Transformational Leadership ADVOCACY & INFLUENCE · 2016-09-21 · TL5 ExB Advocate BroMenn Medical Center 1 Transformational Leadership ADVOCACY & INFLUENCE TL5 - Nurse leaders lead

TL5 ExB Advocate BroMenn Medical Center 1

Transformational Leadership ADVOCACY & INFLUENCE

TL5 - Nurse leaders lead effectively through change.

Example B: Provide one example, with supporting evidence, of the strategies used by nurse leaders to successfully guide nurses through planned change.

The Planned Change

In June 2013, Advocate BroMenn Medical Center (ABMC) embarked on a journey to implement Computerized Physician Order Entry (CPOE) by March 3, 2014 (Exhibit TL5.B.1 CPOE Leadership Update, September 2013). The goal of this project was to provide a safer care environment for patients, in addition to complying with the Meaningful Use Stage Two requirements set by the Centers for Medicare and Medicaid Services. The scope of the project was vast because it touched every direct care provider at ABMC, including all physicians and nurses, ultimately changing the practice environment and workflow. There were two different workgroups to carry out the intense timeline: Medical Informatics and Clinical Informatics. The interprofessional members of the Clinical Informatics Team, which was co-led by Lori Harper, MBA, MSN, RN, NE-BC, Director of Nursing Practice and Mother Baby Unit (nurse leader) and Johanna Samara, BSN, RN, Clinical Informatics Manager were as follows (Exhibit TL5.B.2 Nurse Practice Council Update, October 2013):

Diane Anderson, RN, Clinical Information System Coordinator, Mother Baby Unit

Danielle Auth, Secretary/Technician, Pediatrics/Outpatient Infusion

Jennifer Crytzer, RN, Nurse Clinician II-Float, Nursing Resource Pool

William Cummings, PharmD, Pharmacy Analyst, Information Systems

Donna Deany, RT(R), Senior Analyst, Information Systems

Colleen Ewen, MBA, BSN, RN, Clinical Development Specialist, ClinicalEducation

Teresa Gimbert, BSN, RN, Risk Manager, Risk Management

Chad Goveia, BS, RRT/RCP , Pulmonary Education Specialist, RespiratoryTherapy

Nancy Hand, MT(ASCP) SC, Chemistry Section Head, Laboratory

David Honegger, MA, BA, Supervisor, Radiology

Karen King, BSN, RN, Nurse Clinician II-Float, Nursing Resource Pool

Mary Beth Kirby, RN, Charge Nurse, Progressive Care Unit

Nancy Lishka, MA, BSN, RN, Clinical Development Specialist, Clinical Education

Peggy Mahnke, Senior Analyst, Information Systems

Angela Malinowski, RD, LDN, Senior Clinical Dietician, Nutrition Services

Jenny Messier, BSN, RN, Manager, Care Management

Janet Moser, RN, Nurse Clinician II, Same Day Services

Kristin Remmers, BSN, RN, Nurse Clinician III, Medical Oncology Specialty Unit


Lori Ritter, RN, CEN, Trauma/Quality Coordinator, Emergency Department

Darren Sawyer, BA, RN, Nurse Clinician III, Invasive Cardiology

Kate Saxen, RN, Quality Care Coordinator, Quality Resource Management

Cindy Schaumburg, MSN, RN, CPHQ, Regulatory Compliance Coordinator, Quality Resource Management

Jina Sunday, OTR/L, Occupational Therapist, Therapy Services

Janet Sutter, MSN-ed, RN, CRN, Team Lead Patient Care, Radiology

Natasha Wattleworth, BSN, RN, Clinical Informaticist, Clinical Informatics

Toni Winks, RN-BC, Nurse Clinician III, Mental Health Unit

Lily Young, BSN, RN, CPN, Nurse Clinician II, Pediatrics/Outpatient Infusion

Sandra Young, RN, Clinical Informaticist, Information Systems

Transformational Leadership

Lori Harper co-chaired the Clinical Informatics Team alongside Jo Samara. Lori’s role differed from Jo’s in that she provided oversight to the nursing profession and practice as decisions were made for the new documentation, and Jo provided operational leadership through this team. Lori was instrumental in developing tactics for a successful implementation. It was through her transformational leadership that astute observations and considerations were made during the planning phase. While members of the Clinical Informatics Team needed to be experts in the field, she also brought in front-line associates to verify that the processes being changed made sense in the day-to-day operations and functions. Once the team designed the order sets, workflow, etc., the next assignment was education. With Lori’s experience and leadership in Clinical Education, she utilized inspirational motivation and intellectual stimulation in proposing a new method, interactive computer-based training modules, to educate associates on the CPOE process. This technique, along with the use of Super Users, was well received, allowed for individualized consideration, and contributed to a successful implementation (Exhibit TL5.B.3 ABMC Super User Workbook).

Successful Strategies Utilized by Nurse Leaders To support the efforts of this project and other informatics ventures, the former Clinical Informatics Committee was restructured to increase membership and front-line representation, in preparation for the project. The new Clinical Informatics Team had representation from most disciplines across ABMC and was instrumental in the design, testing, training, implementation and success of the change.

One tactic utilized by the team was the engagement of the Super Users. Each nursing unit and ancillary department appointed Super Users who were given additional training to provide on-unit support to the front-line associates and physicians during the first two weeks of “Go-Live” and to be ongoing resources (Exhibit TL5.B.3 ABMC Super User Workbook). To be a Superuser, the associates were required to provide best practice workflow and documentation support to all interprofessional users, coordinate with the ABMC Project Team to report and resolve any issues, and huddle with other Super


Users to discuss any department-specific challenges and communicate new solutions. The associates identified as Super Users were an example of the way in which individual consideration was applied. They were key to making the CPOE implementation go smoothly.

Communication and education throughout the planning, design, implementation and post-implementation were crucial. Prior to the “Go-Live”, Nursing Practice Council members and nursing leadership were given regular status updates (Exhibit TL5.B.2 Nurse Practice Council Update, October 2013). Nurses and physicians received four hours of classroom training, as well as interactive computer-based training modules based on job description. This tactic had not been utilized at ABMC in the past. The computer modules provided the learner with baseline knowledge and experience prior to attending “hands-on” classroom training. These modules were specific to the role of the learner and were short in duration, requiring no more than 30 “clicks.” The modules included both visual and auditory learning methods and allowed the learner to progress at their own pace. The learner could also repeat the module as often as necessary in order to thoroughly grasp the concepts. Learners were required to display competency at the completion of the modules and before attending the “hands-on” training.

Since this new education technique was used for the documentation changes, the Clinical Informatics Team conducted a survey to obtain feedback on the effectiveness of the education and to determine if it met the user’s educational needs to prepare for the change. The results of the survey taken by a combination of providers, nurses, and nursing technicians/secretaries are as follows (Exhibit TL5.B.4 ABMC Adoption Status, March 2014, slide 21):

1. The program was well-received: 81.2% of learners found it useful to their role 2. The program was effective: 83% felt the courses lent knowledge and confidence

in performing the tasks trained; 94%+ practicum scores on prerequisite work prior to class support the qualitative data

3. Leadership was perceived as committed to the success of the project: 88.4% positive responses.

4. Communication around the project was thorough: 86% positive responses. During implementation, the Super Users on each unit utilized a tool to take concerns or questions related to the new process back to the Clinical Informatics Team, which addressed them on a daily basis. Clinical Informatics nurses rounded almost non-stop during the initial shifts of the “Go-Live” where they were able to provide “at elbow” support for nurses and physicians, using not only their information systems expertise, but also their clinical background. Medical center and nursing leadership also rounded on all nursing units and physician lounges to seek feedback on the implementation process. This information was shared during the daily Clinical Informatics huddle. In April, 2014 an update was provided at the Medical Informatics team on effectiveness of the CPOE implementation. At that time, it was reported that there were 1070 logged requests related to the Go-live of CPOE and that 760 had already been resolved (Exhibit TL5.B.5 Medical Informatics CPOE Update, April 2014, slide 7). After the


rollout and ongoing, the Clinical Informatics Team leaders continued to review reports of compliance with CPOE, take comments from end-users, evaluate requests for updates or changes to the process, and determine new projects related to CPOE documentation. Initial usage of the CPOE system by physicians March 5-25 was 61%.

Overall, this practice change was felt to be successful because of the positive feedback received from physicians, the absence of any major implementation issues, and good usage of the system by physicians. The success of this project resulted from the countless hours and efforts by an array of individuals, and Lori Harper’s leadership. Without the transformational leadership displayed by Lori, the plan and rollout could have been much different. Lori’s engaged and well-orchestrated approach to interprofessional team project management was instrumental on this venture of CPOE implementation.

