1. Quality Improvement at Clinton Hospital
MAK verification process
Telana Fairchild, MSN, FNP-BC
University of Massachusetts Medical School- Worcester
Graduate School of Nursing
2/15/2019

2. Goal: Improve patient safety and quality care
EHR systems has a significant impact on improving quality and safety of patient care.
Goal: Improve patient safety and quality care
Health information technology (HIT) has been exponentially growing and expanding since the HITECH act was passed into law in 2009 (Brailer & Blumenthal, 2010). Constructing and intensifying the electronic health record (EHR) systems has had a significant impact on improving quality and safety of patient care (Gabriel, Jones, Samy, & King, 2014).
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3. CEO was concerned about organizational changes and policy implementation.
Multiple Senior Personal Changes
Policy implementation from large industry to small
Discuss the issue: The Clinton hospital CEO has concerns about the ability to disseminate appropriate policy and practice for incumbent and new employees. Over the last year they had experienced many changes in the senior personnel. Many departments are without nurse managers or those in the role are “acting managers” as well as there is a new acting CNO. Also, the CEO understood the inappropriate use of policies and procedures from Umass Memorial Medical Center- University campus at Clinton hospital. UMMMC-University is a tertiary academic medical center with over 600 beds and Clinton hospital is a 41 bed community hospital. The differences in these two hospitals are exponential and trying to fit polices and procedures from a large academic facility to a small community hospital comes with issues. For example, the policy & procedure for medication administration at each hospital was compared and found they were many difference. However, when the new Medication Administration Check system was implemented the policy and procedures for the University campus was used even for the small community hospital Clinton. Therefore, their were items from the policy and procedure which were not be applicable in total to Clinton community hospital. |
QI_Clinton_MAK |
2/15/2019

4. DNP student will lead project to improve the safety of patients at Clinton Hospital.
Quality Improvement
Systems thinking
Organizational leadership
Technology
Information system
Patient care
Leadership
Collaboration
Interprofessional team
As part of the integrative practice experience, the DNP student will lead a quality improvement project for MAK education and standardized the verification process to improve the safety of patients at Clinton Hospital. The competency essentials for the DNP student distinguish requisite skills and knowledge useful to this quality improvement project. Understanding of organizational and systems leadership for quality improvement and systems thinking allows the DNP student to translate research into practice, subsequently improving nursing process and patient outcomes (American Association of Colleges of Nursing [AACN], 2006). Information system and patient care technology is included for the DNP’s education; therefore, contributing to the DNP student’s knowledge and ability to help Clinton with their EHR system to improve the outcomes of patients (AACN, 2006). In addition, the DNP student has effective leadership skills that will facilitate collaboration among an interprofessional team and oppress any impediments to an interprofessional culture (AACN, 2006). At Clinton, an interprofessional team including nursing, pharmacy, and administration was created to inform and assist the GSN student and facility with this quality improvement project. The DNP student became the leader of the project after establishing the core issues and priorities for Clinton hospital. Once the interprofessional team had corroborated specific aim and goals for this quality improvement project, the DNP student began a literature review.
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5. This framework can be utilized to determine areas of improvement at Clinton.
The Yorkshire Contributory Factors Framework enables a systematic approach of reviewing safety and quality concerns for patients in hospitals.
Literature review verifies concern for quality and safety when implementing EHR.
Function of EHR
Organization structure and support
Technical infrastructure
Large organization support
Policies and procedures implemented
Evaluate and reduce cognitive workload
Culture and attitudes
Methods and models for training and education
External
Healthcare Reform
HIT
Organizational
Policies and procedures
Structure and support
Local conditions
Senior management changes
Contracted hospitalists and pharmacists
Situational
Teamwork
Behavior and attitudes
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6. The Kirkpatrick Model will facilitate the success of the quality improvement project.
The success of the project relies on multifactorial components within the project.
Reaction:
Staff satisfaction
pre- & post-surveys
Learning:
Staff competencies
Met learning objectives
Behavior:
Reduction of interventions per day
Logs
Results:
Improved patient safety and reduced workload
The Kirkpatrick Model will be used to guide and determine the success of the improvement project, the training modules, and the revised process for standardizing verifications. The Kirkpatrick Model was developed in 1950’s to analyze and evaluate training based on four categories: reaction, learning, behavior, and results. However, the Kirkpatrick Foundation modified this model and added an additional level, return on investment and now the model is widely used beyond training evaluation (Kirkpatrick Partners, LLC., 2009). Each of these categories evaluates the project, training, and process at different levels including the learners’ perception, knowledge, ability to apply learned skills, overall success of the project, and return on investment (Kirkpatrick Partners, LLC., 2015). For every category there will be measureable metrics for the project, modules and process.
QI_Clinton_MAK
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7. Improve Clinton’s hospital ability to adapt new EHR and bridge the gap during the transitional period.
Clinton
UMMS-GSN
UMMMC
QI_Clinton_MAK
2/15/2019

