Paper
Sunday, November 4, 2007
156
Testing the Impact of an Electronic Health Record with Integrated Evidence-Based Content
Patricia S. Button, EdD, RN, Zynx Health Incorporated, Lyme, NH, USA, Rosemary Kennedy, RN, MBA, Health Services, SIEMENS Medical Solutions, Malvern, PA, USA, Ida Androwich, RNC, PhD, FAAN, Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA, and Sherri Matter, BSN, MS, Pinnacle Health System, Harrisburg, PA, Harrisburg, PA, USA.
| Learning Objective #1: describe a process of integrating evidence-based knowledge in clinical information systems for delivery to clinicians. |
| Learning Objective #2: discuss staff nurse responses to the availability of evidence-based content in their workflow and documentation. |
The ongoing need to improve the quality and safety of care is clear (IHI 5 Million Lives Campaign, for example) and research shows that the automatic delivery of evidence based knowledge to clinicians at the bedside significantly increases the quality of clinician decision making. The purpose of this paper is to explain and discuss an evaluation project with the overall goal of testing the impact of an electronic health record populated with nursing knowledge and evidence for use by nurses in assessing, planning, evaluating, and communicating patient care. During the project both referential and integrated knowledge and evidence populated clinical applications. The referential knowledge and evidence was available through links from specific points in the clinical workflow in the applications. Links to evidence about four nursing sensitive performance measures, patient falls, acute pain, pressure ulcers, and smoking cessation, were provided to bedside clinicians. Evidence based plan of care, assessment and documentation content regarding six key patient problems was integrated into clinical applications. The six problems were: pain management, prevention of surgical site infection, prevention of ventilator-acquired pneumonia; tissue perfusion and fall prevention. The evidence based plans included comprehensive expected outcomes and interventions and were assembled using a strict evidence based methodology.
This study demonstrated that positive value could be achieved by providing access to evidence based knowledge at the point of decision making. Process and outcome measures were improved. Nurses in this study shifted from task based documentation to knowledge-based decision-making. Success was contingent on strong nursing leadership; evidence based content; tools to customize the content in accordance with institutional practices; a flexible hospital information system; and an inter-disciplinary team of experts from Pinnacle Health, Zynx Health and Siemens Medical. This implementation model can be replicated in other facilities.