified from both IOM and QSEN. From the IOM in 2003: “All health professionals should be educated to deliver patient- centered care as members from a multi-disciplinary team, emphasizing evidence- based practice, quality improvement approaches, and informatics”. Informatics Competencies

The IUP Story

 Informatics Nurse joined the Nursing Faculty in 2009  Encouraged faculty to integrate Informatics activities into the curriculum  Greater interest in professional organizations, ANIA, INACSL, NLN, SSIH.  Starting a regional ANIA locally near IUP Sept  Engaged in scholarship to advance this effort, journal articles, presentations, posters. Infusion of Informatics Competencies and the Faculty

Obtained HRSA Grant Monies to support the use of simulation and informatics: Selected the “Academic Education Solution” from Cerner: Multidisciplinary Able to use an interactive teaching approach to engage students to learn evidence-based clinical practices Teach strategies that encourage critical thinking skills in clinical simulation Practice with an “electronic health record” prior to a clinical experience How we Built from the Ground Up

 Researched several academic ehr solutions  Best solution to meet our needs for teaching and learning  Cost, accessibility, complexity, clinical sites  Implementation plan and challenges  Faculty adoption  Pros and cons of selecting and academic ehr solution EHR Selection Process

Clinical Simulation Labs High fidelity manikins supported by a simulation specialist Scenarios that map clinical situations to the electronic health record Use of standardized patients Engage students in the electronic health record during clinical simulation: Documentation exercises Orders and CPOE processes Medication Administration with ability to practice bar coded medication administration and to teach medication error reduction strategies Plan of Care assignments Clinical Simulation at IUP

Sophomore nursing students: Assigned access to the Academic Electronic Health Record Participate in a series of simulation exercises – mapped to nursing skills Junior and Senior nursing students: Maternal Health – pre-clinical simulation practice Adult Health – pre-clinical simulation practice with medication administration Masters level students: Advanced exercises in Informatics concepts  Nutrition (Consults)  Psychology (Consults)  Computer Science (Build “behind the scenes”)  Educational Technology (Documentation)  Health Administration (Supervisory)  Cross Disciplinary Collaboration 12 Electronic Health Record Integration

Students are shown the live system at the clinical site. Initially, we used a “ Superuser ” as the instructor. It has now transitioned to the faculty member. Day 1 of Clinical “Superuser” Step #1 Infusing Documentation Practice in a 4 year BSN Program Undergraduate Example

Students practicing head to toe assessments, then…charting their findings. Briefing De-Brief Pre-Brief De-Brief Handout Step #2 Undergraduate Example

Day 3 of Clinical Rotation Students charting on their patients at patient bedside or in nursery. Step #3 Undergraduate Example

USA-Charting Based on Medical Model  Patient record adheres to the medical model.  Becoming more interdisciplinary, but folks still not reading/reviewing all relevant documented evidence/notes  When one documents, still need for one to “talk” to the provider and provide clarity and time/direction.  Due to drop-down menus, difficult to Document the critical thinking/analysis.  Hard to find follow up information, hard to track phone follow-up info on patients. Implications for teaching/education.  Clarity for type of contact: phone, doctor visit, hospital. Makes it difficulty to interpret care rendered over the full spectrum. Then, makes it hard to defend in court.  Not easy to demonstrate the “flow” of care from problem list to execution and follow up.  More use of clinical notes, on occasion.  While it is time stamped in the record, encourage use of self time-stamp to assist with chronological show of efforts towards patients.  More involvement with pre/post hospital care environments in the crafting of forms for the electronic health/medical record of patients  That nursing curriculums need to incorporate electronic health record into both theory and practicum courses. Recommendations

-This method is NOT without it’s own pitfalls -For example, when a student “accidentally” enters on a patient that is not theirs. -That authentication is not adequate coverage for documentation of a student. -You MUST write a clinical note that discusses the objectives, assessment and review of a higher authority. -That the “new documentation” is not as effective as the old method (paper/pencil) for protecting the healthcare providers. -That EHR/EMRs continue to evolve and that there should be a plan to keep faculty, facilities and everyone practicing in the CURRENT era. -Expense -Oversight, QA/QI=Whose responsibility is it anyway??? -That it requires diligence from all participating parties -While we would like to get to the next phase for MU-II, data mining, we are still struggling to get folks to adopt this legacy system. Take-away Message

IUP EHR “Part II” Technology trends and thoughts on the future for nursing students Generational gap in nursing education and student learning Nurse Educators of the future Our Story Continues - Discussion Points Which way do we go now?

Thank You! Dr. Julia A. Greenawalt| Questions?

Hommes, T. (2014). Implementation of simulation to improve staff nurse education. Journal for Nurses in Staff Development, 30(2), Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved from Meyer, L. & Sternberger, C. (2011). How to implement the electronic health record in undergraduate nursing education. American Nurse Today, 6(5), Ohlen, A., Forsberg, C., and Broberger, E., (2013). Documentation of Nursing Care in Advanced Home Care, Home Health Care Management & Practice, 25(4), pgs Vana, K. & Silva, G. (2014). Evaluating the use of simulated electronic health records and online drug reference in the case study to enhance nursing student understanding of pharmacologic concepts and resources. Nurse Educator, 49(4), References