As the implementation of electronic patient record (ePR) begins at Providence Care in Kingston, examination of current processes and planning for future processes have led to a number of quality improvement initiatives involving documentation, oversight and equipment.
“The electronic patient record isn’t just about saving paper,” says Robin Saunders, Providence Care’s Director of Decision Support. “It’s also about learning what we’re doing and how we’re doing it, and making changes that benefit the patients, clients and residents we serve.”
Providence Care’s ePR team has been working with undergraduate and graduate students from the University of Ontario Institute of Technology (UOIT) in the Faculty of Health Sciences and the Faculty of Business and Information Technology.
Together, Providence Care and UOIT are examining clinical workflow processes using Patient Journey Modeling Architecture (PaJMa), the process modeling methodology developed by Dr. Carolyn McGregor (Ph.D., Associate Professor in the Faculty of Business and Information Technology, Associate Dean of Research, and the Canada Research Chair in Health Informatics at UOIT ) and Dr. Jennifer Percival, (Ph.D., Assistant Professor in the Faculty of Business and Information Technology).
PaJMa models are detailed diagrams that map out client/resident/patient interactions from admission to discharge across the organization, and how information flows between clinicians within the circle of care. Currently, PaJMa models have been created for each of the inpatient units at Providence Care. A careful examination of these processes will allow the organization to look for efficiencies and opportunities to standardize processes as we move towards the implementation of the ePR.
Saunders says planning for the ePR has also improved the quality of documentation. Nursing Care and Observation Flow sheets have been developed and are in place in two inpatient mental health units so far. These sheets ensure regular and consistent documentation for each patient on each shift. Staff input has been integral to the implementation and revision of this documentation tool. Plans are in place to roll the flow sheets out to all mental health units over the next six months, with the eventual goal of building them into the electronic record.
Additionally, an Inter-Professional Care Planning Working Group has been established and is moving ahead with plans to implement the utilization of an electronic care plan, B Care’s “Care Plan Wizard”, during inter-professional team meetings. The Care Plan Wizard utilizes the Resident Assessment Instrument – Mental Health (RAI-MH) data to highlight areas requiring further assessment and individualized care planning. The goal is to roll out use of the Care Plan Wizard at inter-professional team meetings over the next year.
Finally, equipment pilots are currently underway as well, incorporating use of best practices with use of technology. Different groups of staff have had the opportunity to complete a Falls Risk Assessment Tool (FRAT) and the Braden Skin Assessment Scale electronically, at the point of care, using different computer work stations on wheels. The work stations are also equipped with links to the online Compendium of Pharmaceuticals and Specialties, Registered Nurses Association of Ontario website for quick access best practice guidelines, and to the College of Nurses of Ontario website. These pilot initiatives will allow staff to have input into future product selection for the organization.
“Providence Care is learning that implementation of an electronic health record changes not only how and where one creates and stores documentation,” says Saunders. “It also greatly enhances quality of care, oversight and clinical efficiency.”