Patient safety is the top priority at Nebraska Medicine. There are many facets in the works to protect our patients from harm. Our goal is to cause zero harm to our patients. A big piece of that is preventing health care-acquired infections (HAI).
Improvements within One Chart recently went live to support this important effort. The idea was to create a central place where providers can go to make sure they’re following recommendations on quality and regulatory metrics.
The newly created inpatient Quality Metric Checklist (QMC) highlights patients who are at risk for a catheter-associated urinary tract infection (CAUTI), a central line-associated blood stream infection (CLABSI), venous thromboembolism (VTE) or have orders for telemetry or non-violent restraints.
“We realized there were opportunities within a provider’s One Chart workflow to reduce the amount of interruptions they encounter and make it easier for them to document quality metrics,” said Brandon Fleharty, Clinic Informatics lead.
When a patient meets certain criteria, like a risk for a CAUTI, for example, an alert fires in One Chart.
“Oftentimes, a provider enters the patient’s chart to perform a specific task,” Fleharty said. “An alert comes up about an indwelling urinary catheter, but they want to finish the task they’re working on, so the alert is dismissed. Then they may forget to follow up on the alert.”
The quality team analyzed the alert’s data and learned the alert, known as a Best Practice Advisory (BPA), was not an effective tool that led to change orders.
“We want them to do the right thing before they see an alert,” he said.
The team worked with the Patient Outcomes Committee to develop the new checklist.
“We took a confusing workflow and developed a standardized checklist, that offers all the tools providers need in one spot,” Fleharty said.
To make it easy to find, the team created a banner on a patient’s overview report. When a provider clicks on the banner, it guides them to the checklist.
“The checklist was designed to make relevant quality and time-sensitive clinical activities easier for providers to review and address,” said Justin Birge, M.D., UNMC assistant professor, internal medicine. “Ideally, this design will significantly reduce the amount of interruptive alerts related to such activities. As an added benefit, the checklist has been designed to include appropriate orders and inform documentation through a SmartLink that can be placed in provider notes and eliminate redundant/irrelevant charting.”
The checklist went live on July 10. Three BPAs were discontinued as a result of the new checklist.