Then: The nurse leaves the room to check on the computer at the nursing station. As he’s about to return to the room, he’s called in another direction. The patient waits for the answer.
Now: The nurse looks up the results on the computer in the patient’s room and lets her know within minutes.
With Knowledge-Based Charting, Karen George of Rhoads 6 can answer patient Mike Sozicz's medical questions without leaving the room.
A patient’s blood pressure has dropped.
Then: The nurse calls the patient’s physician, who is doing rounds on another floor, and tells him the patient’s vital signs. The doctor gets to the patient as soon as possible to review the notes and put in an order.
Now: The nurse calls up the physician, who looks up the patient’s information, vital signs and trends on a nearby computer and, within minutes, keys in an order.
What led to this transformation of patient care?
Knowledge Based Charting.
And what a lot of information there is! At HUP alone, “we produce 50,000 documents a day,” said Terese Kornet, MSN, RN, clinical director of Nursing Systems and the KBC site coordinator at HUP.
KBC creates a clinical summary that pulls information from multiple flow sheets to provide a total view of everything – the plan of care, medications, orders, interdisciplinary recommendations, and more. “In the past the social worker’s note was in one place, the respiratory therapist’s in another – some online, some on paper,” Sunday said. “Now it’s all there in one place. . . and it’s all real-time documentation. No more time wasted searching or calling.”
“It also gives us the ability to pull reports and look at clinical data,” Kornet said. “Previously it was a matter of tallying by hand.”
KBC guides documentation through evidence-based, clinical practice guidelines, which form the basis for the plan of care. “If a patient is receiving chemotherapy, that CPG provides assessment and intervention criteria to ask, for example, ‘Is the patient nauseous or constipated?’” said Karen George, BSN, RN, of Rhoads 6, one of the KBC pilot units.“It helps ensure you cover all the bases.”
“It also offers prompts for patient education, based on the patient’s own symptoms,” said Amy Moore, MSN, RN, also of Rhoads 6. “It ties everything together, tailoring goals specific to the medical diagnosis.”
Sunday explained that, although the application was initially “out of the box,” it has been modified for best practice and safety… and will continue to evolve. “We made sure what worked at one hospital would work at another,” he said. “The project gave us the opportunity to standardize care across all our entities.”
Some of the changes came from hands-on experience during the two-month pilot. “During the go-live, the oncology nurses were instrumental in identifying revisions to facilitate efficient documentation,” Moore said. “We also made it more user friendly and worked hard to make it specific for oncology care.”
KBC is another step in HUP’s move toward individualized patient- and family-centered care. According to Kirsten McClintock, nurse manager of Rhoads 6, “Patients and families love the fact that nurses don’t have to leave the room to find answers to their medical questions [ie, ‘What are my counts?’]. Now the information is literally at the nurse’s fingertips.”
Comprehensive Training and Planning
HUP's transition to KBC went smoothly, thanks to advanced planning and training. The changeover actually began in 2009, with the placement of computers in each of the 700+ patient rooms. “It took a lot of time to determine the best location in each room because they are not all the same,” Sunday said. “It wasn’t as simple as ‘It always goes on that wall.’” They specifically chose a device with an arm that swivels to allow the health-care provider to always face the patient.
KBC training came from within, “by employees who have knowledge of the Health System. We trained 30 interdisciplinary end-users from all entities as instructors,” he said. “They did an outstanding job.” They also trained a “super user” from each nursing unit or clinical service for on-site assistance.
The KBC team developed a separate set of training tools for each discipline. In some cases, they also trained users who never before needed to sign on to SCM – such as HUP’s chaplains -- to navigate the system.
“The implementation was incredible. The nurses did more than a tremendous job,” said McClintock. “After one day, one RN stated, ‘Wow. This is so easy. Why didn’t we do it sooner!’”
“It’s amazing we were able to function without it,” Sunday said, smiling.
A KBC Celebration!
Help celebrate HUP’s successful KBC launch at the KBC Carnival on Thursday, August 18, on Miller Plaza, from 11:00 am to 3:00 pm and from 6:30 to 8:30 pm. There will be food (with a meal ticket), carnival games, hourly raffles, music and more. The meal ticket voucher pick-up will be in the Nursing Network Center on Rhoads 1 -- between 7:30 am and 5:00 pm -- through Wednesday, August 17. To order meal tickets or for more information, contact firstname.lastname@example.org.