Transcript CPMRC - Instructor Development

Feb 25 and Feb 26, 2008
Copyright© 2007 by The CPM Resource Center. Proprietary and Confidential.
Not for Use or Disclosure outside of The CPM Resource Center &
Abington Memorial Hospital’s Internal Use
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Knowledge Based Charting
(KBC)
Instructor/Super User
Development Workshop
Guiding principles
Collective learning
• Thinking and learning about practice and
documentation in different ways
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Intention
• Support Abington Memorial Hospital’s Instructors &
Super Users in understanding the design, integration,
and clinical relevance of the clinical documentation
system.
• Enhance the teams skills and foster individual and
collective abilities to encourage others in using the
integrated interdisciplinary evidence based
documentation.
• Use a variety of learning strategies
2
Agenda
Day 1
• Foundation/Overview -Intentional Design, Content
and Interdisciplinary Integration
• Documentation Tools and Professional Practice
Framework Integration
• Navigation and Practice
- Intro, key points, hands on, discussions
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Day 2
• Stations regarding Content, Navigation and Practice
Application for tools and professional processes
• Review/ Questions, Analysis & Teaching strategies
• Comfort Zone / Competencies/ Exercises/ Evaluations
3
Today’s objectives
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1. Examine what you think about documentation and
clinical practice.
2. Explain and apply the Professional Practice
Framework© (EBP, Scope of Practice,
Communication, Individual & Integrated
Competency, Partnership)
3. Understand Clinical Practice Guidelines (CPGs).
4. Summarize the purpose of each KBC documentation
tool and how each tool interrelates with the other
tools.
5. Identify how the documentation processes support
each clinical discipline’s Scope of Practice.
6. Navigate and Understand Knowledge-Based
Charting (KBC)
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Tomorrow’s objectives
1. Navigate and Understand Clinical Documentation
with Knowledge-Based Charting (KBC)
2. Summarize the intention of each KBC
documentation tool and how each tool interrelates
with the other tools.
3. Begin explaining how to use KBC and recognize and
identify common problems/concerns in
documentation.
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4. Become familiar with teaching/coaching tips for
documentation processes to support EBP, Scope of
Practice and a vision of interdisciplinary integration.
5
CPMRC Practice-Technology Education Methodology
Practice Integration
Ownership and daily use
Internalization: Practice
Applicability; finding value and personal
meaning for patients
Skill Attainment
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Computer know how; How to navigate KBC; SCM
Education – Knowledge
Professional Practice Framework; Scope of Practice;
Interdisciplinary Evidenced Based Practice; Dialogue etc
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Learning Strategies
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•Small group and large group discussion
•Demonstration
•Lecture didactic- concepts and application
•Hands on computer time
•Clinical context scenarios, exercises and
application
•Games
•Individual reflection
•Individual and group analysis and application
of principles
7
Check-in question
Briefly tell about a time when documentation
did or could have made a difference in patient
care/outcome.
What is Your Current Comfort with teaching
clinical documentation?
(not very comfortable)
–
5
(could teach it now)
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1
8
Healthcare challenges
Health care providers are faced with:
•Complex patients
•Increasing workloads
•Changing skill mix
•Challenge to help patients achieve
outcomes
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•Changing regulatory requirements
•A society worried about safe care
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Documentation represents
•The essence of the patient’s story and
care needs
•The tangible evidence of professional
practice
•The scope of practice of each provider
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•Communication between providers across
shifts, departments, and agencies.