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Leadership UpdateSeptember 25, 2013

Exhibit TL5.B.1 Advocate BroMenn Medical Center

Project Scope

Project Scope – Who, What, When Who: Deployment Scope

– Every Physician

– Every Specialty

– Every Nursing Unit

What: Functional Scope

– Physician Order Entry

– Physician Documentation with Dragon Voice

Recognition

– Home Meds/Medication Reconciliation/e-prescribing

– Discharge Instructions/Process

When: Go Live Date

– March 3, 2014

Project Structure

Med Exec

CPOE

RXM(Med Rec)

Dr First

Medical InformaticsPhysicians VPMMLab Clinical InformaticsHIM Medical AffairsPharmacy Nursing OpsQuality

PDOC

DISCHARGE PROCESS

(Specialty Templates)

Training

CME

Nursing Leadership

Workflow/ Communication

Role changes

Downtime

Clinical Informatics AdvisoryClinical Informatics DieticianIP Acute Care Nurse IP Crit Care NurseOP Nurse ED NurseRT PMRHIM CompliancePharmacy Risk (ad hoc)Case Mgmt Clinical EducationOP Tech/Sec IP Tech SecAEH Nurse MBU Radiology LABOther Ancillaries ad hoc

POM/

Nursing Orders

Training

Med Rec/POM

/Discharge

Meaningful Use

Quality Indicators (and other ‘required’ builds)

Informatics Structure

Exhibit TL5.B.1 Advocate BroMenn Medical Center

Medical Informatics - Physicians Jim Nevin, VPMM, Executive Sponsor

Jim McCriskin (IHLA, co-chair)

Jim Swanson (Med Hills, co-chair)

Robert Braastad(IHLA)

Brian Gebhart (Gen Surgery)

Richard Wellman (OB/GYN)

Susan Svientek (OB/GYN)

Meera Yerrabolu (Hospitalist)

Shane Fogo (AMG EUREKA)

Aaron Traeger (Peds)

Todd Kettering - (Residency)

Vanessa Pitts – (ED)

Samuel Steffen (Family Practice)

Jason Seibly (Neuro)

John Fulk (PA – Digestive Disease)

Daniel Alyea (Anesthesiology)

Nikhil Chokshi (Orthopedics)

Kevin Richardson (CV/Thoracic Surgery)

Jonathan Foss (Radiology)

Joseph Larouche (Resident)

Joshua Bentley (Resident)

(Oncology)

(Psychiatry)

Medical Informatics – Org Leaders

Nancy Allen (AEH)

Yvonne Blyth (Med Affairs)

Janell Durdle (Lab)

Ann Frederick (Quality)

Dave Harper (IS)

Lori Harper (Nursing Practice)

Tim Koch (IS – Applications)

Steve Pinneke (Pharmacy)

Brandi Sweeney (HIM)

Johanna Samara (Clinical Informatics)

Sandy Young (Clinical Informatics)

Natasha Wattleworth (Clinical Informatics)

Clinical Informatics MembersCo-Chairs: Lori Harper and Jo Samara

Angela Malinowski (Nut. Serv.)

Kristin Remmers (IP Nurse)

Lily Young (IP, Peds )

Jen Crytzer (IP, Crit Care)

Karen King (IP, Crit Care)

Toni Winks (Behav Health)

Janet Moser (OP Nurse)

Darren Sawyer (OP Nurse)

Lori Ritter (ED Nurse )

Chad Goveia (RT)

Jina Sunday (PMR)

Nancy Hand (Lab)

Katie Saxen (QCC)

Sandy Young (Clin Inform)

Natasha Wattleworth (Clin Inform)

Donna Deany (IS – Apps)

Peggy Mahnke (IS – Apps)

Amy Wickenhauser (HIM)

Lynette Haller (HIM)

Cindy Schaumburg (Compliance )

Bill Cummings (Pharmacy)

Teresa Gimbert (Risk Mgmt)

Jenny Messier (Case Mgmt)

Nancy Lishka (Clin Ed)

Colleen Ewen (Clin Ed)

Danielle Auth (OP Tech/Sec)

Mary Beth Kirby (IP Tech Sec &

Nursing)

Diane Anderson (MBU)

Janet Sutter (Radiology )

David Honegger (Radiology)

Elizabeth Harper (AEH Nursing)

Ron Bartlett (AEH Nursing)

Project Timeline

Project Timeline CPOE/PDOC

– June: Planning

• Medical Informatics Committee

• Project structure

• Project Plan

– July:

• Introductory call

• Med Exec with Medical Informatics list

• Physician Ask

– August:

• PCM Demo

• I.S./PHA Team Dictionary Training

Project Timeline (cont.) CPOE/PDOC

– September• Project Kickoff

• Design

– October-November• Training/Design/Build/Pre-Live Visit

– December• Testing/Training preparation

– January-February• Training

– March 3: Go Live

– April – June: Meaningful Use reporting

CurrentStatus

Key Activities Design and Build Nursing Orders

Standardize ‘536’ Physician Specific Standing Orders

Design and Build Physician Documentation Templates

Build Pharmacy content for med ordering

Begin CBT Training Development

Implement IMO (standard nomenclature mapping)

Implement PDI (integrated Patient Discharge Instructions)

Implement Version 2 Allergies

Meditech 5.66Upgrade

Timeline

Questions

Nursing Practice CouncilMeeting Date: October 2, 2013 Meeting Time: 1:00 pm Meeting Location: CR 5 & 6

AGENDA ITEM SUMMARY OF DISCUSSION ACTION (WWW) Wins/Announcements • Wins:

o Note good work on quality, patient satisfaction scores o Note great increase in reporting near misses and safety concerns

• Information

Minutes from September meeting

• Motion to approve & seconded • Approved

Pain – EBP – Analyzing Research articles

• Wendy Woith walked the group through a pain article using a review tool. • Use the tool and processes when reviewing yourunit pain project articles

Pain – EB Practice Unit Reports

• Reviewed why the pain project is important: Pain tied to PatientSatisfaction/HCAPS, pain affects most all our patients, DNV wants to see evidenceof improving care

• Unit updates:o Cardiac Rehab – Approached PT to locate an EBP articleo MHU – Have initiated a patient class for patients with chronic pain, PT

contacted for information on unito Pre-Testing/Perioperative group – Have conferenced with Shelly Malin,

have narrowed their focus to neuro surgicals, are discussing options withanesthesia

o 6W – Are meeting with Molly Horio to obtain more articleso Cath Lab – working to minimize back pain for pts with femoral access,

documentation of pain and pre/post-procedure interventionso OB – Working to bring sucrose project to rest of areas where infants are

cared foro Rehab – working on changing unit schedule process/pt flow to improve

pain management and other care processeso MOSU- have been meeting with Wendy Woith to help give directiono Wound Center – Looking for literature on pain with wound debridemento Critical Care – Looking at continuous opioid drip vs intermittent

medications for ventilated patients, throat pain

• Will bring Patient Satisfaction data next month• Continue work on projects• Contact Shelly Malin or Wendy Woith for

assistance

Strategic Plan & CNE update

• Laurie Round expressed concern about how to get information to nursing staffabout the strategic plan (low attendance at town hall meetings).

• Discussed having a nursing page on the intranet, share accomplishments from theyear (falls, patient satisfaction, readmission rates, rounding)

• Encourage physicians to complete the physiciansurvey

•

Exhibit TL5.B.2

Advocate BroMenn Nursing Practice CouncilJuly 3, 2013

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Shared Governance • Discussed thoughts about renaming shared governance – obtained ideas frommembers. Would re-naming better reflect the work? Would it re-energize the work?Would it confuse them? Isn’t the term “Shared Governance” a universal conceptfrom the literature?

• Suggestions: “Unit Practice Council” “Clinical Practice Council”

• Obtain input from unit staff and get theirperspective

• Re-read the article on Shared Governance (MaryAnne to attach to e-mail)

Practice Updates • IPCo Approved summary of changeso Addictions would also like to be addedo Delete signing of the cross-match card

• Crash Cartso Karen King noted that the new resource binders (with forms and tools) are

now on all crash carts. Defib pads are gone – can be obtained from thePharmacy box if needed. Pending: Bagging of supplies within the cartwhich will streamline checking the cart.

• Karen King asked questions about eye wash stations and regularity of checking.

• Approved IPC Changes• Note the new binder and changes to the crash

cart

CPOE Project • Jo Samara gave a preview of the work being done to prepare for physician order entry to go live early next year (see attachment)

• They are writing a nursing order catalog, working on building standing orders intothe process.

• Contact your unit rep to see how unit sharedgovernance groups can assist.

