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Carolinas HealthCare System

Training from Cerner helps Carolinas HealthCare System make a smooth transition during an optimization project

Anytime a large health system like Carolinas HealthCare System makes a change, it’s big. In the spring of 2016, Carolinas HealthCare System optimized its acute care nursing documentation, moving from Cerner’s PowerForms to iView. At the time, they had been a Cerner client for about 10 years, and according to Becky Fox, MSN, RN-BC, assistant vice president and CNIO, the organization’s documentation needed an uplift.

“This phase (of 5 phases) of optimization focused on streamlining documentation,” said Fox, “and leveraging all functionality within iView.”

A crucial aspect of the change was training more than 8,000 nurses, nursing assistants, and other clinical staff on the changes, across 12 acute care facilities. Typically, training would have been held in a four to eight-hour, in-person classroom-style session, but a variety of factors led Carolinas HealthCare System to consider a different approach.

“The logistics of training thousands of people were complicated,” said Fox. “We recognized that nurses have individual training needs, and we knew that finding enough classroom space was going to be a challenge.”  

Another factor was cost — both for the time in a classroom and time away from patients.

“It’s a struggle to make a business case for taking an employee out of their job and away from the bedside,” said Shannon Morton, director of policy, practice and nursing at Carolinas HealthCare System NorthEast, one of the hospitals in the system. “We knew we had to leverage technology and deliver education in a more efficient way.”

Nursing leaders calculated that the cost of putting 6,172 nurses through an eight-hour class, and 1,835 nursing assistants through a four-hour class would have been approximately $1.7 million in wages alone. The additional cost in wages for staff to conduct training brought the total to roughly $1.8 million.

With the help of Cerner’s Learning Services, clinical informatics coordinators developed a series of four web-based training (WBT) videos, each designed for key workflows, such as documenting a head-to-toe assessment or reviewing the electronic medical record. The focused nature of the WBTs meant that they could be shorter — a combined maximum length of two hours — with flexibility to support the nurses’ schedules, and could be taken conveniently at home, on the unit, or at designated areas at each facility.

After completing the WBTs, staff were required to attend an additional practice session, held onsite at designated facilities, for up to two hours, where they could practice what they had learned. Nurses were given scenarios for their specific patient population, and facilitators were on hand to answer questions and provide guidance. Once staff felt that they were competent in the new, optimized documentation, their training was complete.

By moving from a traditional classroom to the WBT with a practice session approach, the required training time was cut in half and helped Carolinas HealthCare System avoid approximately $840,000 in training expenses, wages for training nurses/nursing assistants, and for staff to conduct the training.

This new approach, along with the ability to practice their new documentation workflows, was well-received by the nursing staff. But the real test came at implementation. The documentation conversion required a 16-hour downtime. Within hours of turning the system on, Fox debriefed with the chief nursing executives (CNE) whom reported no major issues with nursing documentation. “It was an amazing and smooth transition. Clearly, our training approach made a difference and ensured that our staff were prepared,” said Denise White, RNC, MSN, NEA-BC, chief nurse executive and vice president of patient care services.

“The benefits of the WBT were that nurses could go at their own pace and review content again if needed. The nurses were driven by their own learning, and their learning was reinforced in the practice sessions” said Fox. “It’s an approach that worked, and one that we will use again in the future.”

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Client outcomes were achieved in respective settings and are not representative of benefits realized by all clients due to many variables, including solution scope, client capabilities and business and implementation models.