8. What questions or concerns do you have?
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9. References:
American Association of Colleges of Nursing (AACN). (2006). The essentials of doctoral education for advanced nursing practice. Retrieved from
Bornstein, S. (2012). An integrated EHR at northern california kaiser permanente: Pitfalls, challenges, and benefits experienced in transitioning. Applied Clinical Informatics, 3(3), doi: /ACI RA-0006
Brailer, D.J. & Blumenthal, D. (2010). Guiding the health information technology agenda. interviewed by david J. brailer. Health Affairs (Project Hope), 29(4), doi: /hlthaff
Colligan, L., Potts, H. W., Finn, C. T., & Sinkin, R. A. (2015). Cognitive workload changes for nurses transitioning from a legacy system with paper documentation to a commercial electronic health record. International Journal of Medical Informatics, doi:S (15)
Fritz, F., Tilahun, B., & Dugas, M. (2015). Success criteria for electronic medical record implementations in low-resource settings: A systematic review. Journal of the American Medical Informatics Association : JAMIA, 22(2), doi: /jamia/ocu038
Gabriel, M. H., Jones, E. B., Samy, L., & King, J. (2014). Progress and challenges: Implementation and use of health information technology among critical-access hospitals. Health Affairs (Project Hope), 33(7), doi: /hlthaff

10. References:
Kirkpatrick Partners, LLC. (2009). The Kirkpatrick Model. Retrieved from
Kirkpatrick Patners, LLC. (2015). Six Sigma: Kirkpatrick Model of Evaluation. W. Patrick. (Ed.). Retrieved from
Lawton, R., McEachan, R. R., Giles, S. J., Sirriyeh, R., Watt, I. S., & Wright, J. (2012). Development of an evidence-based framework of factors contributing to patient safety incidents in hospital settings: A systematic review. BMJ Quality & Safety, 21(5), doi: /bmjqs
Maust, D. (2012). Implementation of an electronic medical record in a health system: Lessons learned. Journal for Nurses in Staff Development : JNSD : Official Journal of the National Nursing Staff Development Organization, 28(1), E11-5. doi: /NND.0b013e318240a715
Provost, L.P. & Murray, S.K. (2011). The health care data guide: Learning from data for improvement [Kindle Edition]. Retrieved from amazon.com
Rosenbaum, S. (2011). The patient protection and affordable care act: Implications for public health policy and practice. Public Health Reports, 126(1), p. 130–135.
Schoville, R. R., & Titler, M. G. (2015). Guiding healthcare technology implementation: A new integrated technology implementation model. Computers, Informatics, Nursing : CIN, 33(3), doi: /CIN

11. References:
Stromberg, S. C. (2011). A training model for orienting newly hired nurses to an organization's electronic health record. L.Q. Thede (Ed.). Computers, Informatics, Nursing : CIN, 29(6), doi: /NCN.0b013e318224e78f
Takian, A., Sheikh, A., & Barber, N. (2012). We are bitter, but we are better off: Case study of the implementation of an electronic health record system into a mental health hospital in england. BMC Health Services Research, 12, doi: /
Turner, M. P. (2010). Stratifying computer literacy: A competency measurement strategy. Computers, Informatics, Nursing : CIN, 28(5), doi: /NCN.0b013e3181ec23fe
UMass Memorial Health Care (UMMHC). (2014a). About Clinton Hospital. Retrieved from
UMass Memorial Health Care (UMMHC). (2014b). About UMass Memorial Medical Center. Retrieved from