Quality • Dashboardo Noted low fall rates, noted a slight bump up in CAUTI one month – the

CAUTI team is working on it, C-diff we are meeting the system target.o Pt Safety Event – reviewed the site events and rates

• Core Measureso Shared a summary of issues and reminders for staffo AMI – making good progresso Heart Failure – dealing with discharge instruction issueso VTE – VTE’s are now reportable, but don’t have a benchmark yeto Immunizations – working on some missed opportunities- especially

offering them to high-risk patients, looking at smoking issueso Note that Advocate sets the goals high

• Infection Control –o Pneumonia – Encourage use of the CareMaps so that the guidelines are

meto See other notes above

• Information – review unit stats with yourmanager and shared governance groups foropportunities.

• Please complete your mid-year reports if you have not already done so • Please submit your reportsNext Meeting November , 2013 1-3 pm in CR 5-6.

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Advocate BroMenn Medical Center Advocate Eureka Hospital

CPOE PROJECT

Advocate BroMenn Medical Center and Advocate Eureka Hospital are embarking on an approximate 6 month journey to implement Computerized Physician Order Entry (CPOE) and Physician Documentation. In addition to providing a safer care environment for our patients, this project is critical to the Meaningful Use Stage 2 compliance for the organization.

In order to support the efforts of this project and other informatics ventures a Medical Informatics Committee and a Clinical Informatics Committee have been formed. These committees have representation from across ABMC and AEH clinical areas and from across the medical staff.

Over the next several months these committees will be instrumental in the design, build and implementation of Meditech functionality to support changes in workflow and processes.

The project scope includes Computerized Physician Order Entry (CPOE), physician documentation, Medication Reconciliation and interdisciplinary discharge. On March 3, 2014 all providers (physicians, APNs, PA, etc) and all clinical associates will ‘go-live’ with the new applications and processes defined within this project.

Communication is key to the success of this project. Please make sure that associates are aware of the project and how they can stay up to date on progress and provide input through their representatives on the Clinical Informatics Committee.

Clinical Informatics Representatives are: Co- Chairs: Lori Harper and Jo Samara Angela Malinowski (Nut. Serv.) Kristin Remmers (IP Nurse) Lily Young (IP, Peds ) Jen Crytzer (IP, Crit Care) Karen King (IP, Crit Care) Toni Winks (MHS) Janet Moser (OP Nurse) Darren Sawyer (OP Nurse) Lori Ritter (ED) Danielle Auth (OP Tech/Sec) Mary Beth Kirby (IP Sec & Nursing) Diane Anderson (MBU) Janet Sutter (Radiology ) David Honegger (Radiology) Nancy Hand (Lab) Elizabeth Harper (AEH Nurse) Ron Bartlett (AEH Nursing) Chad Goveia (RT) Jina Sunday (PMR) Katie Saxen (QCC) Lynette Haller (HIM) Amy Wickenhauser (HIM) Cindy Schaumburg (Compliance ) Teresa Gimbert (Risk) Bill Cummings (Pharmacy) Jenny Messier (Case Mgmt) Nancy Lishka (Clin Ed) Colleen Ewen (Clin Ed) Donna Deany (IS – Apps) Peggy Mahnke (IS – Apps) Natasha Wattleworth (Clin Inform) Sandy Young (Clin Inform)

Please direct any questions/concerns or suggestions to the representative for your area, Lori Harper or Jo Samara.

We look forward to working with you!

Date: October 2013

Exhibit TL5.B.2 Advocate BroMenn Medical Center 1

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Advocate BroMenn/Eureka Nursing Practice Council - 2013 ATTENDEES:

Unit/Dept Name Jan No mtg

Feb Mar April May

June July

Aug Sept Oct Nov Dec

NPC LEADERSHIP Executive Sponsor Dir. Nsg. Practice

Lori Harper RN, MSN, MBA, NE-BC, CPN

X X X X X X X X X

Co-Chair MOSU

Jennifer Abraham RN, BS X X X X X X X X X X

Co-Chair Clinical Ed

Mary Anne Kirchner MS, RN X X X X X X X X X X X

ABMC Endowed Professor Shelly Malin RN, PhD X X X X X phone X Chief Nurse Executive Laurie Round, RN, MS X X X X X X X X X X STAFF AEH - SDS Lisa Schoonover RN, BSN X X AEH- IP Karen Garman RN, BSN X X X X X 6W Jennifer Haskins RN X X X X X X X X Acute Rehab Miaad Abdulrehman, RN X X X X Cardiology Susan Basham RN, BSN X X Cardiopulmonary Rehab Heidi Heite RN, BSN X X X X X X X X X X Cath Lab Kevin Kennel RN, BSN X X X

Lynn Parker, RN X X X X CVCU Jillian Stiles, RN X X X X X ED Grace Fisher RN X X X X ICU Rachel Koerner, RN X X X X X X Mental Health Toni Winks RN, BC X K

Jennings X X X X X

MOSU Patty Omahana, RN, BSN, OCN X X X X X Kristin Remmers, RN X X X X X

Nursing Operations Tara Haynes Kathy Ott, RN X X

OB Jessica Baker RN,C X X X Brenda Drury RN X X X X

Pre-Testing Shelley Walters RN, BSN X X X X X X X PACU Teresa Hogan, RN X PCU

Emily Boote, RN X Melissa Reidy, RN X X X X Jen Shanahan RN X

Peds/Infusion

Lorilee Dunahee RN, CPN, BSN X X X X X Amanda Wackt, RN X X

Radiology Janet Sutter MSN, RN-BC X X X X X X

Advocate BroMenn/Eureka Nursing Practice Council - 2013

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SDS Jeanise Frank RN, BSN X Yvonne Rees X X X X

Surgery Michael Hoeft, RN X Alice Deavers

X X X Wound Healing Jennifer Perry RN, BSN, CHRN X X X X X X X X X Wound/Ostomy Becky Hatfield, RN X X X X

MANAGERS AEH - ED/Inpt Ron Bartlett RN, BSN, CEN X 6W/PCU Kristin Peterson, RN, BSN, MSN X X X Acute Rehab/ MHU/Bariatrics

Renee Donaldson X X X X X

Critical Care Stacy Sutton, RN, BSN/Shelly Jiminez

X X X

ED Aaron Barclay, RN X X X X Nursing Operations Stacy Barclay, RN X X OB Stephanie Wollenburg, RN X X X X Peds/Infusion Alicia Allen RN, MS X X X X X X

SUPPORT Cardiac Education Karen King RN, BSN X X X X X CNS – Critical Care Donna Schweitzer RN, MSN, CCRN,

CCNS, APN X X X

CNS – 6W/PCU/Rehab Tori Steinkoenig, RN, APN X X X X X X IS Johanna Samara RN, BSN, FCN X X X X X X X X ISU Wendy Woith, RN, PhD X X X X X X QRM – Case Management Tina Bliss, RN X X X X X

Jenny Messier, RN X X X X QRM- Infection Prevention Pam Bierbaum RN, BSN, CIC X X X X X X QRM – Quality/IC Laurel Mode RN X X QRM – Reg Compliance Cindy Schaumburg RN, MSN,

CPHQ X X X

QRM - Risk Teresa Gimbert RN, BSN X X X X X X X QRM - Safety Kristie Wolfe, RN, MS X X X X X X X

Total

Super User Workbook Version 1.0

Exhibit TL5.B.3 ABMC

Super User Workbook December 2013

Table of Contents

Introduction .................................................................................................................................................. 3

Your Role as a Super User ............................................................................................................................. 3

Prior to the CPOE implementation ........................................................................................................... 3

During the CPOE implementation ............................................................................................................. 3

Ongoing ..................................................................................................................................................... 4

A New Way of Learning ................................................................................................................................. 5

Logging Into the MedU Community .......................................................................................................... 5

Navigating the MedU Community ............................................................................................................ 5

MedU Course List ...................................................................................................................................... 6

What to Expect.......................................................................................................................................... 7

Lesson Activities ........................................................................................................................................ 7

Practicum .................................................................................................................................................. 8

Helpful Hints ............................................................................................................................................. 8

Adult Learning ............................................................................................................................................... 9

Understand Adult Learners – Some Challenges and Techniques for Handling ........................................ 9

Coaching Skills ............................................................................................................................................. 10

Be Positive in Your Approach .................................................................................................................. 10

Set and Manage User Expectations - What Will Happen and When: ..................................................... 10

Becoming a Change Agent ...................................................................................................................... 11

Listen ....................................................................................................................................................... 11

Handling Emotional Responses ............................................................................................................... 12

Handling Resistance ................................................................................................................................ 12

Final Thoughts ............................................................................................................................................. 13

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© 2013 The Breakaway Group – A Xerox Company


Introduction Congratulations on being selected as Super User! Your role as a Super User is essential to the success of Advocate’s users in adopting the CPOE functionality in the Meditech application.