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Intentionally designed automation
Capturing and Communicating the Patient’s Story
Patient Story
Is the difference between
a 19 Year old Male with Spinal
Cord Injury
Knowing and caring for Matt as a
person who has a life changing
injury
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and
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Intentionally Designed Automation:
Capturing and Communicating the Patient’s Story
Patient Story
Trauma Admission :
Training for the Olympics:
•Life-long goal
•Son, brother, boyfriend & doglover
•Student
•Struck by car while running
Heading Home:
•Interdisciplinary care
facilitates a smooth transition
to home environment
Measuring
Education and
Patient Outcomes:
• Initiates from Plan of Care
• Customizes outcomes
based on patient
problems
•Initial Assessment
•Problem identification
and prioritization
Establishing A Plan:
•Reviews & implements Guidelines
•Brings evidence-based
knowledge to the front-line
worker
•Mentors & guides novice to
expert
•Customizes patient record
Individualized Care
for Patient:
•Adds specific
individualized information
from Plan of Care
•Supports documentation
against evidence-based
Guidelines
“Consequently, reducing error and increasing
patient safety are not likely to be achieved by
any single action; rather, a comprehensive
approach, addressing all components of health
care delivery within an organization, is
required.”
Keeping Patients Safe:
Transforming the Work Environment of Nurses.
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2004, IOM
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Practice
Polarities are two opposite
values or points of view that
are interdependent.
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Technology
14
Healthy Culture Molecule
P = Shared Purpose
S = Scope of Practice
C= Competency
P–S–C–G
G= Integrated Competency
D = Dialogue
R = Healthy Relationships
N = Networking Councils
D–H–R
(Partnership Infrastructure)
I
T = Tools and Resources
N
T
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I = Infrastructure
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Mutuality
•The act of being with others in a way that
focuses on what matters most.
•Asking Patients:
- “What questions, fears, or concerns do you have?”
- “What are your goals for today?”
•Asking coworkers what their goals are and
what information you need to help them.
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- “What information would help us care for you
better?”
16
Providing Excellent Patient Care includes Relationshipswith each patient and each other
So what is it that Patients say they want?
•They want to be listened to
•They want to be treated with respect
•They want to be cared for by competent
providers who talk to each other and
coordinate activities
•They want the ability to make informed
decisions about care choices
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•They want to be involved in their care
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Reflection: Practice & Technology
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Wisdom from users: Know the technology – keep the focus on the patient
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Meaningful Conversation
Dialogue: “The discipline of collective
learning and inquiry, is a process for
transforming the quality of
conversation and the thinking that lies
beneath it.”
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~ William Isaacs
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Principles of Dialogue
•Intention: Create a safe place, good context
•Listening: To self and others, the collective,
and between the lines.
•Advocacy: Sharing your thoughts and feelings
to reveal a perspective
•Silence: Reflecting and learning from the quiet
of the soul
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•Inquiry: Asking genuine questions of curiosity to
learn from and about others
20
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Reflection: Think of a time when you did or could have used dialogue
skills in daily practice working with patients and all members of the team
to achieve desired outcomes?
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Principles of Partnership
Equal Accountability
Potential
Balance
Trust
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Intention
Mission Driven
22
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Review Key Points: Dialogue and Partnership
Reflection: Partnership Impacts on Patient Care
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Question?
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Do you think that each person is
accountable for
communication and
integration of his/her
contribution to healthcare?
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Clarity on Scope of Practice
•First step in stopping duplication and
repetition.
•Must be integrated into documentation.
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•IOM: “Inconsistencies are exacerbated by
variation in the scope of practice by setting of
care.”
25
Reflection: Think about working with others. Describe
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what it is like to work with one who is clear on their scope
of practice and one who is not clear on their scope?
26
Evidence-based practice
•The integration of best research evidence with
clinical expertise and patient values
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Sackett, Strauss, Richardson, Rosenberg & Haynes, 2000
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Signs and Symptoms Exercise
Urinary
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Retention
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Example
Urinary Retention
• Inability to void,
• change in urine pattern,
• frequent small voiding,
• abdominal discomfort/pressure,
• urgency,
• suprapubic distention,
• restlessness,
• increased BP, increased HR, anxiety, palpable bladder
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• residual cath or >100cc (adult),
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How to read the Medical Diagnosis CPG
The following slides highlight the sections of the CPG. All CPGs
have the same “layout”. Understanding how the guideline is
designed will help you find information quickly. The sections on
a CPG are:
• Name, Type, & Target Population
• Goals & Outcomes
- Potential Physiologic Problems
• Assessment/Interventions/Clinical Reasoning/Decision
Making
• Signs and Symptoms of Potential Physiological Problems
• General Information
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- Education Goals
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Physiologic
Name
Guideline
Type
ofofGuideline
Goals
Target Population
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Goals and
Outcomes
32
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The Documentation System is not a
Series of Parts.
