DNP 805 Analyze your new practice workflow to incorporate seeing patients and in regard to communication with the health care team and the infusion of the EHR into your practice
DNP 805 Analyze your new practice workflow to incorporate seeing patients and in regard to communication with the health care team and the infusion of the EHR into your practice
DNPs are uniquely prepared and qualified to accept and work in a variety of advanced healthcare roles especially in clinical practice. Roles such as to reduce costs by focusing on primary care, health promotion, and disease prevention as expert clinicians, faculty in schools, health care consultants, entrepreneurs and scholars caring for multiple patient populations in various geographic areas and as global health leaders (Zaccagnini, & Pechacek, 2019). As an expert clinician and academic scholar, the DNP prepared nurse is able to improve patient care through initiation of quality improvement (QI) initiatives, assisting with healthcare policy development. And also has knowledge and skills in healthcare economics, finances, leadership, and quality improvement (Zaccagnini, & Pechacek, 2019).
Workflow is a repeatable series of standard tasks that needs to be completed to achieve specific goals such as clinical processes in nursing. So, healthcare providers (HCPs) should be involved in the creating, planning and the implementation of health information technologies (health IT), to improve support. When an organization adopts an electronic health record (EHR) it changes the usual workflow standard. Therefore, the workflow is redesigned to suit the new system. The workflow redesign is a process of looking at all the aspects of the organization and mapping out current workflows and analyzing how the work gets done in the organization and they plan for the future and create new workflows to increase the organizations efficiency and the quality of health care. Workflow redesign helps most organizations to improve their EHR implementation, their efficiencies, enhance health care quality and safety, remove chaos from your current workflow, improve care coordination (HealtIT.gov., 2019).
As a DNP leader, I would assess to understand what will be involved, such as patients, a new EHR system. I would communicate with the senior information technology (IT) analyst team to understand what kind of system they plan to implement and then plan for a meeting with the nurses that will be working with the EHR to inform them of the system and when training would begin. The training would take place for 1-2 weeks at the most one month to make sure that all the staff is trained appropriately and efficiently by IT professionals and the clinical specialist to integrate the EHR into their work flow. During the implementation, the patients will be informed of the new EHR system and that the IT professionals and the clinical specialist would be available to help the staff to trouble shoot any problems encountered while working with the patients (Fecher, McCarthy, Porreca, & Yaraghi, 2020).
The term “Magnet” is a gold standard term for nursing practice in hospitals which is used to delineate those who are able to attract and retain qualified nurses based on five goals such as transformational leader, structural empowerment, new knowledge, innovation, and empirical outcomes and development. The effectiveness of magnet hospitals is the existence of work environments that focus on decentralized decision-making, autonomy, control over practice, resource adequacy, supportive management, effective inter-professional communication, and career development.
As a DNP leader in a magnet hospital, I will ensure that the staff are well trained to maintain our nursing excellence standards and the structures needed for the training are in place during training as well as during implementation and maintain communication with the staff in terms of when this will take place so that they are well prepared. Adequate structures such as adequate computers, the IT professional team, the scheduling of their time for the training is adequate with enough staffing to cover patient care for those in training to maintain patient safety and excellent nursing care. Providing adequate knowledge of the improvement in the quality of nursing care that this new system will provide will enhance their desire to learn and implement the program.
In a rural setting, the pace would be slower, so, as a DNP leader, I would have to reevaluate my strategy. I would have to also give them time to assimilate the need for change to a new EHR system. They will need more time to train and for implementation knowing that the patient influx maybe slower and the staffing may be less adequate. As the DNP leader, I will collaborate with all the leadership teams to make them aware of the process change taking place and the need for their collaboration with my team, explain to the patients the new changes that will take place. The leader has to make sure that all structural resources are in place as well.
Fecher, K., McCarthy, L., Porreca, D. E., & Yaraghi, N. (2020). Assessing the benefits of integrating health information exchange services into the medical practices’ workflow. Information Systems Frontiers, 23(3), 599-605. https://doi.org/10.1007/s10796-019-09979-x
HealtIT.gov. (2019). What is workflow redesign? Why is it important? | HealthIT.gov. ONC | Office of the National Coordinator for Health Information Technology.
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Mondayblog. (2022, March 31). Workflow definitions & templates for 2022. monday.com Blog. https://monday.com/blog/productivity/workflow/
Rivaz, M., Ebadi, A., & Momennasab, M. (2018). The role of magnet hospitals in making the nursing practice environment attractive. Tehran University of Medical Sciences 4(23), 294-290
Zaccagnini, M., & Pechacek, J. M. (2019). The doctor of nursing practice essentials: A new model for advanced practice nursing. Jones & Bartlett Learning.