Your Role as a Super User To fulfill your role as a Super User, we ask you to help prepare for this change by coaching and supporting colleagues in your department. To help you prepare users for success, you are expected to:

Prior to the CPOE implementation

• Complete assigned online courses for the role(s), department or specialty you are supporting.

• Regularly log into the MedU Community to check for project updates and new reference materials

• Ensure users are aware of the Meditech CPOE implementation including timelines andexpectations.

• Answer questions around the MedU Community and assigned courses.

• Help to identify users who may require additional training and support.

• Participate in education readiness activities

• Reinforce the use of online courses and the MedU Community to prepare for the CPOEimplementation initiative.

During the CPOE implementation

• Provide best practice workflow and documentation support to users.

• Coordinate with the BroMenn & Eureka Project Team to report and resolve any issues.

• Huddle with other Super Users to discuss any department-specific challenges and communicatenew solutions.

• Help communicate any Meditech application and workflow updates within your department aswell as regularly check the MedU Community for new and current information

• Participate in coaching users on functionality, process or policy changes as it relates to theMeditech project.

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Ongoing

• Continue to participate in Super User activities appropriate for your department and function.

• Maintain communication with the BroMenn & Eureka Support Team to report issues and ask questions for your department.

• Ensure that users are aware of MedU Community updates and changes. Participate in coaching users on functionality, process or policy changes as it relates to the Meditech project.

• Support new user proficiency.

What are some of the challenges you may face as a Super User?

Reminder!

• Users will be assigned online training based on their role within the organization. Your job is to coach and leverage what users have learned in the online courses, supporting them in applying their recently learned skills and knowledge.

• Be familiar with the MedU Community and online learning as well as how to help users log in and find online resources.

• Complete assigned online courses, review Quick Reference Guides (QRGs), and participate in Super User Meetings, so that you can best support and coach nursing staff.

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A New Way of Learning

Logging Into the MedU Community

The MedU Community houses online curriculums, documents and communication that will assist you with the upcoming Meditech CPOE implementation...

Getting Started:

• Launch Internet Explorer from your computer.

• Enter www.promisepoint.com/bromenn in the web address field.

• The MedU Community login page will launch.

• Enter your Meditech Log-In User name in the box on the right side of the screen and click login to access the MedU Community.

Navigating the MedU Community

Home:

The Home page displays a Welcome Message to the MedU Community along with access to recent project announcements, upcoming events, assigned learning, and more.

Learning:

• Associates have been assigned online courses based on their role within your organization.

o Click the Take Me to My Online Learning button from the Home page.

o Your list of assigned courses will display. It is best to take the courses in the order that they are assigned.

o To launch a course, click on the course name link. The selected course will load and begin playing.

o After completing a course, click the close X tab at the top of your screen. You will then return to the list of assigned courses in the MedU Community.

o Completed courses can be viewed or retaken by clicking the Completed Modules button at the top of the screen. Then select the appropriate course to launch.

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http://www.promisepoint.com/bromenn


Resources:

• Contains reference materials such as quick reference guides (QRGs), recent announcements, FAQ’s, “Find your Super User,” and more.

Meeting Room:

• Contains specific “rooms” where users may have security access to team or role specific information.

o Super User Network

o Project Team

Reports:

• Users with permissions will have the ability to access course completion and practicum reports from this tab. Curriculum, Location and User reports are available. This will only be available to leadership.

Help:

• Link to Help Desk information.

• If you are using a computer that is not located at the hospital (i.e. a home computer), it is suggested that you reference the Help tab for specific tips and tricks such as turning off your popup blocker, ensuring your browser is compatible, etc.

MedU Course List

• Introduction to Meditech • Search for a Patient • Document Patient Allergies • Manage Orders for Providers • Enter Home Medications • Manage Orders for Clinicians • Manage Med Orders for Clinicians • Use the Patient Care System • Use the Physician Desktop • Utilize Physician Documentation • Perform Medication Reconciliation • Document Problems • Initiate the Transfer Process • Transfer a Patient • Discharge a Patient • View the Patient Records

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What to Expect

The online courses not only provide relevant, role specific learning they also allow you to choose the learning strategy that best suits your needs.

The online courses consist of two key sections:

1. Course Introduction – This introduces you to the topics covered in the course and where these topics might be used in typical patient care workflow.

2. Lessons – These teach you how to perform specific objectives in the application. A course may have one or multiple lessons. For each lesson, you will have two lesson activities, which are explained in more detail below.

Lesson Activities

Two activities are available for each lesson in a course; Watch an Interactive Demonstration and Test Your Proficiency. This gives you the ability to tailor your learning experience based on your current knowledge and skills.

Please note, you must watch the Course Introduction and complete and pass the Test Your Proficiency exam to receive credit for each lesson.

The two lesson activities are:

1. Watch an Interactive Demonstration:

Click the Watch an Interactive Demonstration link to begin a video that explains and guides you through the steps for each learning objective. You will actually perform the correct actions (typing, clicking, navigating) to complete your assigned task. The narration covers best-practice workflows and hospital policies.

Repeat the Interactive Demonstration as many times as necessary until you feel comfortable and confident with the sequence of actions required to accomplish the objective.

2. Test Your Proficiency:

Click the Test Your Proficiency link to demonstrate your ability to perform the task based on the scenario and instructions.

Note: In order to successfully pass the test, you must score within the required threshold percentage noted at the beginning of each exam. You may take the test as many times as necessary to pass.

7



Practicum

The Practicum is a role-specific, mandatory final exam that you must successfully complete before Go Live. It is assigned the same as the role-based courses in HealthStream. The Practicum:

• Provides a “day in the life” experience to demonstrate comprehension and sequencing of tasks within a role-based workflow.

• Evaluates the correct use of key application functions as defined within the workflow.

• Assesses your ability to apply knowledge from your simulation learning to scenarios critical to your daily work.

Helpful Hints

• When you have completed a lesson proficiency test, click the “Return to Course Topics” link to return to the course menu to select the next lesson.

• The Course Outline button, located on the navigation toolbar at the bottom, left of the screen, also provides quick navigation access, which allows you to move between lessons and learning options with a few clicks of your mouse.

• Remember: you must successfully complete all Proficiency Tests and watch the Course Introduction for the course to register as complete.

• Double clicking a correct item or button will advance you to the next step but may also display a “That’s incorrect.” message. If the screen advances, the action is counted as correct and you can continue the practice or test.

• Using the back button on the course player will only take you back to the beginning of the sequence you are currently viewing. If you need to go back further, use the Course Outline on the navigation toolbar at the bottom of the screen.

8



Adult Learning

Understand Adult Learners – Some Challenges and Techniques for Handling

What adult learning challenges are you most likely to see with users you are assigned?

Adult Learning Challenge

Adult Learning Techniques

Big picture learners • Give an of the steps they need to complete.

• Help them adjust their perspective on the amount of from their current process. What percent is it?

Visual learners • Show them the __________________ with the basic divisions of steps.

• Demonstrate the _________ if they lack confidence. Repetitive learners • Ask them to do one section of the task at a time and then

____________ review with them what they have done.

• Let them ________________ difficult sections again. Nervous learners • Remind them of ___________ ___________________ they have had

when learning something new.

• Encourage users to use the _______________ environment and reference the MedU Community for additional resources.

Resistant to change learners • Reassure them that they will still perform the same tasks but perhaps in

a different _________.

• Give them _________ _______________ for the change, such as the efficiency with which orders will be carried out.

Detailed learners • Help them balance their need for details while giving them a clear view of the new process – the “_______ ____________.”

9



Coaching Skills

Be Positive in Your Approach

• Be friendly.

• Convey your confidence in the new application and your experience with the application.

• Explain that typically users are quite proficient within a week or two of continued use.

• Let them know you are there to help them.

• Assure them that they have the skills to learn the process and workflow changes as well as the new tasks in the Meditech system.

Set and Manage User Expectations - What Will Happen and When:

Questions

Be sure you can answer the following for the users.

Answers

• When will the online courses be available to staff?

• When are users expected to complete them?

• What date is the Meditech CPOE GO LIVE?

• How will this CPOE implementation affect patients?

• What type of support will be available for the CPOE implementation?

• What is the escalation process?

• What issues need to be escalated?

o Hardware

o Software

o People

10



Becoming a Change Agent

• Expect resistance: Remember; 20% of people won’t get on board or will take a lot of effort, may sabotage, 50% need to be convinced or shown but will eventually believe (Doubting Thomas), and 30% will be trying to get ahead of the pack.

• Information: Explain the rationale for change.

• Attitude: Control your attitude, don’t let it control you. You have a lot invested in the system. Don’t let a challenge put you on the defensive.

• Ownership: Take ownership of the changes, the design. Be proud. Be open.

• Tolerance: Be tolerant of other perspectives and opinions. Be respectful.

