Question

The Jayhawk Medical Center uses an electronic health record (EHR) certified by the Office of the National Coordinator of Health Information Technology. To demonstrate nursing’s contribution to patient care, the chief nursing officer supports the Council for Nursing Informatics and provides trained informatics nurses to help the Council achieve the goals of safe patient care and quality nursing data. Jayhawk Medical Center is a Magnet hospital and is actively engaged in a patient safety program, including National Database for Nursing Quality Indicators (NDNQI) quality metrics.

Cassandra Mendoza, MSN, RN, is one of the informatics nurse specialists. Her current informatics project is to design and implement a falls risk management protocol in the electronic health record that also collects data to submit to NDNQI. She first meets with the nursing staff to determine the evidence supporting falls risk management. Based on this evidence they select, a falls risk assessment tool and other data that need to be collected to document and manage the falls risk. They determined the levels of risk are none, moderate, and high risk and defined order sets for each risk level. Next, Cassandra interviews and observes the staff to determine the workflow surrounding the assessment, documentation, and management of a falls risk.

With this information, she begins to design the screens for the assessment and order sets to facilitate accurate data entry and present the information in a way that all clinicians can understand and make accurate clinical judgments about the care of the patient at the point of care. As she evaluates the evidence, she determines the data elements and their values (assessment questions and possible patient observation) and the appropriate data types (e.g., numeric, free text, coded response list). This is the first step in representing the data for both data input and data retrieval. For each question and coded response list, she matches each concept to a standardized language. Cassandra selects the appropriate standardized language from a list that has been approved as HIPAA code sets and in the “meaningful use” criteria. Next she ensures that the design reveals the nursing process and maps each component to the Reference Information Model of Health Level Seven, an electronic message standardrequired for health information exchange as specified in the HITECH Act of 2009. She adds a decision support rule that states: “When the falls risk assessment score indicates a risk, Falls Risk is added to the patient problem list and an order set for the indicated risk level is presented to the nurse for approval.” Finally, she determines the staff members who may view and interact with the protocol to ensure confidentiality.

After Cassandra completes the implementation of the protocol, she meets with the nursing staff again to evaluate whether the protocol meets their needs and represents the evidence for falls risk management. After the final approvals for the protocol, she builds the screens in the electronic health record and implements a training program for the staff. Three months after implementation, Cassandra evaluates the protocol and its use by the staff. The number of falls has been reduced by 15%, all of the NDNQI falls metrics were collected electronically (saving money on data collection from charts), nurses loved the decision support that saved them time by automatically adding the risk to the problem list and entering orders, and patient satisfaction increased by 10% with free text comments about the staff’s thoughtfulness in keeping them safe.

Case Analysis

This case is an example of how and informatics nurse specialist works with staff nurses to design assessment and clinical decision support tools to improve quality and safety of patients at risk for falls. Falls and fall injury are the most frequently reported adverse event among adults in the inpatient setting. Although fall prevention is addressed as an interprofessional problem, falls are a nurse-sensitive measure, and nurses play a key role in prevention. Fall risk assessment is an essential component to a fall reduction and prevention program. The exemplar case demonstrated how the informatics specialist collaborated with nursing staff to develop and implement an electronic fall assessment and prevention protocol that ultimately reduced fall incidence and increased patient and nurse satisfaction. Before designing the clinical tool, the informatics nurse involved the nursing staff to determine evidence to support level of risk and to examine workflow patterns to determine best fit for data collection within the EHR. These are key elements to increase usability of the tool. Also, note that the clinical decision support tool implementation included training and follow-up evaluation.

Question 1

What are some examples of how Cassandra functioned to ensure that the protocol developed would be effective and implemented by the staff?

Question 2

What are the meaningful use criteria?

Answer 1

1. Protocol is particular set of rules.protocol helps to maintain standards.Standards define quality and minimum requirements and provide recognized solutions for protection of consumers health safety and environment. Some of the examples a.by using audience and stake holders participation protocols may develop. b.maintain study time line. .c.Expedited protocol review request help to develop standard peotocal. d.Continues assessment and periodical evaluation help to maintaining protocol.
2. Meaningful use criteria: Meaning full use means that electronic health record technology is used in a meaning full way and ensure that health information is shared and exchanged to improve patients components. Meaning full use criteria include10 goals.a.provide access to comprehensive patient health data for health care team.b.used evidence based order set and computerized physician order entry .c.apply clinical decision support at point of care.d.provide transparency of data sharing to the patient.e.Ensure privacy and security protection for confidential information.f.communicate with public health agency .g.Exchange of health information between health care team.h.generates list of patients who need care and use them to reach out patients.I.Quality improvement in reporting .j.provide timely access to data to manage health