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BACKGROUND/RATIONALE:
More than 98,000 people die each year due to medical errors (IOM, 2000). Currently, nearly 3 million registered nurses provide 80% of all direct "hands-on" care. In 2005, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) reported that communication problems accounted for nearly 70% of sentinel events in accredited health care facilities (JCAHO, 2007) and that ineffective handoff communication was responsible for nearly 50% of the communication breakdowns. Existing methods of care planning are static and do little to enhance the flow of information and clinical decision-making. Hand Off communication is further complicated by multiple changes in personnel within and across disciplines and shifts during the patient health care encounter.
Currently, there is no "gold standard" for care-planning or hand off nursing communication, putting patients and nurses at significant risk for less than optimal health care outcomes.
OBJECTIVE(S):
1) To identify barriers, facilitators and approaches that will enable the successful implementation of the HANDS method and care plan.
2) To develop an implementation plan, technical plan, and a sustainable funding strategy that will inform future implementation of an evidence-based patient care plan.
3) To establish a framework for implementation of the HANDS method of care planning throughout VHA.
METHODS:
The initial planning includes use of strategic planning method over a six-month time frame. Miami VA Healthcare System Nursing Staff lead this effort and serve as liaisons to the other VHA health care facilities in partnership with senior members of the HANDS research team. A Core Executive Team that comprised local and national Nursing Leadership included the Principal Investigator, Associate Director for Patient Care Services/Chief Nurse Executive, Office of Nursing Service (ONS) Program Director, and the HANDS (Contractors) Research Team Principal Investigator and HANDS Grant coordinator.
The overall strategic implementation plan included development of three interdisciplinary committees to address developing: a) strategic plan; b) technical plan; and c) a long-term sustainable funding strategy. A strategic vision and charter was developed for each of the three committees. Agendas are developed in advance of each meeting. Committee meetings are held using various teleconference and web conferencing technologies each week. Teleconferences are audiotaped and the minutes are transcribed and reviewed for accuracy by committee members. Transcriptions are revewed by committee members for accuracy and ammended as indicated.
Each of the committees receives either virtual group demonstration using "LIVE meeting" or individual interactive virtual demonstration of the HANDS program. The PI and the HANDS team lead committees in conducting an organizational infrastructure assessment. A gap analysis is being conducted to identify barriers to implementation and implementation over time. Techniques used to identify specific planning strategies and methods included management coaching, demonstration, education, think-aloud technique, and self-assessment.
FINDINGS/RESULTS:
HANDS functionality and technical requirements has been assessed. The selection, adoption and use of standardized nursing language has been discussed. The Technical planning committee has explored issues surrounding three main conceptual areas: a) data integration, b) data structure c) data access and security. Gaps have been identified in these areas and subcommittees have been formed to address each of the three areas in depth. Additional committee members have been added to the technical committee that can serve as subject matter experts in these three areas. The Strategic Planning committee has formed and discussed issues related to previous VA health information technologies (BCMA, CPRS). The funding committee has formed.
IMPACT:
Improving care planning and hand-off communication is a JCAHO National Patient Safety Goal and keeping patients safe can occur by transforming the nursing work environment. Evidence-based technologic solutions must be implemented to support improved patient safety in nursing hand -off- communication using the nursing process. The Hands-on Automated Nursing Data System (HANDS) uniquely represents nursing care through regular capture and display of the status of the clinical problems, care provided, and progress toward outcomes. The dynamic nature of the system supports early intervention and revision of care when progress toward outcomes is not moving in desired directions, ultimately reducing length of stay, readmission rates, and care errors. Currently, there is no standardized system in VA for tracking nursing interventions based on an assessment of patient care needs to meet patient care goals and specifically addressing patient outcomes in relation to nursing interventions. HANDS is evidence-based and demonstrates success in standardizing nursing communication and providing patient centric decision support for use across all health care settings.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems
DRE:
Quality of Care
Keywords:
Management, Organizational issues, Staffing
MeSH Terms:
none
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