• Humor: Keep your sense of humor. Be able to laugh at yourself.

• Stress management: Practice good stress management techniques.

• Support: Support the decisions of the project team, leadership and upper management. Don’t sell anyone out or point blame.

• Look forward, not back: Invent the future instead of trying to redesign the past. Don’t get caught in the trap - “We’ve always done it this way”.

• Myths: All the problems are evidence that change is bad. This will go away. I can just keep on doing my job like I have been.

• Reality: Problems are a natural side effect of change process. Change is here to stay. The Healthcare System is changing; you need to be changing too.

Listen

• Listen, listen, listen: you can be their stress reliever. Listen as much as or more than you talk.

• Listen to the entire message – do not jump to conclusions, get distracted or interrupt.

• Use questions to clarify and confirm your understanding of what is being said.

11



Levels of Listening

There are three levels of listening you will likely encounter as a Super User:

1. Tuned in – listener is paying full attention

2. Tuned in and out – listener is somewhat distracted; moves in and out of paying full attention

3. Tuned out – listener is not paying attention

Handling Emotional Responses

• Acknowledge the emotion, but don’t feed into it.

• Remain calm and supportive.

• Don’t take negative reactions personally: the person is reacting to the pressures of change, not to you.

• Offer encouragement, no matter how small progress seems to be.

• Help the staff member see where progress is being made.

• Reinforce the expertise the staff member brings to the job to create a more positive environment.

Handling Resistance

• Recognize signs of resistance such as:

o Avoiding eye contact

o Restricting nonverbal feedback

o Too busy to pay attention

o Finding fault with the task flow

12



• Understand the basis for the resistance

o Are they covering up for a lack of confidence?

o Do they not understand the task?

o Are they trying to draw attention to themselves?

o Is there a true gap in workflow or functionality?

• Ask them what they are uncomfortable with and reassure them.

• Be patient and supportive.

Final Thoughts If we had to summarize this course in three words, they would be:

• Listen

• Communicate

• Coach

Listen to the concerns of the users.

Communicate and communicate some more. Provide information and reminders to users (important dates, tasks, resources, department-specific issues, etc.) to help them stay connected and on track with “the change” and with their training. Communicating is essential in fostering user acceptance.

Coach users on the Meditech education and resources available to them – MedU Community, online courses, Quick Reference Guides, and more. Use positive reinforcement, encouragement, acknowledge emotional responses (fear, resistance), put the change into perspective, and encourage practice.

Reminder!

• It is your role to hold users accountable for their own learning.

• As a Super User, remind users to complete the online courses, to ask questions about workflow changesbefore the CPOE implementation.

• Remind them that this preparation will make it consistent and safer for patient care.

13


Super User Workbook Version 1.0



Table of Contents

Introduction .................................................................................................................................................. 3

Your Role as a Super User ............................................................................................................................. 3

Prior to the CPOE implementation ........................................................................................................... 3

During the CPOE implementation ............................................................................................................. 3

Ongoing ..................................................................................................................................................... 4

A New Way of Learning ................................................................................................................................. 5

Logging Into the MedU Community .......................................................................................................... 5

Navigating the MedU Community ............................................................................................................ 5

MedU Course List ...................................................................................................................................... 6

What to Expect.......................................................................................................................................... 7

Lesson Activities ........................................................................................................................................ 7

Practicum .................................................................................................................................................. 8

Helpful Hints ............................................................................................................................................. 8

Adult Learning ............................................................................................................................................... 9

Understand Adult Learners – Some Challenges and Techniques for Handling ........................................ 9

Coaching Skills ............................................................................................................................................. 10

Be Positive in Your Approach .................................................................................................................. 10

Set and Manage User Expectations - What Will Happen and When: ..................................................... 10

Becoming a Change Agent ...................................................................................................................... 11

Listen ....................................................................................................................................................... 11

Handling Emotional Responses ............................................................................................................... 12

Handling Resistance ................................................................................................................................ 12

Final Thoughts ............................................................................................................................................. 13

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Introduction Congratulations on being selected as Super User! Your role as a Super User is essential to the success of Advocate’s users in adopting the CPOE functionality in the Meditech application.

Your Role as a Super User To fulfill your role as a Super User, we ask you to help prepare for this change by coaching and supporting colleagues in your department. To help you prepare users for success, you are expected to:

Prior to the CPOE implementation

• Complete assigned online courses for the role(s), department or specialty you are supporting.

• Regularly log into the MedU Community to check for project updates and new reference materials

• Ensure users are aware of the Meditech CPOE implementation including timelines andexpectations.

• Answer questions around the MedU Community and assigned courses.

• Help to identify users who may require additional training and support.

• Participate in education readiness activities

• Reinforce the use of online courses and the MedU Community to prepare for the CPOEimplementation initiative.

During the CPOE implementation

• Provide best practice workflow and documentation support to users.

• Coordinate with the BroMenn & Eureka Project Team to report and resolve any issues.

• Huddle with other Super Users to discuss any department-specific challenges and communicatenew solutions.

• Help communicate any Meditech application and workflow updates within your department aswell as regularly check the MedU Community for new and current information

• Participate in coaching users on functionality, process or policy changes as it relates to theMeditech project.

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Ongoing

• Continue to participate in Super User activities appropriate for your department and function.

• Maintain communication with the BroMenn & Eureka Support Team to report issues and ask questions for your department.

• Ensure that users are aware of MedU Community updates and changes. Participate in coaching users on functionality, process or policy changes as it relates to the Meditech project.

• Support new user proficiency.

What are some of the challenges you may face as a Super User?

Reminder!

• Users will be assigned online training based on their role within the organization. Your job is to coach and leverage what users have learned in the online courses, supporting them in applying their recently learned skills and knowledge.

• Be familiar with the MedU Community and online learning as well as how to help users log in and find online resources.

• Complete assigned online courses, review Quick Reference Guides (QRGs), and participate in Super User Meetings, so that you can best support and coach nursing staff.

4



A New Way of Learning

Logging Into the MedU Community

The MedU Community houses online curriculums, documents and communication that will assist you with the upcoming Meditech CPOE implementation...

Getting Started:

• Launch Internet Explorer from your computer.

• Enter www.promisepoint.com/bromenn in the web address field.

• The MedU Community login page will launch.

• Enter your Meditech Log-In User name in the box on the right side of the screen and click login to access the MedU Community.

Navigating the MedU Community

Home:

The Home page displays a Welcome Message to the MedU Community along with access to recent project announcements, upcoming events, assigned learning, and more.

Learning:

• Associates have been assigned online courses based on their role within your organization.

o Click the Take Me to My Online Learning button from the Home page.

o Your list of assigned courses will display. It is best to take the courses in the order that they are assigned.

o To launch a course, click on the course name link. The selected course will load and begin playing.

o After completing a course, click the close X tab at the top of your screen. You will then return to the list of assigned courses in the MedU Community.

o Completed courses can be viewed or retaken by clicking the Completed Modules button at the top of the screen. Then select the appropriate course to launch.

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http://www.promisepoint.com/bromenn


Resources:

• Contains reference materials such as quick reference guides (QRGs), recent announcements, FAQ’s, “Find your Super User,” and more.

Meeting Room:

• Contains specific “rooms” where users may have security access to team or role specific information.

o Super User Network

o Project Team

Reports:

• Users with permissions will have the ability to access course completion and practicum reports from this tab. Curriculum, Location and User reports are available. This will only be available to leadership.

Help:

• Link to Help Desk information.

• If you are using a computer that is not located at the hospital (i.e. a home computer), it is suggested that you reference the Help tab for specific tips and tricks such as turning off your popup blocker, ensuring your browser is compatible, etc.

MedU Course List

• Introduction to Meditech • Search for a Patient • Document Patient Allergies • Manage Orders for Providers • Enter Home Medications • Manage Orders for Clinicians • Manage Med Orders for Clinicians • Use the Patient Care System • Use the Physician Desktop • Utilize Physician Documentation • Perform Medication Reconciliation • Document Problems • Initiate the Transfer Process • Transfer a Patient • Discharge a Patient • View the Patient Records

6



What to Expect

The online courses not only provide relevant, role specific learning they also allow you to choose the learning strategy that best suits your needs.

The online courses consist of two key sections:

1. Course Introduction – This introduces you to the topics covered in the course and where these topics might be used in typical patient care workflow.

2. Lessons – These teach you how to perform specific objectives in the application. A course may have one or multiple lessons. For each lesson, you will have two lesson activities, which are explained in more detail below.

Lesson Activities

Two activities are available for each lesson in a course; Watch an Interactive Demonstration and Test Your Proficiency. This gives you the ability to tailor your learning experience based on your current knowledge and skills.

