Kaiser informatics director: IT must be about continuous quality improvement for nurses

No one IT system is perfect for improving care, according to Ann O'Brien, R.N., director of clinical informatics at Oakland, Calif.-based Kaiser Permanente. Rather, she said, continuous performance improvement should be the primary goal of healthcare technology.

"You have to look at what can enable small amounts of change" as it relates to a larger goal of better quality for patients, O'Brien (pictured) said, speaking last Friday at an IT summit for nurses held by the Office of the National Coordinator for Health IT, the American Nursing Informatics Association and the American Nurses Association at Baltimore Washington Medical Center in Glen Burnie, Md.

O'Brien talked about Kaiser's work around reducing pressure ulcers to drive her point home. A two-pronged approach focused on:

  • Developing across-the-board electronic health record standards at the system's hospitals for recording and using patient data; and
  • Cutting back on the complexity of inpatient care for nurses by reducing non-value-added tasks

"If you look at the inpatient environment right now, it's not perfect, it's chaotic," O'Brien said. "For nurses taking care of patients, it's cognitive overload. They want their path and workload simplified."

With that in mind, she said, Kaiser implemented rapid sign-on technology and a system that moved clinical care dashboard information to their whiteboard. The former means that nurses only have to type in their login and password information once a day to gain access to patient charts; an RFID chip on the nurses badges enables them to tap in or out of disparate records for the rest of the day until they're logged off.

"If you're saving 8 seconds and the nurse is logging on 100 times, you're getting more than 13 minutes of direct care back," O'Brien said. "In that time, you can talk with a patient or their family instead of spending your time looking for information."

The latter technology, meanwhile, helps to ensure that nurses have the most up-to-date information they need on their patients in real time, according to O'Brien. "This provides the opportunity for care to then move, to be much more patient-centric, real-time, intelligent and actionable," she said.

What's more, she said, the EHRs send alerts to nurses to remind them of various tasks, such as turning patients every few hours.

To date, O'Brien said, Kaiser's rate of hospital-associated pressure ulcer incidences in the southern California region is less than 1 percent.

"Everything in care is multifactorial," she said. "In terms of moving large numbers of nurses to highly reliable care, if you have an evidenced based bundle and you remind them to do the interventions, you can move the needle really, really well."

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