Leader rounding is very importance in leadership. This includes both team member and patient rounding. During the leader rounding you can better understand from the customer how to best improve the quality of the services provided. This time often brings up questions that they have. This is when it is best to integrate in the Electronic Medical Record (EHR). That is just one of many ways. Another example is with interdisciplinary rounds. This results in increased communication and streamlined care throughout the interdisciplinary team. These are necessary elements in magnet facilities. This is what produces the patient experience, nursing engagement, and improved patient outcomes that are necessary elements to achieve magnet designation. This also helps with efficiency of the busy acute care setting.
The beauty of this is that it does not have to change when moving into the rural setting. The only things that should change with the setting is the resources available. It is possible to rural regional hospital’s to designate as magnet facilities. They are able to do all of the same things to make sure that patient and nurse engagement are high as well as patient outcomes. I work in a community hospital that just designated as a magnet facility as well as a recent recipient of Presidential Malcomb Baldrige Award which is the highest quality achievement award. These were made possible by our lean management system. This has been as transformative to me as a leader. It has taught me how to lead thru engagement of the front line team members and pushing them to be the problem solvers, and supporting them thru it. This can and should be implement in all hospital settings regardless of size or resources. Consistent utilization of a daily lean management system has been proven to improve the quality of care and patient outcomes in the acute hospital setting (Shazia et al., 2020).
Shazia Sarwar Alvi, Zahid Hamid, Sidra Riaz, Muhammad Sarwar Alvi, & Naila Azam. (2020). Effect of Lean Daily Management (Ldm) System on Quality of Healthcare Delivery in Indoor Setting – a Pilot Suudy. Pakistan Armed Forces Medical Journal, 70(3), 842–848.
A few areas to consider in a busy, metropolitan area would be access to critical care needs and the volume of patients needing assistance by that clinic. The patient flow in a clinic would need quick triage which an electronic system can assist with in addition to a real time bed board with priority of patients being seen. If a magnet organization improving patient safety, care and treatment leading to an excellence nursing service would be support by the magnet program needing to be explored and implemented.
If in a more rural area I would consider once again the patient needs and flow. It might be possible that the volume of patients would be less but more critical patients may be waiting in a clinic in order to be transferred to a trauma center, etc. Connectivity would also be something to consider, having clear, precise downtime procedures would be very important. I would also consider downtime drills in order to make sure staff are well prepared if the electronic system were to go down. “This study confirms that downtime is highly disruptive to patient care. The hybrid qualitative–quantitative analysis, which combined interview data with operational data, assessed the delays in laboratory result reporting. The analysis of the paper records suggested that the TAT of tests during downtime increased by 20 minute, or 62%, compared with normal operation.” (Hoffman, 2019).
Larsen, E., Hoffman, D., Rivera, C., Kleiner, B. M., Wernz, C., & Ratwani, R. M. (2019). Continuing Patient Care during Electronic Health Record Downtime. Applied clinical informatics, 10(3), 495–504. https://doi.org/10.1055/s-0039-1692678
DNP prepared nurses working in a leadership position in clinical practice has the foundation to practice at all levels of health care organizations, however, don’t provide direct patient care (AACN, 2006). DNP nursed work with diverse internal and external organization stakeholders in designing, patient-centered care, delivery and policy delivery methods. (AACN, 2006) Implementing systems, for example, electronic health records systems. Workflow redesign consist of analyzing current workflows and how the organization currently operates, planning for the future using templates, and design processes to improve efficiency and to provide alerts to improve safety and decrease duplication of care.
Implementing an electronic health record system (EHRs) requires an organization to undergo workflow redesign. Prior to this process, the current workflow must be assessed. Use of electronic health records in utilization management in collaboration with evidence-based medicine helps to facilitate best decisions. (Ghazisaeedi, et. al, 2014). Implementing workflow redesign includes improving efficiencies, improve quality, safety, cost, decrease duplications, improve care coordination. (HIT.gov, 2019)
Resources to ensure staff have time to learn the workflows, work through the workflows, appropriate follow-up to ensure staff understands the process.
When working with rural health care systems, external factors may contribute to less than desirable implementation outcomes. For example, lack of reliable internet access.
Guidelines to follow when implementing include identifying inefficiencies in current workflow, decide what workflows need improvement/prioritize. Work in stages, test new workflow using quick change tools such as Plan-Do Study-Act to see what works and how to improve, listen to staff, customize templates to improve efficiency. (HealthIT.gov, 2013)
Whether implementing at an urban facility or rural area, it’s important to be compassionate, just, authentic, using stewardship to provide necessary tools to educate the staff in implementing electronic health records.
American Association of Colleges of Nursing (AACN). (2006). DNP essentials. https://www.aacnnursing.org/DNP/DNP-Essentials
Ghazisaeedi M, Mohammadzadeh N, Safdari R. Electronic Health Record (EHR) As a Vehicle for Successful Health Care Best Practice. Med Arch. 2014 Dec;68(6):419-421. doi: 10.5455/medarh.2014.68.419-421. Epub 2014 Dec 16. PMID: 25648601; PMCID: PMC4314170.