Please note, you must watch the Course Introduction and complete and pass the Test Your Proficiency exam to receive credit for each lesson.

The two lesson activities are:

1. Watch an Interactive Demonstration:

Click the Watch an Interactive Demonstration link to begin a video that explains and guides you through the steps for each learning objective. You will actually perform the correct actions (typing, clicking, navigating) to complete your assigned task. The narration covers best-practice workflows and hospital policies.

Repeat the Interactive Demonstration as many times as necessary until you feel comfortable and confident with the sequence of actions required to accomplish the objective.

2. Test Your Proficiency:

Click the Test Your Proficiency link to demonstrate your ability to perform the task based on the scenario and instructions.

Note: In order to successfully pass the test, you must score within the required threshold percentage noted at the beginning of each exam. You may take the test as many times as necessary to pass.

7



Practicum

The Practicum is a role-specific, mandatory final exam that you must successfully complete before Go Live. It is assigned the same as the role-based courses in HealthStream. The Practicum:

• Provides a “day in the life” experience to demonstrate comprehension and sequencing of tasks within a role-based workflow.

• Evaluates the correct use of key application functions as defined within the workflow.

• Assesses your ability to apply knowledge from your simulation learning to scenarios critical to your daily work.

Helpful Hints

• When you have completed a lesson proficiency test, click the “Return to Course Topics” link to return to the course menu to select the next lesson.

• The Course Outline button, located on the navigation toolbar at the bottom, left of the screen, also provides quick navigation access, which allows you to move between lessons and learning options with a few clicks of your mouse.

• Remember: you must successfully complete all Proficiency Tests and watch the Course Introduction for the course to register as complete.

• Double clicking a correct item or button will advance you to the next step but may also display a “That’s incorrect.” message. If the screen advances, the action is counted as correct and you can continue the practice or test.

• Using the back button on the course player will only take you back to the beginning of the sequence you are currently viewing. If you need to go back further, use the Course Outline on the navigation toolbar at the bottom of the screen.

8



Adult Learning

Understand Adult Learners – Some Challenges and Techniques for Handling

What adult learning challenges are you most likely to see with users you are assigned?

Adult Learning Challenge

Adult Learning Techniques

Big picture learners • Give an of the steps they need to complete.

• Help them adjust their perspective on the amount of from their current process. What percent is it?

Visual learners • Show them the __________________ with the basic divisions of steps.

• Demonstrate the _________ if they lack confidence. Repetitive learners • Ask them to do one section of the task at a time and then

____________ review with them what they have done.

• Let them ________________ difficult sections again. Nervous learners • Remind them of ___________ ___________________ they have had

when learning something new.

• Encourage users to use the _______________ environment and reference the MedU Community for additional resources.

Resistant to change learners • Reassure them that they will still perform the same tasks but perhaps in

a different _________.

• Give them _________ _______________ for the change, such as the efficiency with which orders will be carried out.

Detailed learners • Help them balance their need for details while giving them a clear view of the new process – the “_______ ____________.”

9



Coaching Skills

Be Positive in Your Approach

• Be friendly.

• Convey your confidence in the new application and your experience with the application.

• Explain that typically users are quite proficient within a week or two of continued use.

• Let them know you are there to help them.

• Assure them that they have the skills to learn the process and workflow changes as well as the new tasks in the Meditech system.

Set and Manage User Expectations - What Will Happen and When:

Questions

Be sure you can answer the following for the users.

Answers

• When will the online courses be available to staff?

• When are users expected to complete them?

• What date is the Meditech CPOE GO LIVE?

• How will this CPOE implementation affect patients?

• What type of support will be available for the CPOE implementation?

• What is the escalation process?

• What issues need to be escalated?

o Hardware

o Software

o People

10



Becoming a Change Agent

• Expect resistance: Remember; 20% of people won’t get on board or will take a lot of effort, may sabotage, 50% need to be convinced or shown but will eventually believe (Doubting Thomas), and 30% will be trying to get ahead of the pack.

• Information: Explain the rationale for change.

• Attitude: Control your attitude, don’t let it control you. You have a lot invested in the system. Don’t let a challenge put you on the defensive.

• Ownership: Take ownership of the changes, the design. Be proud. Be open.

• Tolerance: Be tolerant of other perspectives and opinions. Be respectful.

• Humor: Keep your sense of humor. Be able to laugh at yourself.

• Stress management: Practice good stress management techniques.

• Support: Support the decisions of the project team, leadership and upper management. Don’t sell anyone out or point blame.

• Look forward, not back: Invent the future instead of trying to redesign the past. Don’t get caught in the trap - “We’ve always done it this way”.

• Myths: All the problems are evidence that change is bad. This will go away. I can just keep on doing my job like I have been.

• Reality: Problems are a natural side effect of change process. Change is here to stay. The Healthcare System is changing; you need to be changing too.

Listen

• Listen, listen, listen: you can be their stress reliever. Listen as much as or more than you talk.

• Listen to the entire message – do not jump to conclusions, get distracted or interrupt.

• Use questions to clarify and confirm your understanding of what is being said.

11



Levels of Listening

There are three levels of listening you will likely encounter as a Super User:

1. Tuned in – listener is paying full attention

2. Tuned in and out – listener is somewhat distracted; moves in and out of paying full attention

3. Tuned out – listener is not paying attention

Handling Emotional Responses

• Acknowledge the emotion, but don’t feed into it.

• Remain calm and supportive.

• Don’t take negative reactions personally: the person is reacting to the pressures of change, not to you.

• Offer encouragement, no matter how small progress seems to be.

• Help the staff member see where progress is being made.

• Reinforce the expertise the staff member brings to the job to create a more positive environment.

Handling Resistance

• Recognize signs of resistance such as:

o Avoiding eye contact

o Restricting nonverbal feedback

o Too busy to pay attention

o Finding fault with the task flow

12



• Understand the basis for the resistance

o Are they covering up for a lack of confidence?

o Do they not understand the task?

o Are they trying to draw attention to themselves?

o Is there a true gap in workflow or functionality?

• Ask them what they are uncomfortable with and reassure them.

• Be patient and supportive.

Final Thoughts If we had to summarize this course in three words, they would be:

• Listen

• Communicate

• Coach

Listen to the concerns of the users.

Communicate and communicate some more. Provide information and reminders to users (important dates, tasks, resources, department-specific issues, etc.) to help them stay connected and on track with “the change” and with their training. Communicating is essential in fostering user acceptance.

Coach users on the Meditech education and resources available to them – MedU Community, online courses, Quick Reference Guides, and more. Use positive reinforcement, encouragement, acknowledge emotional responses (fear, resistance), put the change into perspective, and encourage practice.

Reminder!

• It is your role to hold users accountable for their own learning.

• As a Super User, remind users to complete the online courses, to ask questions about workflow changesbefore the CPOE implementation.

• Remind them that this preparation will make it consistent and safer for patient care.

13


Nursing Practice CouncilMeeting Date: October 2, 2013 Meeting Time: 1:00 pm Meeting Location: CR 5 & 6

AGENDA ITEM SUMMARY OF DISCUSSION ACTION (WWW) Wins/Announcements • Wins:

o Note good work on quality, patient satisfaction scores o Note great increase in reporting near misses and safety concerns

• Information

Minutes from September meeting

• Motion to approve & seconded • Approved

Pain – EBP – Analyzing Research articles

• Wendy Woith walked the group through a pain article using a review tool. • Use the tool and processes when reviewing yourunit pain project articles

Pain – EB Practice Unit Reports

• Reviewed why the pain project is important: Pain tied to PatientSatisfaction/HCAPS, pain affects most all our patients, DNV wants to see evidenceof improving care

• Unit updates:o Cardiac Rehab – Approached PT to locate an EBP articleo MHU – Have initiated a patient class for patients with chronic pain, PT

contacted for information on unito Pre-Testing/Perioperative group – Have conferenced with Shelly Malin,

have narrowed their focus to neuro surgicals, are discussing options withanesthesia

o 6W – Are meeting with Molly Horio to obtain more articleso Cath Lab – working to minimize back pain for pts with femoral access,

documentation of pain and pre/post-procedure interventionso OB – Working to bring sucrose project to rest of areas where infants are

cared foro Rehab – working on changing unit schedule process/pt flow to improve

pain management and other care processeso MOSU- have been meeting with Wendy Woith to help give directiono Wound Center – Looking for literature on pain with wound debridemento Critical Care – Looking at continuous opioid drip vs intermittent

medications for ventilated patients, throat pain

• Will bring Patient Satisfaction data next month• Continue work on projects• Contact Shelly Malin or Wendy Woith for

assistance

Strategic Plan & CNE update

• Laurie Round expressed concern about how to get information to nursing staffabout the strategic plan (low attendance at town hall meetings).

