Getting Started
This section addresses the following questions:
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How do we assess readiness to implement On-Time?
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What resources are needed to implement On-Time:
- Technology?
- Staff?
- Facilitator?
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What is the overall workplan?
A nursing home is ready to implement On-Time if the
following are true:
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High pressure ulcer rates and priority on reducing
in-house pressure ulcer incidence rates. Typically, On-Time nursing
homes have an in-house pressure ulcer incidence rate greater than 2 percent on
at least one nursing unit.
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Leadership commitment and endorsement and support of top
leadership to enhance care processes related to pressure ulcer prevention.
While frontline staff are the cornerstone of On-Time, a nursing home is not
ready to start On-Time without the support of top leadership.
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Experience with quality improvement (QI). A
nursing home is more likely to implement On-Time successfully if it has
experience with QI, such as implementing a QI project in the last 6 to 12
months or participating in State or national quality improvement efforts, such
as the Advancing Excellence Campaign.
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Existing health information technology (Health IT) for
Certified Nursing Assistant (CNA) daily documentation or in planning stage.
Facilities that have electronic documentation in place for CNAs are less likely
to experience project delays. The facility does not depend on vendor timelines
since software is installed already and CNA staff are familiar with using
computers for daily documentation. This eliminates time and costs associated
with new software training.
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Technology
The technology requirements are:
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Facility has an Health IT system for CNA daily documentation.
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Vendor software meets the On-Time requirements for standardized
CNA data elements and On-Time reports.
Table 1 illustrates next Health IT steps for a facility given
their current state of CNA documentation:
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CNA staff are completing daily documentation on paper.
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CNA staff are documenting electronically but using software that
has not met On-Time requirements.
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CNA staff are documenting electronically and using software that
has already met On-Time requirements.
Table 2 provides descriptions of the Health IT steps.
As of September 2010, 10 vendors were compliant with
On-Time.i
Staff
Table 3 provides information on staff resources
needed to implement On-Time, responsibilities of each, and estimated time commitment.
Facilitation
Facilitation Skills and Experience
Based on experience to date, On-Time facilitation requires
three categories of skills and experience:
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Clinical informatics: Serve as liaison between facility and Health IT vendor.
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Project management: Oversee the project, develop and manage the workplan,
and establish plans for impact monitoring data collection and reporting.
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Process improvement: Facilitate the team's implementation of
On-Time process improvements.
Facilitation Responsibilities
One or more people assume facilitation responsibilities.
Responsibilities and time commitment vary throughout the implementation process
and depend on level of support from facility leadership and available internal
IT resources, e.g., IT department.
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Each
team reviews the generic On-Time work plan (Table 4) and customizes to their
specific situation.
In addition, On-Time
implementation efforts have involved collaborative working sessions with other
participating facilities. At these meetings, facility team members (1) discuss
and compare experiences and outcomes to date, (2) discuss issues and problems
with the project and ways they could be addressed, and (3) share successful
strategies for implementing and sustaining On-Time process improvements.
i The vendor names are provided
for informational purposes only. Their inclusion does not imply endorsement by
the Agency for Healthcare Research and Quality or the U.S. Department of Health
and Human Services: American Data—ECS (Electronic Chart System), EHealth
Solutions—SigmaCare, Healthcare System Connections, HealthMedX—Vision, Lintech—Clinical EMR Suite, Mylex Corporation, Optimus EMR, PointClickCare—Point of
Care, Reliable, and Resource Systems—CareTracker.
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