Date of Graduation

Summer 8-7-2018

Document Type

Project/Capstone

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

First Advisor

Nancy Taquino

Abstract

Problem: An innovative method to communicate with the patient and between interdisciplinary team members is the use of the interactive patient careboard (IPC) which has declined since its implementation. Concurrently, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores for the med surg unit need improvement. The low HCAHPS scores in communication suggested to nursing leadership that revitalizing use of the IPC could lead to improvements in the scores. The ideal shift handoff includes IPC as a focal point of communication. The RN is expected to display the careboard during handoff and identify for the patient the healthcare providers and the patient’s current goals. According to the assistant nurse manager, about three in four RNs do not currently incorporate the careboard during (personal communication, 2017).

Furthermore, the resurgence of daily multidisciplinary rounds, which include the physician, patient care coordinator (PCC), the RN, and the patient, is necessary to provide the intended level of communication. The lack of communicating the patient’s goals, the plan of care, and discharge plans in daily rounds, then failing to input information to be displayed on the patient’s careboard may lead to miscommunication and a dissatisfied patient. Having the healthcare team in the patient’s room together delivering the same information shows teamwork and a consistent plan of care. As the amount of information shared with a patient during a hospital stay can be overwhelming, displaying the information gives the patient an accessible point of reference for review of their care.

Context: The medical surgical unit, with a capacity of 28 patients, is comprised of a multidisciplinary team. With a constant flux of RNs floating to the unit, patient safety becomes a potential issue, which makes a good shift handoff critical. RN communication with patients are also very important for patient safety. A good introduction to the team serves as a good starting point for communication, handoff, and rounds.

Interventions: The interventions included educating staff on the new Epic functionality, updating the IPC database with current staff and their photos, then re-training super-user RNs and PCCs followed by all RNs on IPC.

Measures: A family of measures was developed for this project. The outcome measure focuses on the number of RNs and PCCs utilizing the careboard during shift handoff and rounds. The process measures include the accuracy of staff photos and staff access to IPC. Other process measure includes completion of staff training on IPC and utilization of the Sign In functionality on Epic. The balance measure is the integration error between Epic and IPC.

Results: Prior to this project, only one in four of the staff RNs (8%) utilized IPC during shift handoff. The PCCs were not utilizing the careboard at all during rounds. After the first intervention, utilization of the careboard during shift handoff increased to 30%. After RN super users were trained, careboard usage slightly increased to 31%. After 91% of the RNs on med surg were trained, usage increased to 69%.

Conclusions: The low utilization of the IPC overall and even lower use of specific elements (e.g., referencing the healthcare team, acknowledging current goals) that enhance patient communication showed the need for re-education of the staff on IPC. They need to be re-trained on IPC to understand how the different elements fit together to optimize its usage and improve communication with patients. As staff receive training, observations will reveal the extent to which the training is successful and suggest subsequent interventions to achieve the project aim. The joint efforts made by nurse leaders, physicians, and ancillary staff is anticipated to lead to the long-term success of this project. It is expected that as more features of IPC are integrated with Epic to streamline the workflow, staff will find it advantageous to use IPC more in their daily practice.

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