 

Taylor Musick, Shannon Dolan, Becka Johnson, Kali Coenen

April, 25, 2018 1
 The focus of this presentation is centered on
information and healthcare technology related to
the discrepancies between the use of both paper
charts and electronic records on a hospital unit.
• Carondelet St. Joseph's Hospital
• Couplet Care Unit - 34 rooms, 68 patients
• Microsystem Model of Healthcare Delivery

2
 “Servant Leadership means to put serving
others as the number one priority, including
employees and the community. Servant leaders
focus on listening, keeping an open mind, and
always thinking before reacting. They lead
through their service.”
• Annual Evaluation Survey
• Charge RN and House Supervisor available
every shift
• Unit Manager available during day shift
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed. p. 65). Philadelphia: Wolters Kluwer Health
3
 “In a service line organization, the overall goals
would be determined by the larger organization
(Carondelet), but the service line (Couplet Care)
would decide on the processes to be used to
achieve the goals.”
• Huddle
• Float Nurses from NICU or Labor & Delivery
• Postpartum Depression Book
• Lactation

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing:
Theory and application (9th ed. p. 304). Philadelphia: Wolters Kluwer Health 4
 Patient focus: Care “that is respectful of and responsive
to individual patient preferences, needs, values, and
ensuring that patient values guide all clinical decisions”
• Forming relationships
• Increasing bonds

 Staff focus: Staffing patterns and scheduling policies

must be administered fairly and economically
• Monthly staff meetings
• On call days
• Staffing ratios
• HCL Warren, N. (2012). Involving patient and family advisors in the patient and family-
centered care model. MEDSURG Nursing, 21(4), 233-239.

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management

functions in nursing: Theory and application (9th ed. p. 434) Philadelphia: Wolters
Kluwer Health
5
 “Team-based models of PHCT delivery have been
created to achieve (or work toward) several benefits
to the health system, health care providers, and
patients, including better coordination of care,
increased focus on collaborative problem solving
and decision making, and a commitment to patient-
centered care”.
• Neonatologists always around
• Daily meeting with OB charge nurses
• Coordination with healthcare team
• Use of voceras
Sibbald, S. L., Wathen, C., Kothari, A., & Day, B. (2013). Knowledge flow and exchange in interdisciplinary
primary health care teams (PHCTs): An exploratory study, Journal of the Medical Library Association,
101(2), 129.
6
  The utilization of both electronic and paper patient
charts can lead to discrepancies in care.
• Patients: Even though St. Joe’s has a patient
portal, it is possible that not all of their health
information will be within this system because of
the use of paper charts.
• Staff and providers: Missed orders from
providers, inefficient communication.
• Integration of information with technology: EHRs
lead to increased productivity and accuracy
Hawley, G., Janamian, T., Jackson, C., Wilkinson, S. A. (2014). In a maternity shared-care environment, what do we
know about the paper hand-held and electronic health record: A systematic literature review. BMC Pregnancy and
Childbirth, 14(52). doi: 10.1186/1471-2393-14-52 7
  “An audit is a systematic and official examination of a
record, process, structure, environment, or account to
evaluate performance.”

• Initiate quality assurance to check accuracy and

efficiency of EHR documentation
• Monthly meetings with QA team, managers, and staff
members to identify strengths and weaknesses as a
team
• Initiate quality assurance to check accuracy and
efficiency of EHR documentation
• Individual feedback to staff members who need more
guidance with documentation

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and
application (8th ed. p. 551). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 8
  “Performance appraisals let employees know the
level of their job performance as well as any
expectations that the organization may have of
them.”

• Identify biases and concerns regarding EHR

implementation with the healthcare team
• Continual quality assurance and improvement
• Continuing education on EHR best practices
• Meeting individually with staff members to
discuss performance of using the EHR.
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and
application (8th ed. p. 574). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 9
The unit uses combination of paper / electronic documentation.
Variations in location of medical information can lead to:
 Reduced Patient Safety
 Reduced Efficiency

Evidence Based: Standardization and simplicity of documentation

improves quality of care and patient safety.

Intervention: Shift to Electronic Medical Record (ERH) use for all

documentation and orders.
King, J., Patel, V., Jamoom, E. W., & Furukawa, M. F. (2013). Clinical benefits of
electronic health record use: National findings. Health Services Research, 49(1pt2), 392-404. doi:10.1111/1475-6773.12135
Middleton, B., Bloomrosen, M., Dente, M. A., Hashmat, B., Koppel, R., Overhage,
J. M., . . . Zhang, J. (2013). Enhancing patient safety and quality of care by improving the usability of electronic health record
systems: Recommendations from AMIA. Journal of the American Medical Informatics Association, 20(E1), 2-8.
doi:10.1136/amiajnl-2012-001458 10
o Propose change to key leaders
o Presentation of change to interdisciplinary team
o Educate RNs, Physicians and Clerk on Cerner
applications
o Implementation of change to completely electronic
documentation and order placement
o Project Evaluation

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 1 month 2 months 6 months 10 months 16 months

Root Cause Analysis Present the Project Education Change Implementation Evaluation

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 Hawley, G., Janamian, T., Jackson, C., Wilkinson, S. A. (2014). In a maternity
shared-care environment, what do we know about the paper hand-held and
electronic health record: A systematic literature review. BMC Pregnancy and
Childbirth, 14(52). doi: 10.1186/1471-2393-14-52
 King, J., Patel, V., Jamoom, E. W., & Furukawa, M. F. (2013). Clinical benefits of
electronic health record use: National findings. Health Services Research,
49(1pt2), 392-404. doi:10.1111/1475-6773.12135
 Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions
in nursing: Theory and application (9th ed.). Philadelphia: Wolters Kluwer Health
 Middleton, B., Bloomrosen, M., Dente, M. A., Hashmat, B., Koppel, R., Overhage,
J. M., . . . Zhang, J. (2013). Enhancing patient safety and quality of care by
improving the usability of electronic health record systems: Recommendations
from AMIA. Journal of the American Medical Informatics Association, 20(E1), 2-
8. doi:10.1136/amiajnl-2012-001458

13
 Sibbald, S. L., Wathen, C., Kothari, A., & Day, B. (2013). Knowledge flow and
exchange in interdisciplinary primary health care teams (PHCTs): An exploratory
study, Journal of the Medical Library Association, 101(2), 129.
 Warren, N. (2012). Involving patient and family advisors in the patient and family-
centered care model. MEDSURG Nursing, 21(4), 233-239.

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