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Electronic Charting The Spring of a New
Documentation Era

• Steve Biondi, M.S., RN
• Wendy Ehnis, M.S.N., RN
• Rita Roedel, M.S., RN
• Extendicare Health Services, Inc.

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Spring Thoughts

• In like a Lion out like a Lamb
• Spring Forward
• Spring Training
• Spring Fever

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Focal Areas

• Why
• Pilot Experience
• Front Line Staff Characteristics
• Documentation Elements
• System Design
• Operational Considerations
• Teaching Strategies
• Outcomes

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Background

• Why
• Wanted to improve resident care
• Real time documentation
• Up to the minute compliance monitoring
• Standardization of charting
• Eliminate illegible handwriting
• Wanted to improve manual system
• Incomplete
• Labor intensive
• Data analysis was difficult
• Trending was cumbersome
• People at all organizational levels had positive
  experience with electronic CNA charting system

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Background

• Outcomes
• Easy to learn
• Flexible as documentation parameters change
• Easy to use

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Background

• Pilot
• Facility proven track record
• Stable Administrator, DON, MDS Coordinator
• Good survey history
• Supportive of corporate systems
• Adapts well to change
• Five geographically diverse locations began in
  April 2006
• Four basic clinical parameters chosen
• Within 6 months decided to implement corporate
  wide

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The worlds favorite season is the spring. All
things seem possible.--Edwin Way Teale
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Front Line Staff

• Characteristics
• Visual Learners
• Bright colors
• Visual Cues
• Emphasize key concepts
• Native Language
• Workforce diversity
• Reading Skills
• Simple terms
• Reinforce with graphics

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Front Line Staff

• As Adult Learners
• Need to see value of system
• Need to see practicality of system
• Need to be shown respect for prior life and work
  experiences

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Documentation Elements

• Why Chosen
• Based on elements most frequently charted by CNAs
• Encompass some of more prominent QI/QM and RUG
  elements that are critical to the resident POC

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DocumentationImplementation Elements
Section RUG QI/QM
E 21 27
G 7 17
H 2 4
K 5 4
35 (32) 52
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Documentation

• Elements
• Mood (E)
• 16 elements
• Frequency
• Up to 5 days
• 6 to 7 days
• Behavior (E)
• 6 elements
• Frequency
• 1 to 3 days
• 4 to 6 days
• Daily

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Documentation

• Elements
• Mood (E)/Behavior (E)
• Consider alterability
• System tracks interventions tried
• Effectiveness of interventions

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Documentation

• Elements
• ADLs (G)
• 11 Elements
• Self performance and support provided
• Focus late loss because of RUG and QI/QM
  implications
• Bed mobility
• Transfer
• Eating
• Toilet Use

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Documentation

• Elements
• Continence (H)
• Bowel/Bladder
• Self control categories
• Scheduled toileting
• Bladder retraining

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Documentation

• Elements
• Weight Loss (K)
• 5 30 days
• 10 180 days
• System has flexibility for percentages and time
  parameters
• Nutritional Approaches (K)
• Considers IV, tube feeding
• Tracking of food and fluid intake

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Documentation

• Elements Added
• Restorative Nursing (P)
• Number of minutes/24 hours
• Number of days gt 15 minutes/24 hours
• Staff consistently communicate they want
  documentation on elements added!!

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An optimist is the human personification of
spring.--Susan J. Bissonette
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Documentation System

• Design
• Easy to learn
• Must be able to de-CMSize language
  (i.e. support provided of 1
  person coded 2 on MDS)
• Get up to speed quickly
• Visual
• Images/graphics reinforce key concepts
• Basic reading skills
• Target was 6th 8th grade level
• Time sensitive
• Entries date/time stamped
• Prohibit charting until logical
  (i.e. unable to
  document lunch consumption until time
  appropriate)
  
  

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Documentation System

• Design (cont.)
• Independent
• Avoid copy cat charting
• Staff working smarter
• Chart as you go
• Alerts staff to situations requiring attention
• No bm in last 9 shifts
• Less than 1000 cc fluid intake over 24 hours
• Acknowledge job well done
• Real time feedback
• Able to pinpoint shift, location, individual
  employee performance

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Operational Considerations

• Security access
• Based on function at building
• CNA kiosk for data entry
• Licensed staff care alert reports
• HIPAA compliance
• Used unique resident demographic information
• Reinforced confidentiality _at_ kiosks
• System backup
• Nightly back-up at off-site date center
• Home like environment
• Aquarium screen saver

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Spring is when you feel like whistling even with
a shoe full of slush.-- Doug Larson
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Flexible Teaching Strategies

• Classroom
• Initial rollout training
• Short session
• One to One
• Kiosk for data entry
• Work station for report overviews
• Used tell-show-do approach
• Chewable bits
• ADL and Mood/Behavior coding week before
• Education Resource Binder
• Mood/Behavior Bingo
• ADL cards describing scenario
• Real time resident function/behavior

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Flexible Teaching Strategies (cont.)

• Visual Aids
• Quick reference laminates at Kiosks
• Story boards
• System has additional help screens
• Key Points
• 75 adults retain more information from sight
  education than other senses
• 72 hours is key for retention of learning
• Went live within 24 hours

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Outcomes

• Completeness of documentation
• Corporate standard gt 95
• Consider
• 100 documentation elements
• 100 bed SNF
• 10,000 documentation elements/24 hours _at_ 95
  compliance is 9500
• Monitor resident status
• Care alert reports
• Enhanced communication
• Messaging feature
• Catch staff doing it right
• Individual staff, shift, unit
• Capture resident acuity
• Fewer holes
• Multiple entries
• Fire story

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Spring is natures way of saying Lets
Party!--Robin Williams