HealthIT.gov. (2013) What are some tips for approaching workflow redesign
Health IT.gov. (2019)What is workflow redesign? Why is it important? What is workflow redesign? Why is it important? https://www.healthit.gov/faq/what-workflow-redesign-why-it-important
DNP-prepared nurse leadership oversees various essential functions, processes, and systems within a health care facility to optimize patient care delivery. The elements under a leadership supervision can include everything from patient records and legal compliance to nursing staff and facility finance. Nurse leaders are also typically tasked with identifying gaps in a health care facility’s patient delivery strategy and making recommendations on how to mitigate them.
The collective duties of an effective leader can create a positive professional atmosphere that minimizes conflict and encourages positivity and teamwork. This can have a substantial impact on a health care facility’s ability to create and execute effective patient-centered care that is proactive and cost-effective for both the patient and the facility. Ultimately, this can boost the potential to improve patient outcomes (Akhu-Zaheya L, Al-Maaitah R, Bany Hani S,2018).
The Magnet Recognition Program will continually elevate patient care around the world in an environment where DNPs, in collaboration with the interprofessional team, flourish by setting the standard for excellence through leadership, scientific discovery and dissemination and implementation of new knowledge. Effective collaborative care has been associated with improving health outcomes by reducing patient complications, decreasing length of hospital say, improving patient and employee satisfaction and decreasing costs of care. Magnet organizations utilize a model grounded in the core principles of flexibility, discovery, and innovation to empower nurses to lead change and improve health outcomes.
As a DNP, communication is an important part of day-day activity. From educating patients to coordinating with coworkers, the ability to articulate information is critical in nursing. This need only increases when an individual takes on a management role and are responsible for managing staff members. Electronic health record (EHR) nursing documentation offers a method to record the patient’s health status, individual needs, and responses to care, and to support clinical reasoning regarding the patient’s future care.1 Additionally, the EHR has the potential to improve patient care, care team communication, and patient experiences through well-designed workflows and clinical content relevant to the role, venue, and patient’s clinical status (Okaisu EM, Kalikwani F, Wanyana G, Coetzee M,2014).
Akhu-Zaheya L, Al-Maaitah R, Bany Hani S, (2018). Quality of nursing documentation: paper-based health records versus electronic-based health records. Journal of Clinical Nursing. 2018;27(3–4): e578–e589.
Okaisu EM, Kalikwani F, Wanyana G, Coetzee M. Improving the quality of nursing documentation: an action research project: original research. Curationis. 2014;37(2): 1–11.
You are right about the role of DNP leaders. As a leader in a rural hospital, I will encourage patient and staff engagement with the HIT system such as the EHR with scheduling appointments, assessing their charts because overall, patient engagement is critical to achieve health care quality and literacy with early diagnosis, continuity of care, treatment adherence and with reducing healthcare disparities. Also, when staff participate in the implementations of HIT such as EHR and have a voice in the design and implementation, they understand better the clinical processes and the need for them and be able to help to educate the patients as well. A recent study found that urban and rural providers used EHRs at similar rates, but patient engagement was lower among rural residents; due to the different Internet accesses, access to a particular source of care, and whether there was provider encouragement to access records.
A study noted that compared to urban areas, rural areas have a higher percent of older adults with limited knowledge of digital technology, higher incidence of health disparities, lower patient volume in health care facilities-they don’t go to hospitals often, and substantially poorer health care infrastructure, including telehealth and health information technology (HIT) system capabilities. Telehealth refers to a broad variety of technologies that is used to deliver care, provide patient education, and support services. While telehealth can improve health care delivery, quality, and costs, the main barrier to telehealth advancement in rural hospitals is the cost of implementation, which is exacerbated by the complicated and slow reimbursement for telehealth services by state and federal agencies. Other barriers include technologic concerns and a belief that patient needs can be met without telehealth.
A priority of the Office of the National Coordinator for Health Information Technology is to leverage the capabilities of HIT systems to accelerate health care integration and invest in rural HIT infrastructure. All various health care providers, such as hospitals, home health agencies, long-term care facilities, community partners, public health systems, transportation services, local networks, federal and state health systems, and policy makers should all come together to improve treatment efficiency, population health, and health equity in rural communities.
Alexander, S., Hoy, H., & Frith, K. (2019). Applied clinical informatics for nurses (2nd ed.). Jones & Bartlett Learning.
Chen, J., Amaize, A., & Barath, D. (2020, November 12). Evaluating Telehealth adoption and related barriers among hospitals located in rural and urban areas. Wiley Online Library. 37(4), 801-811. https://onlinelibrary.wiley.com/doi/full/10.1111/jrh.12534