Class

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Class 175 IMPLEMENTATION OF NEW NURSING
TECHNOLOGIES

• ROADMAP TO SUCCESS

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Presenters

• Regina Alexander-Reis RN MS
• BCMA Coordinator/Nursing Clinical Applications
  Coordinator
• Eastern Colorado Health Care System (Denver)
• PICTURE

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Kathryn G. Sapnas RN, PhD, CCRN, CNOR Chief
Nurse, Research Informatics Miami VA Healthcare
System
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HOUSE KEEPING
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HOUSE KEEPING

• This is 1.5 Hour class
• Restrooms are located
• Cell Phones
• Please turn off or change to vibrate
• If you must answer a call, please leave the room.

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HOUSE KEEPING

• Please,
• No questions during the presentation.
• Questions written on the 3X5 card will be
  answered at the conclusion of the presentation.
• For questions not answered,
• the question and the answer will be available on
  the web.

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Introduction
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Safety, Quality Informatics

• Informatics as a Quality Driver
• Role in Magnet Designation
• Clinical Excellence
• Patient Safety
• Inextricably linked
• Interdisciplinary Collaboration
• Efficiency
• Effectiveness

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Failed Implementations

• What do you consider a failed Implementation?
• EXAMPLES
• US Business
• Hershey
• US Healthcare
• Santa Barbara County Care Data Exchange

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Successful implementations
Miami Interdiscplinary Nursing Informatics Model

• Positively impact
• Patient safety
• Staff satisfaction
• Patient satisfaction

Patient-Centered
Outcomes - Driven
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Successful Implementation

• Stakeholder Communication
• Strategic plan
• Organizational assessment
• Framework (Gugerty, Rook and Maranda, 2006)
• Pre-implementation,
• Go live
• Post implementation.
• Concept of between within
• Coordination
• Cooperation
• Collaboration

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Evolution of NI in VA
(Moorer Rick 2006)
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Evolution of NI in VA
(Moorer Rick 2006)
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Chief Nurse Executive Role

• Critical in Selection, Implementation
  Evaluation
• Overall Facility/Healthcare System Impact
• Requires alignment with the
• Complicated Process
• CNO must be actively involved in over-all
  decision-making implementation process
• (http//www.aone.org)

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CNE Technology Guiding Principles

• Pre-Acquisition
• Acquisition (before selection supplier)
• Contract Negotiation
• Implementation (Managing the process)
• ROI- Benefit Management

• Post Implementation
• Understanding overall policy issues related to IT
• Survival Tips
• Directives from the CEO/BOD
• Legal Aspects
• (http//www.aone.org)

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CNE/Nurse Informaticist Dyad

• Pre-Acquisition
• Contract Negotiation
• Critical in success of the acquisition,
  implementation, and evaluation
• Acquisition (before selection supplier)
• Implementation (Managing the process)
• ROI- Benefit Management

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Domains of NI Practice

• System Lifecycle
• Human Factors
• Information Technology
• Information Management
• Professional Practice
• Models and Theories

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Functional Areas of NI

• Survey conducted by Sensmeier
• Weaver
• 776 respondents
• Top 3 most frequent roles reported
• System Implementation (45)
• System Development (41)
• Liaison (32)
• (HIMSS, 2007)

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NI Leadership Skills

• Superb communication
• Change management
• Risk Assessment
• Coalition building
• Political finesse
• Business acumen
• Strategic application
• (ANA, 2008)

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Nursing Informatics Competencies

• Informatics Nurse Specialist skills common to
  Nurse Executive skills
• Computer literacy skills
• Information literacy skills
• Project management skills
• Information management and communication
• Consultant
• Make judgments based on data trends patterns

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Analyst Role

• Quality and Safety
• Outcomes management
• Synthesize knowledge
• Performance Improvement
• Maintain data integrity and reliability
• Aggregate data
• Identify benchmarks
• Develop Performance Measures
• Assess workflow

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NI Competencies

• Leadership Innovation
• Computer Information Literacy
• Change Management
• Computer Knowledge Skills
• Project Management (NII)
• Administration, Communication,

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SHARED VISION

• Chief Nurse Executive and Nurse Informatcist
  DEVELOP solid foundation of collaboration
• Work together to make the vision a reality
• Look to future to create realities in present
• Work though people support and encourage
• CELEBRATE SUCCESSES!!!!!!!
• LAUGH !!!! Use Lessons Learned to develop Best
  Practices
• Share the results

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Why do we continue to introduce new technologies
in nursing?
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Benefits of IT in Healthcare

• Safety
• computer technologies can place safety barriers
  within high risk processes to improve patient
  safety

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Benefits of IT in Healthcare (cont)

• Efficiency
• Achieved through the use of computers and
  computer technology as a data management tool
• Moving away from paper records improves access
  to the data you need without flipping through a
  bulky patient record
• Easier retrieval of data associated with a
  particular process
• Data sharing is improved between disciplines