• Discussed having a nursing page on the intranet, share accomplishments from theyear (falls, patient satisfaction, readmission rates, rounding)

• Encourage physicians to complete the physiciansurvey

•

Exhibit TL5.B.2

Advocate BroMenn Nursing Practice CouncilJuly 3, 2013

2

Shared Governance • Discussed thoughts about renaming shared governance – obtained ideas frommembers. Would re-naming better reflect the work? Would it re-energize the work?Would it confuse them? Isn’t the term “Shared Governance” a universal conceptfrom the literature?

• Suggestions: “Unit Practice Council” “Clinical Practice Council”

• Obtain input from unit staff and get theirperspective

• Re-read the article on Shared Governance (MaryAnne to attach to e-mail)

Practice Updates • IPCo Approved summary of changeso Addictions would also like to be addedo Delete signing of the cross-match card

• Crash Cartso Karen King noted that the new resource binders (with forms and tools) are

now on all crash carts. Defib pads are gone – can be obtained from thePharmacy box if needed. Pending: Bagging of supplies within the cartwhich will streamline checking the cart.

• Karen King asked questions about eye wash stations and regularity of checking.

• Approved IPC Changes• Note the new binder and changes to the crash

cart

CPOE Project • Jo Samara gave a preview of the work being done to prepare for physician order entry to go live early next year (see attachment)

• They are writing a nursing order catalog, working on building standing orders intothe process.

• Contact your unit rep to see how unit sharedgovernance groups can assist.

Quality • Dashboardo Noted low fall rates, noted a slight bump up in CAUTI one month – the

CAUTI team is working on it, C-diff we are meeting the system target.o Pt Safety Event – reviewed the site events and rates

• Core Measureso Shared a summary of issues and reminders for staffo AMI – making good progresso Heart Failure – dealing with discharge instruction issueso VTE – VTE’s are now reportable, but don’t have a benchmark yeto Immunizations – working on some missed opportunities- especially

offering them to high-risk patients, looking at smoking issueso Note that Advocate sets the goals high

• Infection Control –o Pneumonia – Encourage use of the CareMaps so that the guidelines are

meto See other notes above

• Information – review unit stats with yourmanager and shared governance groups foropportunities.

• Please complete your mid-year reports if you have not already done so • Please submit your reportsNext Meeting November , 2013 1-3 pm in CR 5-6.

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Advocate BroMenn Medical Center Advocate Eureka Hospital

CPOE PROJECT

Advocate BroMenn Medical Center and Advocate Eureka Hospital are embarking on an approximate 6 month journey to implement Computerized Physician Order Entry (CPOE) and Physician Documentation. In addition to providing a safer care environment for our patients, this project is critical to the Meaningful Use Stage 2 compliance for the organization.

In order to support the efforts of this project and other informatics ventures a Medical Informatics Committee and a Clinical Informatics Committee have been formed. These committees have representation from across ABMC and AEH clinical areas and from across the medical staff.

Over the next several months these committees will be instrumental in the design, build and implementation of Meditech functionality to support changes in workflow and processes.

The project scope includes Computerized Physician Order Entry (CPOE), physician documentation, Medication Reconciliation and interdisciplinary discharge. On March 3, 2014 all providers (physicians, APNs, PA, etc) and all clinical associates will ‘go-live’ with the new applications and processes defined within this project.

Communication is key to the success of this project. Please make sure that associates are aware of the project and how they can stay up to date on progress and provide input through their representatives on the Clinical Informatics Committee.

Clinical Informatics Representatives are: Co- Chairs: Lori Harper and Jo Samara Angela Malinowski (Nut. Serv.) Kristin Remmers (IP Nurse) Lily Young (IP, Peds ) Jen Crytzer (IP, Crit Care) Karen King (IP, Crit Care) Toni Winks (MHS) Janet Moser (OP Nurse) Darren Sawyer (OP Nurse) Lori Ritter (ED) Danielle Auth (OP Tech/Sec) Mary Beth Kirby (IP Sec & Nursing) Diane Anderson (MBU) Janet Sutter (Radiology ) David Honegger (Radiology) Nancy Hand (Lab) Elizabeth Harper (AEH Nurse) Ron Bartlett (AEH Nursing) Chad Goveia (RT) Jina Sunday (PMR) Katie Saxen (QCC) Lynette Haller (HIM) Amy Wickenhauser (HIM) Cindy Schaumburg (Compliance ) Teresa Gimbert (Risk) Bill Cummings (Pharmacy) Jenny Messier (Case Mgmt) Nancy Lishka (Clin Ed) Colleen Ewen (Clin Ed) Donna Deany (IS – Apps) Peggy Mahnke (IS – Apps) Natasha Wattleworth (Clin Inform) Sandy Young (Clin Inform)

Please direct any questions/concerns or suggestions to the representative for your area, Lori Harper or Jo Samara.

We look forward to working with you!

Date: October 2013

Exhibit TL5.B.2 Advocate BroMenn Medical Center 1

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Advocate BroMenn/Eureka Nursing Practice Council - 2013 ATTENDEES:

Unit/Dept Name Jan No mtg

Feb Mar April May

June July

Aug Sept Oct Nov Dec

NPC LEADERSHIP Executive Sponsor Dir. Nsg. Practice

Lori Harper RN, MSN, MBA, NE-BC, CPN

X X X X X X X X X

Co-Chair MOSU

Jennifer Abraham RN, BS X X X X X X X X X X

Co-Chair Clinical Ed

Mary Anne Kirchner MS, RN X X X X X X X X X X X

ABMC Endowed Professor Shelly Malin RN, PhD X X X X X phone X Chief Nurse Executive Laurie Round, RN, MS X X X X X X X X X X STAFF AEH - SDS Lisa Schoonover RN, BSN X X AEH- IP Karen Garman RN, BSN X X X X X 6W Jennifer Haskins RN X X X X X X X X Acute Rehab Miaad Abdulrehman, RN X X X X Cardiology Susan Basham RN, BSN X X Cardiopulmonary Rehab Heidi Heite RN, BSN X X X X X X X X X X Cath Lab Kevin Kennel RN, BSN X X X

Lynn Parker, RN X X X X CVCU Jillian Stiles, RN X X X X X ED Grace Fisher RN X X X X ICU Rachel Koerner, RN X X X X X X Mental Health Toni Winks RN, BC X K

Jennings X X X X X

MOSU Patty Omahana, RN, BSN, OCN X X X X X Kristin Remmers, RN X X X X X

Nursing Operations Tara Haynes Kathy Ott, RN X X

OB Jessica Baker RN,C X X X Brenda Drury RN X X X X

Pre-Testing Shelley Walters RN, BSN X X X X X X X PACU Teresa Hogan, RN X PCU

Emily Boote, RN X Melissa Reidy, RN X X X X Jen Shanahan RN X

Peds/Infusion

Lorilee Dunahee RN, CPN, BSN X X X X X Amanda Wackt, RN X X

Radiology Janet Sutter MSN, RN-BC X X X X X X

Advocate BroMenn/Eureka Nursing Practice Council - 2013

2

SDS Jeanise Frank RN, BSN X Yvonne Rees X X X X

Surgery Michael Hoeft, RN X Alice Deavers

X X X Wound Healing Jennifer Perry RN, BSN, CHRN X X X X X X X X X Wound/Ostomy Becky Hatfield, RN X X X X

MANAGERS AEH - ED/Inpt Ron Bartlett RN, BSN, CEN X 6W/PCU Kristin Peterson, RN, BSN, MSN X X X Acute Rehab/ MHU/Bariatrics

Renee Donaldson X X X X X

Critical Care Stacy Sutton, RN, BSN/Shelly Jiminez

X X X

ED Aaron Barclay, RN X X X X Nursing Operations Stacy Barclay, RN X X OB Stephanie Wollenburg, RN X X X X Peds/Infusion Alicia Allen RN, MS X X X X X X

SUPPORT Cardiac Education Karen King RN, BSN X X X X X CNS – Critical Care Donna Schweitzer RN, MSN, CCRN,

CCNS, APN X X X

CNS – 6W/PCU/Rehab Tori Steinkoenig, RN, APN X X X X X X IS Johanna Samara RN, BSN, FCN X X X X X X X X ISU Wendy Woith, RN, PhD X X X X X X QRM – Case Management Tina Bliss, RN X X X X X

Jenny Messier, RN X X X X QRM- Infection Prevention Pam Bierbaum RN, BSN, CIC X X X X X X QRM – Quality/IC Laurel Mode RN X X QRM – Reg Compliance Cindy Schaumburg RN, MSN,

CPHQ X X X

QRM - Risk Teresa Gimbert RN, BSN X X X X X X X QRM - Safety Kristie Wolfe, RN, MS X X X X X X X

Total

W W W . T H E B R E A K A W A Y G R O U P . C O M

MEDITECH ADOPTION ACCELERATORPOWERED BY THE BREAKAWAY GROUP

ADOPTION STATUS REPORT

MARCH 31, 2014

MEGAN MORRIS| SR. ENGAGEMENT MANAGER


1


AGENDA

Meditech Upgrade Education Performance Measurements• Did people use it? Completion data

• Did they like it? Relevance data

• Was it effective? Knowledge, and Confidence data, Proficiency scores

Options and ObjectivesDiscussion and Next Steps

2


MEDITECH UPGRADE EDUCATION

PERFORMANCE DATA

3


COURSE ASSIGNMENTS BY ROLEAs, an organization, 71% Overall Complete

1261 Total Users, 10621 Course Assignments

All Courses

Nurse

Other

Provider

Unit Secretary/Technologist

Nurse4478

Other1476

Provider3528

Unit Secretary983

All Courses156

4


COURSE COMPLETION BY DEPARTMENT

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

5



0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

6



0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

7


ENGAGED LEADERSHIP SURVEY

8


I UNDERSTAND HOW

THE MEDTIECH

UPGRADE WILL IMPACT

MY JOB.