Rather a
Whole Picture of
Individuals and the Care Provided
33
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There is no one person, discipline, or department
that will assure quality care for Matt.
34
Overview of Documentation Tools: Use a Story
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Matt’s Story
35
Consistent Format to Review All
Documentation Tools
•Intention of the tool
•Who will use that tool
•How it interrelates with other tools
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•Key features and functions
36
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Example: The Patient Profile
37
Stress Practice Patterns when Emphasizing
Points to Consider
•Interviewing skills
•Data Collection
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•Interdisciplinary Contributions – patterns
38
Patient Profile
Intention of the tool
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● Patient/family story:
Body/Mind/Spirit
● Prioritization/mutuality
● Support partnership &
meaningful conversation
● Provide a therapeutic
communication tool for all
providers
● Facilitate risk screening, referrals
& discharge planning
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Patient Profile
Who will use this Tool?
• All disciplines
• Replaces past medical history
from discipline specific initial
evaluations/assessments.
• General Information
• Allergies
• Health History/Review of
Systems
• Medication Usage
• First Level Screening for
Referrals
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Key Points
40
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Reflection: How do I currently interview patients: to learn their story or
collect just the facts/data?
41
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Planning Care for
Patients
42
Emphasize Key Professional Accountabilities in
addition to the computer function
Individualizing the Plan of Care
So what does “Individualizing” mean?
- An intervention
- A specific preference or request from the
patient or family
- Unique to this patient
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- An approach to achieve a goal
43
Questions and Answers – Use to stimulate thinking.
Documenting to the Plan of Care
A. Documenting to a protocol
B. Documenting per policy
C. Documenting to the CPGs on
the Plan of Care
Correct Answer is:
C. Documenting to the
CPGs on the Plan of Care
• This means that you have
implemented interventions on
the CPG when appropriate.
• It documents the correlation of
appropriate assessment data
and critical thinking/clinical
judgment to implement specific
interventions “as appropriate”
for each patient/family.
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What does it mean to
document to the Plan
of Care?
Click for example
44
Documenting to the Plan of Care demonstrates professional
accountability and critical thinking.
So What does “Implemented Interventions as appropriate” really mean?
Clinical Reasoning:
•Correlate, Anticipate,
Differentiate, Evaluate:
•Assess, Monitor,
Detect, Prevent
Decision Making:
• actionable
interventions are
documented when
needed, at the time
they are
implemented
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•Clinical Judgment
45
Reviewing the Plan of Care with the Patient
A.
Cognitive perceptual
B.
Coping
C.
Evaluation
D.
Interventions
Correct Answer is:
B: Coping
• In the coping section there is a
place to indicate that the plan of
care was reviewed and with
whom it was reviewed. This
action provides the opportunity
for mutuality.
• Mutuality is the process of
mutually reviewing and agreeing
on the Plan of care – it is during
this process that individual needs
and goals are confirmed
together with the patient and/or
family.
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In which section would you
document that you have
reviewed the Plan of Care
with your patient?
46
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Key Points and Reflection: Planning Care for the Person and their problem
47
Specific Strategies for the Instructor Workshop
GOAL: Increased confidence of
participants and personal identification
of clinical use for the electronic
product.
- Group rotation stations
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- Return demonstrations
48
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CPMRC Instructor Workshop-Rotation Stations
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•Purpose of the station
•Concepts for Station Instructor to Review
•Keys to Success
•Common Problems and Pitfalls
•Helpful Hints – system function and computer skills
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•Links with other documentation and care processes
50
51
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Examples of Questions for Station 6
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