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Benefits of IT in Healthcare (cont)

• Quality Improvement
• Allows for auditing to assure a consistent
  standard of care
• Measurement of performance against standards of
  practice to identify systems issues and
  opportunities for improvement

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Benefits of IT in Healthcare (cont)

• Decision Support
• Cues and information built into the system to
  assist the clinician in making care decisions
• BCMA - provides a double check against the 5
  Rights of Medication Administration,
• PCA pumps and Smart IV pumps - alert when dose
  limits are exceeded and can prevent
  misprogramming

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Principles of System Life Cycle
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Planning and Analysis

• System planning
• Definition of the problem
• Feasibility study
• Recommendations
• Allocation of resources
• System analysis
• Data collection
• Data analysis
• Data Review
• Benefits identification
• System Proposal development
• System design
• Functional specifications
• Technical specifications
• Implementation planning

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Testing and Training

• Functional Testing
• Integrated systems testing
• End-User Training
• Hands-on, interactive
• How it works, how it will be integrated into the
  users environment
• reference tools, support

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Implementation

• "Go-Live" work plan
• description of preparation
• timeline
• indicators for completion of critical tasks
• person responsible for determining criteria have
  been met
• Activation
• gtgtParallel gtgtPilot
• gtgtPhased-in gtgtBig Bang theory

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Evaluation

• System evaluation and maintenance
• Use criteria established in the planning and
  design phase
• Has the system accomplished the stated
  objectives?
• Continuous phase associated with quality
  improvement and continually meeting the needs of
  users

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Application in the Nursing Environment

• Implementation strategies in the nursing
  environment
• Functional testing
• Workflow analysis
• Documentation of polices and procedures
• Education and Training
• Go Live

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Evaluation of an Implementation Process
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PCA pumps with programming software

• What went right
• Things that could have been done differently.
• What are some implementation lessons learned from
  this process.

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Practical Application

• Clinical Flowsheets
• Functional testing
• Workflow analysis
• Documentation of polices and procedures
• Education and Training
• Go Live

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Summary

• Strategies for successful implementations
• Strategic Pre-planning
• Shared vision
• Clear expectations
• Include Senior and Executive Leadership as well
  as Nursing Leadership team and staff
• Measurable outcomes
• Relationships with stakeholders
• Post implementation follow up evaluation metrics

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Measuring Implementation Success

• Clinical Information Systems Implementation
  Evaluation Scale (CISIES)
• 37 items on a 6 point Likert-type scale
• Strongly Disagree to Strongly Agree
• Valid reliable (a.94)
• Total score identifies degree of staff
  satisfaction with implementation and likelihood
  of non-problem or problem implementations
• (Gugerty, 2005)

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EXAMPLES of CISES questions

• The system has improved my practice.
• Adequate resources were available when I was
  learning to use the system.
• I feel the use of the system has improved patient
  outcomes.
• The system take into account specific needs of my
  care area(s).
• Members of other disciplines should receive more
  training on how their entry information affects
  my use of the system.
• Overall, the introduction to the system has been
  effective.
• I am physically comfortable when I use the
  system.
• http//cisevaluation.com/Gugerty_Consulting__LLC
• (Gugerty, 2005)

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References

• American Nurses Credentialing Institute (2007).
  Testing information Informatics nurse. Retrieved
  on August 9, 2007 from http//www.nursecredentiali
  ng.org/ancc/cert/PDFs/InformaticsBrochure.pdf
• American Organization of Nurse Executives.
  Defining the role of the nurse executive in
  technology acquisition and implementation.
  Retrieved July 25, 2007 from http//www.aone.org
• American Organization of Nurse Executives.
  Organizational information. Retrieved July 13,
  2007 from http//www.aone.org
• American Organization of Nurse Executive.
  Strategic plan. Retrieved July 23, 2007 from
  http//www.aone.org/aone/pdf/Strategic2020Opera
  ting20Plans/200720200920AONE20Strategic20Plan
  20Final.pdf

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References

• American Nurses Association (2006). Standards of
  practice for nursing informatics. American Nurses
  Publishing Washington, D.C.
• Gugerty, B, Maranda, M, Rook, D. (2006). The
  Clinical Information System Implementation
  Evaluation Scale. Proceedings of The 9th
  International Congress in Nursing Informatics,
  June, Seoul, Korea.
• Gugerty, B. (2005). Clinical Information System
  Implementation Evaluation Effectiveness Scale.
  Retrieved from http//cisevaluation.com/Gugerty_Co
  nsulting__LLC
• Severino, D.G., Passino, J. (2004). Making I/T
  work A executives guide to implementing
  information technology systems. Jossey-Bass, Inc
  San Francisco, CA.