9


I UNDERSTAND WHY

WE ARE

IMPLEMENTING THE

MEDITECH UPGRADE.

10


THE LEADERSHIP

TEAM IS COMMITTED

TO THE SUCCESS OF

THIS PROJECT.

11


THE LEADERSHIP TEAM

HELPS ME UNDERSTAND

WHAT I NEED TO DO TO

ADOPT THE NEW

SYSTEM.

12


COMMUNICATION

FROM THE LEADERSHIP

TEAM HAS MADE ME

FEEL MORE

COMFORTABLE ABOUT

THE CHANGE

13


I KNOW WHO TO

CONTACT WHEN I HAVE

A QUESTION ABOUT THE

MEDITECH APPLICATION

14


COURSEWARE KNOWLEDGE AND

CONFIDENCE ASSESSMENTS

15


THIS COURSE IS USEFUL

TO MY ROLE IN THE

ORGANIZATION.

16


BASED ON THIS

COURSE, I HAVE THE

KNOWLEDGE NEEDED TO

PERFORM THE TASKS IN

THE APPLICATION.

17


BASED ON THIS COURSE, I HAVE THE CONFIDENCE

NEEDED TO PERFORM THE

TASKS IN THE

APPLICATION.

18


AVERAGE TRAINING TIME PER ROLEEstimated Time to Complete Simulators and Practicum

• Provider: 4.5 Hrs

• Nurse: 4.25 Hrs

• Unit Secretary: 1.75 Hrs

Course NameAvg.

Duration

Introduction to Meditech : 7Search for a Patient : 11Use the Physician Desktop :16Document Patient Allergies :15Manage Orders for Providers :60Manage Orders for Clinicians :42Utilize Physician Documentation :43Perform Medication Reconciliation :33Initiate the Transfer Process for Providers :15Initiate the Transfer Process for Nurses :15Process a Patient Transfer : 7Discharge a Patient for Providers :34Discharge a Patient for Nurses :34Use the Patient Care System :37Manage Med Orders for Clinicians :17

TOTAL DURATION FOR ALL COURSES 6:36

19

Presenter

Presentation Notes

1 – Course seat-time is calculated using a Breakaway-researched formula, which is driven by the number of clicks/keystrokes in each Interactive Demo/Lesson.


PROFICIENCY DATA: ROLE-BASED PRACTICUM SCORES

RoleAverage

Proficiency Score

Average Attempts per User

Completion Percentage

Provider 94% 1.22 30%

Nurse 95% 1.29 41.3%

UnitSecretary/Tech

96% 1.17 34.8%

20

Presenter

Presentation Notes

*Still gathering actual data for Neonatal/Pediatric Practicum completion


PERFORMANCE METRICS CONCLUSIONS

1. The program was widely used: 71% of assignments werecompleted.

2. The program was well-received: 81.2% of learners found ituseful to their role.

3. The program was effective: 83% felt the courses lentknowledge and confidence in performing the tasks trained;94%+ Practicum scores support the qualitative data

4. Leadership was perceived as committed to the success ofthe project (88.4%) and communication around the projectwas thorough (86%).

21

qrm.jlm

Oval


NEXT STEPS

22


PROFICIENCY APTITUDE TESTS

Certification Checklists for Visual Verification of End User Comprehension

Focuses on workflows/tasks chosen by BroMenn Role-Based Can be administered on-site by TBG

23


NEXT STEPS

• Determine how additional 10 lessons will be used• Identifying other training opportunities• Develop Proficiency Aptitude Tests• On-Site Assessment Opportunity

24


DISCUSSION

25

W W W . T H E B R E A K A W A Y G R O U P . C O M26

Presenter

Presentation Notes

Thank everyone for their time and attendance.�Let them know you look forward to working with them and their teams towards a successful outcome. Let them know you are excited to have the rest of the TBG team meet them soon while working on the project.

BroMenn / Eureka –Medical

Informatics

April 2, 2014


Topics

Wins

CPOE/PDOC Project Status

Other Projects

CPOE Statistics

2

WINS!

Wins “Saves me time”; “ I spend more quality time with my

patients…. I take the computer into the room and have

conversations with the patient about their care at

bedside” – Dr. Ranjan

“Much smoother go live than Epic”; “Support staff

helpful, did not get yelled at if I made a mistake”;

“everyone responsive” – Dr. Jarzabkowski

“CPOE go live went fairly smoothly…” – Dr. Koh at

governing council

4

CPOEUpdate

Items that went Live

Physician Order Management

Physician Documentation

Discharge/Med Reconciliation/Transfer

Dragon – Upgraded and have trained 101

physicians

Intelligent Medical Objects (IMO)/Meditech

Integration

6

CPOE Go Live – Status Week 4 No Major Issues

Command Center Closed on 3/16/14 at 1800

Week 3: Clinical Informatics staff on site 0500 – 1900

Week 4: Normal off hours support process, Rounding

daily on physicians/associates by 3 consultants

Week 4: Weekend 8 - 9 calls; Offhours (1630 – 0700) 2

– 3 average calls

Super Users – First level of support

Issues/Requests

– 1070 logged

– 307 still active

– 763 resolved

7

qrm.jlm

Highlight

CPOE Go Live – Opportunities Transfer Routine – Process Change

– Process change in effect 3/24/14

– ED Process being streamlined

– IP to IP process is less confusing

Requests for Order Set changes

– Collating these for review

– Approved changes will go for appropriate signatures

– Once signed, changes will be made in Meditech

Requests for Physician Documentation Changes

– Collating these for review

– Will go to Medical Informatics

Education/Refreshers

– Weekly Updates

– Support Staff in Physician Lounges/key areas

– At elbow support upon request during business hours

8

Other Projects

Clinical Informatics Projects CPOE Order Set Optimizations/Build

Physician Documentation Optimizations

Meditech Upgrade – May 14

Transfer Routine – Process Changes

Meaningful Use Quality Measures and Documentation

changes

CBT Development

Midas Upgrade

RXNorm

Meditech Mobile Rounding

10

Clinical Informatics Projects QS to Meditech Interface

Hemodynamic Monitoring Interfaces

eICU

CBORD Upgrade

Spiritual Care Documentation Redesign and Productivity

Reporting

Palliative Care Documentation

Quality – Core Measures Interventions and Status Board

design

Immunization Routine

Dialysis Documentation

ICD – 10

Downtime Procedures/Processes

11

Clinical Informatics Projects ED Protocols and Documentation Review

Plan of Care Review/Redesign

PMR OP Documentation Redesign

PMR Charge on Documentation

Acute Rehab Redesign of FIM Documentation

D/C Instructions Update (all areas)

Hospitality – Bed Board Processes and Productivity

Tracking

Bed Board Telephony Interface

CBORD Move to Corporate Application/Interfaces

12

CPOE Statistics

StatisticsMarch 5, 2014 – March 25, 2014BroMenn Medical Center

Total Orders: 73,380

– 60.65% by Physicians

– 12.65% by Telephone

– 6.19% by Paper

– 2.30% by Verbal

– 18.21% by Other

Eureka Hospital

Total Orders: 3,741

– 82.44% by Physicians

– 4.30% by Telephone

– 3.90% by Paper

– 0.53% by Verbal

– 8.82% by Other

14

ABMC Trend

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

% o

f O

rders

CPOE Trend Report 3/5/14 - 3/25/2014

CPOE

Paper

Verbal

Phone

AEH Trend

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

% o

f O

rders

CPOE Trend Report 3/5/14 - 3/25/14

CPOE

Paper

Verbal

Phone

Questions

17

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